Panhypopituitarism Secondary to Hypothalamic Involvement in a Woman With Diffuse Large B-Cell Lymphoma

Abstract

A 50-year-old woman presented with night sweats and weight loss. Computed tomography (CT) revealed bulky adenopathy involving the mesentery (16 cm), retroperitoneum, external iliac nodes, and mediastinum. Core biopsy of the mesenteric mass disclosed diffuse large B-cell lymphoma. Bone marrow was not involved at presentation; thus, she had stage IIIB disease. She received cyclophosphamide, doxorubicin,vincristine,prednisone,andrituximab(CHOP-R)chemotherapy, and interval CT scans showed positive response. She completed six cycles of chemotherapy without incident but presented 3 weeks after the final cycle with altered mental status. Head CT (Fig Magnetic resonance imaging (MRI; Figs The infundibulum and pituitary were within normal limits. The patient was started on dexamethasone and transferred to a tertiary care center a week later. At that time, the patient displayed personality changes but ate and drank ad libitum.