Endocrine Abstracts

Background: Diffuse large B-cell lymphoma is the most common non-Hodgkin’s lymphoma (NHL). It can involve extranodal sites in about 30%, but the involvement of endocrine organs is rare (adrenal involvement is estimated<0.2%) and correlates with poor prognosis. In contrast to pituitary metastases from solid tumors, NHL involvement of the anterior lobe of the pituitary is more frequently seen.

Case presentation: A 84-year-old woman presented to the A&E for intermittent fever, progressive fatigue, night sweats and weight loss started from two months. She referred increasing pain in the left upper quadrant of abdomen. Computed tomography revealed a 8×7 cm left adrenal gland mass with diffuse abdominal lymphadenomegaly. Labs revealed central hypoadrenalism (ACTH 20 pg/ml, serum cortisol 30 ng/ml) with hyponatremia (128 mmol/l) and normokalemia (4.2 mmol/l). Additional evaluations revealed anterior hypopituitarism: TSH:0.01μUI/ml, FT3:1.3 pg/ml, FT4:4.8 pg/ml, FSH:2.5 mU/ml, LH:0.2 mU/ml, IGF-I:<15.00 ng/ml, PRL:55.7 ng/ml. The patient was treated with hydrocortisone 30 mg/day and thyroxine 75 mg/day. Pituitary magnetic resonance showed a 1.3×2.2×1.2 cm heterogeneous mass with intrasellar and suprasellar extension and thickening of the pituitary peduncle. FDG-18 PET/CT revealed lesions with a high metabolism in left adrenal gland, pituitary, nodes, liver and other organs. Following left adrenal biopsy, the diagnosis of diffuse large B-cell non-Hodgkin lymphoma with pituitary and adrenal involvement was confirmed. Ki-67 index was 65%. The patient later died during hospitalisation after developing massive pulmonary thromboembolism and respiratory failure.

Conclusions: In presence of NHL, endocrine involvement and endocrine dysfunctions must be considered. Clinical signs and symptoms may overlap. A biochemical endocrine assessment should be evaluated, so that a rapid and effective therapy can be started. Hormonal dysfunctions may also be reversible after treatment of lymphoma.