Lauzon Brian, Abu-Hijleh Tala, McInnes Natalia, Prebtani Ally
Department of Medicine, Division of Endocrinology & Metabolism, McMaster University, Hamilton L8S 4L8, Ontario, Canada.
JCEM Case Rep. 2024 Sep 11;2(9):luae147. doi: 10.1210/jcemcr/luae147. eCollection 2024 Sep.
Hematologic malignancies are rare causes of sellar masses and hypopituitarism. We report 2 cases of hypopituitarism due to sellar masses from hematologic malignancies. The first patient was found to have hypopituitarism but initial non-gadolinium-enhanced magnetic resonance imaging (MRI) sella did not demonstrate a mass. Subsequent gadolinium-enhanced MRI and transsphenoidal biopsy confirmed a diagnosis of intravascular lymphoma. Treatment with systemic chemotherapy resulted in resolution of abnormalities on MRI. The second patient had a known diagnosis of chronic lymphocytic leukemia, and sellar involvement contributing to hypopituitarism was confirmed on biopsy. Treatment with ibrutinib, acalabrutinib, and stereotactic radiosurgery resulted in resolution of abnormalities on MRI. Both patients were treated with hormone replacement for hypopituitarism. These cases highlight that hematologic malignancies should be suspected as causes of sellar masses/hypopituitarism in patients with concurrent symptoms atypical for a pituitary adenoma (eg, constitutional symptoms), known diagnoses of hematologic malignancies, or rapid tumor growth and invasion on imaging. Gadolinium-enhanced MRI should be pursued if nonenhanced MRI is nondiagnostic. Transsphenoidal biopsy can be considered for diagnosis. Malignancy-directed systemic therapy may improve hypopituitarism and radiographic abnormalities on MRI.
血液系统恶性肿瘤是鞍区肿块和垂体功能减退的罕见病因。我们报告2例因血液系统恶性肿瘤导致鞍区肿块引起的垂体功能减退病例。首例患者被发现存在垂体功能减退，但最初的非钆增强磁共振成像（MRI）检查未显示鞍区有肿块。随后的钆增强MRI和经蝶窦活检确诊为血管内淋巴瘤。全身化疗使MRI上的异常表现消失。第二例患者已知患有慢性淋巴细胞白血病，活检证实鞍区受累导致垂体功能减退。使用伊布替尼、阿卡替尼和立体定向放射外科治疗后，MRI上的异常表现消失。两名患者均接受了垂体功能减退的激素替代治疗。这些病例表明，对于伴有非典型垂体腺瘤症状（如全身症状）、已知患有血液系统恶性肿瘤或影像学上肿瘤生长迅速且有侵袭性的患者，应怀疑血液系统恶性肿瘤是鞍区肿块/垂体功能减退的病因。如果非增强MRI检查不能确诊，应进行钆增强MRI检查。可考虑经蝶窦活检以明确诊断。针对恶性肿瘤的全身治疗可能改善垂体功能减退和MRI上的影像学异常表现。
