Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 6, 2019; 7(23): 4075-4083
Published online Dec 6, 2019. doi: 10.12998/wjcc.v7.i23.4075
Diffuse large B cell lymphoma with bilateral adrenal and hypothalamic involvement: A case report and literature review
Ping An, Kang Chen, Guo-Qing Yang, Jing-Tao Dou, Yu-Long Chen, Xin-Ye Jin, Xian-Ling Wang, Yi-Ming Mu, Quan-Shun Wang
Ping An, Kang Chen, Guo-Qing Yang, Jing-Tao Dou, Yu-Long Chen, Xin-Ye Jin, Xian-Ling Wang, Yi-Ming Mu, Department of Endocrinology, Chinese PLA General Hospital, Beijing 100853, China
Quan-Shun Wang, Department of Hematology, Chinese PLA General Hospital, Beijing 100853, China
Author contributions: Chen K made substantial contributions to conception and design of the case report; An P analyzed the data and drafted the manuscript; Chen YL and Jin XY made substantial contributions to acquisition of data; Yang GQ, Dou JT, and Wang QS made critical revisions related to important intellectual content of the manuscript; Wang XL made substantial contributions to interpretation of data; Mu YM provided advice for this report; and all authors have approved the final version to be published.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Kang Chen, MD, PhD, Assistant Professor, Department of Endocrinology, Chinese People’s Liberation Army General Hospital, 28 Fuxing Road, Beijing 100853, China. cycon_ck@yeah.net
Telephone: +86-18801217670 Fax: +86-10-66937711
Received: September 7, 2019
Peer-review started: September 7, 2019
First decision: September 23, 2019
Revised: October 22, 2019
Accepted: November 14, 2019
Article in press: November 14, 2019
Published online: December 6, 2019
Processing time: 90 Days and 1.1 Hours
Abstract
BACKGROUND

Non-Hodgkin’s lymphoma (NHL) can involve extralymphatic organs, resulting in diverse clinical manifestations, especially if the endocrine organs are affected. This type of involvement can often be difficult to detect accurately. Until now, no patients with NHL and concomitant bilateral adrenal and hypothalamic involvement have been reported. The purpose of this article is to discuss the diagnosis and treatment of lymphoma with bilateral adrenal gland and hypothalamic involvement so as to help physicians avoid misdiagnosis and missed diagnosis.

CASE SUMMARY

We describe a case of a 52-years-old male patient with bilateral adrenal masses, who presented with a fever of unknown origin on admission. Subsequently, hypopituitarism of the anterior pituitary followed by posterior pituitary developed. 18fluorine-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) showed lesions with a high metabolism in both adrenal glands, hypothalamus, left supraclavicular lymph nodes, and other organs. The etiological diagnosis was determined based on a left supraclavicular lymph node biopsy. The patient, who eventually present with panhypopituitarism, was finally diagnosed with diffuse large B cell lymphoma with bilateral adrenal gland and hypothalamic involvement. After immunochemotherapy, glucocorticoids administration and desmopressin acetate replacement therapy, the symptoms of fever and panhypopituitarism improved, and all the lesions reduced in size.

CONCLUSION

This report demonstrates that, although synchronous involvement of two endocrine organs is rare in NHL, extra caution should be taken when dysfunction occurs in multiple endocrine organs.

Keywords: Non-Hodgkin’s lymphoma; Bilateral adrenal glands; Hypothalamus; Panhypopituitarism; Case report

Core tip: The synchronous involvement of two endocrine organs is rare in Non-Hodgkin’s lymphoma (NHL). This is the first case of NHL with bilateral adrenal gland and hypothalamic involvement that caused adrenocortical insufficiency and panhypopituitarism. The presentation created a diagnostic dilemma, which was resolved by determination of various endocrine hormone levels, biopsy, and 18fluorine-fluorodeoxyglucose positron emission tomography/computed tomography. This article aims to discuss the treatment approaches available when a patient with NHL has multiple endocrine organs involved. This report can help physicians avoid misdiagnosis of this disease.