Poster Presentation Annual Meetings of the Endocrine Society of Australia and Society for Reproductive Biology and Australia and New Zealand Bone and Mineral Society 2016

"Why is everything so dark ?" - dimming of vision and more in a young mother (#405)

Matthew Seymour 1 , Emma Duncan 1
  1. Endocrine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia

A 34-year-old woman presented 18 months postpartum with a six month history of amenorrhoea, fatigue, polyuria, polydipsia (5L/day), headaches and visual disturbance. She had no past medical history. Biochemically she had secondary hypoadrenalism and hypothyroidism and hypogonadotropic hypogonadism. Pituitary MRI revealed a sellar mass with thickened pituitary stalk. Computerised perimetry showed a dense field loss on the left and temporal field loss on the right. High dose glucocorticoids were commenced for presumed lymphocytic hypophysitis, however, there was no significant improvement radiologically or on computerised perimetry. A frontal craniotomy and pituitary biopsy was performed. The surgeon commented that the lesion involved the optic chiasm which was abnormal looking with grey subchiasmatic tissue seen. Initial histology suggested granulomatous hypophysitis. Despite high dose glucocorticoids, our patient’s vision deteriorated with decreasing light perception and there was no improvement of field defecits on computerised perimetry nor had the appearance of the sellar mass changed on MRI. Further neuropathological assessment of the biopsy suggested partially treated lymphoma. FDG PET showed intense uptake in the sellar mass, spleen, and supra- and infra-diaphragmatic lymph nodes. An infraclavicular excisional lymph node biopsy was performed; histology showed nodular lymphocyte predominant Hodgkin’s lymphoma. The histology of the sellar lesion was regarded as consistent with this diagnosis. Hodgkin’s lymphoma involving the pituitary gland is exceedingly rare. Two cases have been described previously in the literature. Involvement of the pituitary in widespread lymphoma does not necessarily confer a worse prognosis. Treatment follows chemotherapy protocols for Hodgkin’s lymphoma with CNS involvement; however, this is complicated in our patient’s case as the large volumes of hydration fluid required per protocol significantly impact on the management of diabetes insipidus. Following the first cycle of chemotherapy,the sellar lesion has decreased in size on imaging; however, our patient’s vision has not recovered.

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