Generic placeholder image

Endocrine, Metabolic & Immune Disorders - Drug Targets

Editor-in-Chief

ISSN (Print): 1871-5303
ISSN (Online): 2212-3873

Case Report

Syndrome of Inappropriate Antidiuresis and Diabetes Insipidus as Two Sides of the Same Coin in Hypothalamic Lymphoma: A Case Report

Author(s): Mormando Marilda, Lauretta Rosa, Telera Stefano, Bianchini Marta, Chiefari Alfonsina, Natalino Fiammetta, Puliani Giulia and Appetecchia Marialuisa*

Volume 23, Issue 5, 2023

Published on: 20 January, 2023

Page: [732 - 737] Pages: 6

DOI: 10.2174/1871530323666221124125253

Price: $65

conference banner
Abstract

Background: Hypothalamic-pituitary region lymphoma is rare and diabetes insipidus (DI) represents one of the most common endocrine manifestations. We report the first case of hypothalamic lymphoma associated with both the syndrome of inappropriate antidiuresis (SIAD) and DI.

Case Presentation: A 64-year-old woman with a history of stage IV large B-cell non-Hodgkin lymphoma, underwent atypical right lung resection for pulmonary nodules. A few days after surgery, the patient presented severe normovolemic hyponatremia and serum hypo-osmolarity, therefore, we suspected a paraneoplastic syndrome (SIAD) related to the lung neoplasm, histologically diagnosed as typical carcinoid. The brain magnetic resonance imaging (MRI) showed a 9 mm lesion in the hypothalamic region that significantly increased one month later with the onset of neurological symptoms. A trans-sphenoidal biopsy showed localization of the large B-cell lymphoma. After surgery, the patient presented with polyuria and polydipsia, so desmopressin therapy was started. In the following days, serum osmolarity and sodium fluctuated between normal and low values, then DI was excluded, and SIAD became more likely. Desmopressin therapy was discontinued and hyponatremia was treated with sodium infusion. Hypothalamic lymphoma was treated with chemotherapy and radiotherapy with substantial shrinkage. The hyponatremia persisted during anticancer treatments and improved only after radiotherapy, confirming paraneoplastic SIAD.

Conclusion: Lymphomas of the hypothalamic region can cause electrolyte imbalance for various causes. The differential diagnosis between SIAD, DI and impaired thirst centers may not be straightforward and the electrolyte disorders must be evaluated step by step in all different stages of the disease.

Keywords: Lymphoma, hypothalamic neoplasms, diabetes, insipidus, inappropriate ADH syndrome, electrolytes.

« Previous
Graphical Abstract
[1]
Shin, D.W.; Kim, J.H.; Kim, Y.H.; Cho, Y.H.; Hong, S.H. Primary central nervous system lymphoma involving the hypothalamic–pituitary axis: A case series and pooled analysis. J. Neurooncol., 2020, 147(2), 339-349.
[http://dx.doi.org/10.1007/s11060-020-03422-x] [PMID: 32221784]
[2]
Komninos, J.; Vlassopoulou, V.; Protopapa, D.; Korfias, S.; Kontogeorgos, G.; Sakas, D.E.; Thalassinos, N.C. Tumors metastatic to the pituitary gland: Case report and literature review. J. Clin. Endocrinol. Metab., 2004, 89(2), 574-580.
[http://dx.doi.org/10.1210/jc.2003-030395] [PMID: 14764764]
[3]
Freda, P.U.; Post, K.D. Differential diagnosis of sellar masses. Endocrinol. Metab. Clin. North Am., 1999, 28(1), 81-117.
[http://dx.doi.org/10.1016/S0889-8529(05)70058-X] [PMID: 10207686]
[4]
Fine, H.A.; Mayer, R.J. Primary central nervous system lymphoma. Ann. Intern. Med., 1993, 119(11), 1093-1104.
[http://dx.doi.org/10.7326/0003-4819-119-11-199312010-00007] [PMID: 8239229]
[5]
Snider, W.D.; Simpson, D.M.; Aronyk, K.E.; Nielsen, S.L. Primary lymphoma of the nervous system associated with acquired immune-deficiency syndrome. N. Engl. J. Med., 1983, 308(1), 45.
[http://dx.doi.org/10.1056/NEJM198301063080112] [PMID: 6847922]
[6]
Eby, N.L.; Grufferman, S.; Flannelly, C.M.; Schold, S.C., Jr; Vogel, F.S.; Burger, P.C. Increasing incidence of primary brain lymphoma in the US. Cancer, 1988, 62(11), 2461-2465.
[http://dx.doi.org/10.1002/1097-0142(19881201)62:11<2461::AID-CNCR2820621135>3.0.CO;2-M] [PMID: 3179963]
[7]
Tarabay, A.; Cossu, G.; Berhouma, M.; Levivier, M.; Daniel, R.T.; Messerer, M. Primary pituitary lymphoma: An update of the literature. J. Neurooncol., 2016, 130(3), 383-395.
[http://dx.doi.org/10.1007/s11060-016-2249-z] [PMID: 27581598]
[8]
Yasuda, M.; Akiyama, N.; Miyamoto, S.; Warabi, M.; Takahama, Y.; Kitamura, M.; Yakushiji, F.; Kinoshita, H. Primary sellar lymphoma: Intravascular large B-cell lymphoma diagnosed as a double cancer and improved with chemotherapy, and literature review of primary parasellar lymphoma. Pituitary, 2010, 13(1), 39-47.
[http://dx.doi.org/10.1007/s11102-009-0196-9] [PMID: 19707877]
[9]
Yang, J.; Zhao, N.; Zhang, G.; Zheng, W. Clinical features of patients with non-Hodgkin’s lymphoma metastasizing to the pituitary glands. Oncol. Lett., 2013, 5(5), 1643-1648.
[http://dx.doi.org/10.3892/ol.2013.1266] [PMID: 23760877]
[10]
Kenchaiah, M.; Hyer, S.L. Diffuse large B-cell non Hodgkin’s lymphoma in a 65-year-old woman presenting with hypopituitarism and recovering after chemotherapy: A case report. J. Med. Case Reports, 2011, 5(1), 498.
[http://dx.doi.org/10.1186/1752-1947-5-498] [PMID: 21970824]
[11]
Rudnik, A.; Larysz, D.; Blamek, S.; Larysz, P.; Bierzyńska-Macyszyn, G.; Właszczuk, P.; Bazowski, P. Primary pituitary lymphoma. Folia Neuropathol., 2007, 45(3), 144-148.
[PMID: 17849366]
[12]
Biasiotta, A.; Frati, A.; Salvati, M.; Raco, A.; Fazi, M.; D’Elia, A.; Cruccu, G. Primary hypothalamic lymphoma in a patient with systemic lupus erythematosus: Case report and review of the literature. Neurol. Sci., 2010, 31(5), 647-652.
[http://dx.doi.org/10.1007/s10072-010-0338-x] [PMID: 20585820]
[13]
Tanki, H.N.; Malik, K.N.; Makhdoomi, R.; Feroz, S.; Ramzan, A.U. Primary hypothalamic lymphoma in an adult male: A case report and literature review. Oman Med. J., 2018, 33(4), 346-351.
[http://dx.doi.org/10.5001/omj.2018.63] [PMID: 30038736]
[14]
Layden, B.T.; Dubner, S.; Toft, D.J.; Kopp, P.; Grimm, S.; Molitch, M.E. Primary CNS lymphoma with bilateral symmetric hypothalamic lesions presenting with panhypopituitarism and diabetes insipidus. Pituitary, 2011, 14(2), 194-197.
[http://dx.doi.org/10.1007/s11102-008-0166-7] [PMID: 19123039]
[15]
Broussalis, E.; Kraus, J.; Kunz, A.B.; Luthringshausen, G.; McCoy, M.; Muss, W.; Hutarew, G.; Ladurner, G.; Trinka, E.; Killer-Oberpfalzer, M. Cerebral localized marginal zone lymphoma presenting as hypothalamic-pituitary region disorder. Case Rep. Neurol., 2011, 3(2), 129-135.
[http://dx.doi.org/10.1159/000329342] [PMID: 21720530]
[16]
Malaise, O.; Frusch, N.; Beck, E.; Servais, S.; Caers, J.; Caers, J.; de Prijck, B.; Betea, D.; Beguin, Y. Panhypopituitarism and diabetes insipidus in a patient with primary central nervous system lymphoma. Leuk. Lymphoma, 2012, 53(12), 2515-2516.
[http://dx.doi.org/10.3109/10428194.2012.682312] [PMID: 22563813]
[17]
Giustina, A.; Gola, M.; Doga, M.; Rosei, E.A. Clinical review 136: Primary lymphoma of the pituitary: An emerging clinical entity. J. Clin. Endocrinol. Metab., 2001, 86(10), 4567-4575.
[http://dx.doi.org/10.1210/jcem.86.10.7909] [PMID: 11600505]
[18]
Giustina, A.; Romanelli, G.; Candrina, R.; Giustina, G. Growth hormone deficiency in patients with idiopathic adrenocorticotropin deficiency resolves during glucocorticoid replacement. J. Clin. Endocrinol. Metab., 1989, 68(1), 120-124.
[http://dx.doi.org/10.1210/jcem-68-1-120] [PMID: 2535850]
[19]
Patrick, A.W.; Campbell, I.W.; Ashworth, B.; Gordon, A. Primary cerebral lymphoma presenting with cranial diabetes insipidus. Postgrad. Med. J., 1989, 65(768), 771-772.
[http://dx.doi.org/10.1136/pgmj.65.768.771] [PMID: 2616407]
[20]
Bolanowski, M.; Kuliszkiewicz-Janus, M.; Sokolska, V. Diffuse malignant lymphoma type B with optic chiasm infiltration, visual disturbances, hypopituitarism, hyperprolactinaemia and diabetes insipidus. Case report and literature review. Endokrynol. Pol., 2006, 57(6), 642-647.
[PMID: 17253438]
[21]
Akhaddar, A.; Baite, A.; Naama, O.; Elmostarchid, B.; Safi, L.; Boucetta, M. Hypothalamic lymphoma with symptoms mimicking pituitary apoplexy. Intern. Med., 2009, 48(6), 491-492.
[http://dx.doi.org/10.2169/internalmedicine.48.1850] [PMID: 19293554]
[22]
Fadoukhair, Z.; Amzerin, M.; Ismaili, N.; Belbaraka, R.; Latib, R.; Sbitti, Y.; M’rabti, H.; Boutayeb, S.; Ichou, M.; Errihani, H. Symptomatic hypopituitarism revealing primary suprasellar lymphoma. BMC Endocr. Disord., 2010, 10(1), 19.
[http://dx.doi.org/10.1186/1472-6823-10-19] [PMID: 21114849]
[23]
Papanastasiou, L.; Pappa, T.; Dasou, A.; Kyrodimou, E.; Kontogeorgos, G.; Samara, C.; Bacaracos, P.; Galanopoulos, A.; Piaditis, G. Case report: Primary pituitary non-Hodgkin’s lymphoma developed following surgery and radiation of a pituitary macroadenoma. Hormones, 2012, 11(4), 488-494.
[http://dx.doi.org/10.14310/horm.2002.1382] [PMID: 23422773]
[24]
Qari, F.A.; AbuDaood, E.A.; Nasser, T.A. Diabetes insipidus following neurosurgery at a university hospital in Western Saudi Arabia. Saudi Med. J., 2016, 37(2), 156-160.
[http://dx.doi.org/10.15537/smj.2016.2.12848] [PMID: 26837398]
[25]
Kadir, M.L.; Islam, M.T.; Hossain, M.M.; Sultana, S.; Nasrin, R.; Hossain, M.M. Incidence of diabetes insipidus in postoperative period among the patients undergoing pituitary tumour surgery. Mymensingh Med. J., 2017, 26(3), 642-649.
[PMID: 28919622]
[26]
Garrahy, A.; Moran, C.; Thompson, C.J. Diagnosis and management of central diabetes insipidus in adults. Clin. Endocrinol., 2019, 90(1), 23-30.
[http://dx.doi.org/10.1111/cen.13866] [PMID: 30269342]

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy