Panhipopituitarismo y diabetes insípida central como primera manifestación de linfoma primario del sistema nervioso central en una paciente inmunocompetente
PDF (Español (España))
HTML (Español (España))

Keywords

panhipopituitarismo
reporte de caso
diabetes insípida central
linfoma primario de sistema nervioso central
panhypopituitarism
Central diabetes insipidus
Primary Central Nervous System Lymphoma
Case report

How to Cite

Wandurraga Sánchez, E. A., Morales Camacho, W. J., & Plata Ortiz, J. E. (2017). Panhipopituitarismo y diabetes insípida central como primera manifestación de linfoma primario del sistema nervioso central en una paciente inmunocompetente. Revista Colombiana De Endocrinología, Diabetes &Amp; Metabolismo, 3(1), 43–46. https://doi.org/10.53853/encr.3.1.24

Abstract

El panhipopituitarismo (PH) hace referencia a la pérdida total de la función de la hipófisis anterior (adenohipófisis) que incluye los ejes somatótropo, tirótropo, corticótropo, gonadótropo, entre otros. La diabetes insípida central (DIC) no está contemplada en la definición de PH y su asociación simultánea implica la destrucción o degeneración de las neuronas localizadas en los núcleos supraóptico y paraventricular a nivel hipotalámico, es decir, un compromiso más extenso, dicha asociación se ha reportado hasta en 27% de los casos de linfoma primario del sistema nervioso central (LPSNC), la presencia de esta alteración obliga siempre a descartar enfermedades de carácter hematológico, infiltrativo, infeccioso y autoinmune. Presentamos el caso de una paciente de 19 años quien debutó con PH y DIC en la que no se pudo esclarecer un diagnóstico definitivo en su abordaje inicial, luego de casi tres años de evolución, una segunda biopsia realizada a nivel cerebral permitió confirmar el diagnóstico de linfoma primario del SNC. El curso lento y progresivo observado en nuestra paciente es propio de dicha neoplasia; sin embargo, el efecto citorreductor de los corticoides utilizados para el manejo de su déficit hormonal, favoreció el retraso en la identificación de esta enfermedad hematológica.

Abstract
The panhypopituitarism (PH) refers to total loss of function of the anterior pituitary (adenohypophysis), which ultimately can lead to commitment at differents endocrine axes involved at this level. Central diabetes insipidus (CDI) is not covered by the definition of PH and its simultaneous association involves the destruction or degeneration of neurons located in the supraoptic and paraventricular nuclei of the hypothalamus, it means a greater and more extent commitment. We present the case of a 19 years old female who debuted with PH and CDI in which failed to elucidate a definitive diagnosis in its initial approach. Finally, after nearly three years of evolution and a second biopsy performed in the brain the diagnosis of primary central nervous system lymphoma was confirmed.

https://doi.org/10.53853/encr.3.1.24
PDF (Español (España))
HTML (Español (España))

References

1. Mohamad M, Cosi G,Genovese E, Manca-Bitti ML,Cohen A, Et all.Central diabetes insipidus in children and young adults.N Engl J Med. 2000 ;( 343):998-1007.
2. Akhtar S, Cheesman E,Jude EB. SIADH and partial hypopituitarism in a patient with intravascular large B-cell lymphoma: a rare cause of a common presentation. BMJ Case Rep. 2013 Jan 28; 2013.
3. Tanriverdi F, Dokmetas HS,Kebapc? N,Kilicli F, Atmaca H, Et all.Etiology of hypopituitarism in tertiary care institutions in Turkish population: analysis of 773 patients from pituitary study group database.Endocrine.2014;( 47):198–205.
4. Toogood AA,Stewart PM.Hypopituitarism: Clinical Features, Diagnosis, and Management. Endocrinol Metab Clin N Am. 2008; (37): 235-261.
5. Giustina A, Gola M, Doga M, Rosei EA. Clinical review 136: Primary lymphoma of the pituitary: an emerging clinical entity. J Clin Endocrinol Metab.2001; (86):4567-4575.
6. Layden BT, Dubner S, Toft DJ, Kopp P, Grimm S, Et al.Primary CNS Lymphoma with Bilateral Symmetric Hypothalamic Lesions Presenting with Panhypopituitarism and Diabetes Insipidus. Pituitary. 2011; 14(2): 194–197.
7. Kasenda B, Haug V, Schorb E, Fritsch K, Finke J, Et al. 18F-FDG PET Is an Independent Outcome Predictor in Primary Central Nervous System Lymphoma. THE JOURNAL OF NUCLEAR MEDICINE. 2013; 54(2):184-91.
8. Braaten KM, Betensky RA, de Leval L, et al. BCL6 expression predicts improved survival in patients with primary central nervous system lymphoma. Clin Cancer Res. 2003;(9):1063-1069.
9. Abla O, Weitzman S, Blay JY, et al. Primary CNS lymphoma in children and adolescents: a descriptive analysis from the International Primary CNS Lymphoma Collaborative Group (IPCG). Clin Cancer Res. 2011;(17):346-352.
10. Mohile NA, DeAngelis LM, Abrey LE. The utility of body FDG PET in staging primary central nervous system lymphoma. Neuro Oncol. 2008;10(2):223-228.
11. Coulter I, Garrioch S ,Toft A. An atypical cause of trigeminal neuralgia and Panhypopituitarism.The British Journal of Radiology.2010; (83): 1087–1089.
12. Singh AD, Lewis H, Schachat AP. Primary lymphoma of the central nervous system. Ophthalmol Clin North Am. 2005; (18): 199-207.
13. Mohile NA, Deangelis LM, Abrey LE. Utility of brain FDG-PET in primary CNS lymphoma. Clin Adv Hematol Oncol. 2008 ;6(11):818-20, 840.
14. Cote TR, Manns A, Hardy CR, Yellin FJ, Hartge P. Epidemiology of brain lymphoma among people with or without acquired immunodeficiency syndrome. AIDS/Cancer Study Group. J Natl Cancer Inst 1996; (88): 675-679.

Authors must state that they reviewed, validated and approved the manuscript's publication.  Moreover, they must sign a model release that should be sent.  A copy may be reviewed here

Downloads

Download data is not yet available.