Filter

Refine by subject

Refine by date

—
  • Print
  • Save
  • Print

Diagnosis and Treatment > Medication

You are looking at 1 - 3 of 3 items for :

  • Doxorubicin x
  • Hydrocortisone x
Clear All
Kaja Grønning Department of Endocrinology, Akershus University Hospital, Lorenskog, Norway

Search for other papers by Kaja Grønning in
Google Scholar
PubMed Close
,
Archana Sharma Department of Endocrinology, Akershus University Hospital, Lorenskog, Norway

Search for other papers by Archana Sharma in
Google Scholar
PubMed Close
,
Maria Adele Mastroianni Department of Haematology, Akershus University Hospital, Lorenskog, Norway

Search for other papers by Maria Adele Mastroianni in
Google Scholar
PubMed Close
,
Bo Daniel Karlsson Department of Radiology, Akershus University Hospital, Lorenskog, Norway

Search for other papers by Bo Daniel Karlsson in
Google Scholar
PubMed Close
,
Eystein S Husebye Department of Clinical Science and K.G. Jebsen Center of Autoimmune Disorders, University of Bergen, Bergen, Norway
Department of Medicine, Haukeland University Hospital, Bergen, Norway

Search for other papers by Eystein S Husebye in
Google Scholar
PubMed Close
,
Kristian Løvås Department of Clinical Science and K.G. Jebsen Center of Autoimmune Disorders, University of Bergen, Bergen, Norway
Department of Medicine, Haukeland University Hospital, Bergen, Norway

Search for other papers by Kristian Løvås in
Google Scholar
PubMed Close
, and
Ingrid Nermoen Department of Endocrinology, Akershus University Hospital, Lorenskog, Norway
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway

Search for other papers by Ingrid Nermoen in
Google Scholar
PubMed Close

Summary

Primary adrenal lymphoma (PAL) is a rare cause of adrenal insufficiency. More than 90% is of B-cell origin. The condition is bilateral in up to 75% of cases, with adrenal insufficiency in two of three patients. We report two cases of adrenal insufficiency presenting at the age of 70 and 79 years, respectively. Both patients had negative 21-hydroxylase antibodies with bilateral adrenal lesions on CT. Biopsy showed B-cell lymphoma. One of the patients experienced intermittent disease regression on replacement dosage of glucocorticoids.

Learning points:

  • Primary adrenal lymphoma (PAL) is a rare cause of adrenal insufficiency.

  • Bilateral adrenal masses of unknown origin or in individuals with suspected extra-adrenal malignancy should be biopsied quickly when pheochromocytoma is excluded biochemically.

  • Steroid treatment before biopsy may affect diagnosis.

  • Adrenal insufficiency with negative 21-hydroxylase antibodies should be evaluated radiologically.

Taxonomy:
Clinical Overview, Gland/Organ, Adrenal, Topic, Adrenal, Hormone, ACTH, Cortisol, Condition/ Syndrome, Adrenal insufficiency, Patient Demographics, Age, Geriatric, Gender, Male, Ethnicity, White, Country of Treatment, Norway, Diagnosis and Treatment, Signs and Symptoms, Abdominal discomfort, Anorexia, Arthralgia, Bowel movements - bleeding, Dizziness, Fatigue, Hyponatraemia, Hypotension, Nausea, Pyrexia, Renal failure, Tachycardia, Vomiting, Weight loss, Investigation, ACTH, ACTH stimulation, Adrenal antibodies, Biopsy, Cortisol, Creatinine (serum), CT scan, MRI, Potassium, Sodium, Urine osmolality, Intervention, Fluid repletion, Radiotherapy, Medication, Cortisone acetate, Doxorubicin, Fludrocortisone, Glucocorticoids, Hydrocortisone, Mineralocorticoids, Prednisolone, Rituximab, Sodium chloride, Related Disciplines, Oncology, Radiology/Rheumatology, Urology, Publication Details, Case Report Type, Unique/unexpected symptoms or presentations of a disease
DOI:
https://doi.org/10.1530/EDM-19-0131
Volume/Issue:
Volume 2020: Issue 1
Open access
Philip D Oddie Medical School, University of Oxford, Oxford, UK

Search for other papers by Philip D Oddie in
Google Scholar
PubMed Close
,
Benjamin B Albert Liggins Institute, University of Auckland, Auckland, New Zealand

Search for other papers by Benjamin B Albert in
Google Scholar
PubMed Close
,
Paul L Hofman Liggins Institute, University of Auckland, Auckland, New Zealand
Starship Children’s Health, Auckland District Health Board, Auckland, New Zealand

Search for other papers by Paul L Hofman in
Google Scholar
PubMed Close
,
Craig Jefferies Starship Children’s Health, Auckland District Health Board, Auckland, New Zealand
Starship Children’s Health, Auckland District Health Board, Auckland, New Zealand

Search for other papers by Craig Jefferies in
Google Scholar
PubMed Close
,
Stephen Laughton Starship Children’s Health, Auckland District Health Board, Auckland, New Zealand

Search for other papers by Stephen Laughton in
Google Scholar
PubMed Close
, and
Philippa J Carter Starship Children’s Health, Auckland District Health Board, Auckland, New Zealand

Search for other papers by Philippa J Carter in
Google Scholar
PubMed Close

Summary

Adrenocortical carcinoma (ACC) during childhood is a rare malignant tumor that frequently results in glucocorticoid and/or androgen excess. When there are signs of microscopic or macroscopic residual disease, adjuvant therapy is recommended with mitotane, an adrenolytic and cytotoxic drug. In addition to the anticipated side effect of adrenal insufficiency, mitotane is known to cause gynecomastia and hypothyroidism in adults. It has never been reported to cause precocious puberty. A 4-year-old girl presented with a 6-week history of virilization and elevated androgen levels and 1-year advancement in bone age. Imaging revealed a right adrenal mass, which was subsequently surgically excised. Histology revealed ACC with multiple unfavorable features, including high mitotic index, capsular invasion and atypical mitoses. Adjuvant chemotherapy was started with mitotane, cisplatin, etoposide and doxorubicin. She experienced severe gastrointestinal side effects and symptomatic adrenal insufficiency, which occurred despite physiological-dose corticosteroid replacement. She also developed hypothyroidism that responded to treatment with levothyroxine and peripheral precocious puberty (PPP) with progressive breast development and rapidly advancing bone age. Five months after discontinuing mitotane, her adrenal insufficiency persisted and she developed secondary central precocious puberty (CPP). This case demonstrates the diverse endocrine complications associated with mitotane therapy, which contrast with the presentation of ACC itself. It also provides the first evidence that the known estrogenic effect of mitotane can manifest as PPP.

Learning points:

  • Adrenocortical carcinoma is an important differential diagnosis for virilization in young children

  • Mitotane is a chemotherapeutic agent that is used to treat adrenocortical carcinoma and causes adrenal necrosis

  • Mitotane is an endocrine disruptor. In addition to the intended effect of adrenal insufficiency, it can cause hypothyroidism, with gynecomastia also reported in adults.

  • Patients taking mitotane require very high doses of hydrocortisone replacement therapy because mitotane interferes with steroid metabolism. This effect persists after mitotane therapy is completed

  • In our case, mitotane caused peripheral precocious puberty, possibly through its estrogenic effect.

Taxonomy:
Clinical Overview, Gland/Organ, Adrenal, Topic, Adrenal, Hormone, 17OHP, ACTH, Aldosterone, Androstenedione, Cortisol, DHEA, Testosterone, Thyroxine (T4), Condition/ Syndrome, Adrenal insufficiency, Adrenocortical carcinoma, Hypothyroidism, Puberty (precocious), Sexual development disorders, Patient Demographics, Age, Paediatric, Gender, Female, Ethnicity, Native Hawaiian/other Pacific Islander, Country of Treatment, New Zealand, Diagnosis and Treatment, Signs and Symptoms, Clitoromegaly, Fatigue, Hyperpigmentation, Hypomagnesaemia, Hyponatraemia, Hypotension, Hypothyroidism, Puberty (early/precocious), Virilisation (abnormal), Investigation, 17OHP, ACTH, ACTH stimulation, Aldosterone (blood), Androstenedione, Bone age, Chloride, Cortisol, DHEA Sulphate, GNRH stimulation, Histopathology, MRI, pH (blood), Potassium, Plasma renin activity, Sodium, Tanner scale, Testosterone, Thyroid function, Total T4, Ultrasound scan, Intervention, Adrenalectomy, Chemotherapy, Laparoscopic adrenalectomy, Resection of tumour, Medication, Anthracyclines, Cisplatin, Corticosteroids, Doxorubicin, Etoposide, Glucocorticoids, Hydrocortisone, Leuprolide acetate, Levothyroxine, Mitotane, Related Disciplines, Oncology, Paediatrics, Publication Details, Case Report Type, Unusual effects of medical treatment
DOI:
https://doi.org/10.1530/EDM-18-0059
Volume/Issue:
Volume 2018: Issue 1
Open access
A León-Suárez Department of Endocrinology and Metabolism, Neuroendocrinology Clinic, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico

Search for other papers by A León-Suárez in
Google Scholar
PubMed Close
,
P Roldán-Sarmiento Department of Endocrinology and Metabolism, Neuroendocrinology Clinic, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico

Search for other papers by P Roldán-Sarmiento in
Google Scholar
PubMed Close
,
M A Gómez-Sámano Department of Endocrinology and Metabolism, Neuroendocrinology Clinic, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico

Search for other papers by M A Gómez-Sámano in
Google Scholar
PubMed Close
,
A Nava-De la Vega Department of Endocrinology and Metabolism, Neuroendocrinology Clinic, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico

Search for other papers by A Nava-De la Vega in
Google Scholar
PubMed Close
,
V M Enríquez-Estrada Department of Endocrinology and Metabolism, Neuroendocrinology Clinic, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico

Search for other papers by V M Enríquez-Estrada in
Google Scholar
PubMed Close
,
F J Gómez-Pérez Department of Endocrinology and Metabolism, Neuroendocrinology Clinic, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico

Search for other papers by F J Gómez-Pérez in
Google Scholar
PubMed Close
, and
D Cuevas-Ramos Department of Endocrinology and Metabolism, Neuroendocrinology Clinic, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico

Search for other papers by D Cuevas-Ramos in
Google Scholar
PubMed Close

Summary

Non-Hodgkin lymphoma (NHL) is a hematological tumor caused by abnormal lymphoid proliferation. NHL can arise in any part of the body, including central nervous system (CNS). However, pituitary involvement is a quite rare presentation. The diffuse large B-cell lymphoma (DLBCL) is the most common subtype when pituitary is infiltrated. Here, we report a case of pituitary infiltration of NHL DLBCL type in a woman with hypopituitarism and an infundibulum-hypophysitis-like image on magnetic resonance imaging (MRI). A female aged 64 years, complained of dyspepsia, fatigue, weight loss and urine volume increment with thirst. Endoscopy and gastric biopsy confirmed diffuse large B-cell lymphoma. Treatment with chemotherapy using R-CHOP was initiated. During her hospitalization, hypotension and polyuria were confirmed. Hormonal evaluation was compatible with central diabetes insipidus and hypopituitarism. Simple T1 sequence of MRI showed thickening of the infundibular stalk with homogeneous enhancement. After lumbar puncture analysis, CNS infiltration was confirmed showing positive atypical lymphocytes. Pituitary and infundibular stalk size normalized after R-CHOP chemotherapy treatment. In conclusion, pituitary infiltration of NHL with infundibular-hypophysitis-like image on MRI is a rare finding. Clinical picture included hypopituitarism and central diabetes insipidus. Diagnosis should be suspected after biochemical analysis and MRI results. Treatment consists of chemotherapy against NHL and hormonal replacement for pituitary dysfunction.

Learning points:

  • Pituitary infiltration by lymphoma can present with signs and symptoms of panhypopituitarism and diabetes insipidus.

  • MRI findings can resemble an autoimmune hypophysitis.

  • Patients can recover pituitary function as well as normalization of MRI after chemotherapy treatment.

Taxonomy:
Clinical Overview, Gland/Organ, Pituitary, Topic, Pituitary, Hormone, Cortisol, FSH, LH, Oestradiol (E2), Prolactin, Thyroxine (T4), Condition/ Syndrome, Adrenal insufficiency, Diabetes insipidus - neurogenic/central, Hypopituitarism, Hypothyroidism, Non-Hodgkin lymphoma, Panhypopituitarism, Pituitary tumour (malignant), Patient Demographics, Age, Adult, Gender, Female, Ethnicity, Hispanic or Latino - Mexican, Mexican American, Chicano, Country of Treatment, Mexico, Diagnosis and Treatment, Signs and Symptoms, Dyspepsia, Fatigue, Hypoadrenalism, Hypogonadism, Hyponatraemia, Hypopituitarism, Hypotension, Hypothyroidism, Nausea, Polydipsia, Polyuria, Vomiting, Investigation, ACTH stimulation, Biopsy, Cortisol (serum), CT scan, Endoscopy, FSH, FT4, Gastric biopsy, Histopathology, LH, MRI, Oestradiol (E2), Prolactin, Sodium, Urine 24-hour volume, Urine osmolality, Intervention, Chemotherapy, Medication, Anthracyclines, Antibiotics, Desmopressin, Dexamethasone, Doxorubicin, Glucocorticoids, Hydrocortisone, Levothyroxine, Norepinephrine, Prednisolone, Rituximab, Related Disciplines, Oncology, Publication Details, Case Report Type, Unique/unexpected symptoms or presentations of a disease
DOI:
https://doi.org/10.1530/EDM-16-0103
Volume/Issue:
Volume 2016: Issue 1
Open access