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Diagnosis and Treatment > Medication

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Charlotte Delcourt Departments of Endocrinology and Nutrition, Université catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium

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Halil Yildiz Internal Medicine, Université catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium

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Alessandra Camboni Pathology, Université catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium

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Eric Van den Neste Hematology, Université catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium

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Véronique Roelants Nuclear Medicine, Université catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium

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Alexandra Kozyreff Ophthalmology, Université catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium

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Jean Paul Thissen Departments of Endocrinology and Nutrition, Université catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium

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Dominique Maiter Departments of Endocrinology and Nutrition, Université catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium

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Raluca Maria Furnica Departments of Endocrinology and Nutrition, Université catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium

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Summary

A 26-year-old woman presented with persistent headache and tiredness. Biological investigations disclosed a moderate inflammatory syndrome, low PTH-hypercalcemia and complete anterior hypopituitarism. A magnetic resonance imaging (MRI) of the pituitary gland was performed and revealed a symmetric enlargement with a heterogeneous signal. Ophthalmological examination showed an asymptomatic bilateral anterior and posterior uveitis, and a diagnosis of pituitary sarcoidosis was suspected. As the localization of lymphadenopathies on the fused whole-body FDG-PET/computerized tomography (CT) was not evoking a sarcoidosis in first instance, an excisional biopsy of a left supraclavicular adenopathy was performed showing classic nodular sclerosis Hodgkin’s lymphoma (HL). A diagnostic transsphenoidal biopsy of the pituitary gland was proposed for accurate staging of the HL and surprisingly revealed typical granulomatous inflammation secondary to sarcoidosis, leading to the diagnosis of a sarcoidosis–lymphoma syndrome. The co-existence of these diseases constitutes a diagnostic challenge and we emphasize the necessity of exact staging of disease in order to prescribe adequate treatment.

Learning points:

  • The possibility of a sarcoidosis–lymphoma syndrome, although rare, should be kept in mind during evaluation for lymphadenopathies.

  • In the case of such association, lymphoma usually occurs after sarcoidosis. However, sarcoidosis and lymphoma can be detected simultaneously and development of sarcoidosis in a patient with previous lymphoma has also been reported.

  • An accurate diagnosis of the disease and the respective organ involvements, including biopsy, is necessary in order to prescribe adequate treatment.

Taxonomy:
Clinical Overview, Gland/Organ, Pituitary, Topic, Pituitary, Hormone, ACTH, Cortisol, FSH, IGF1, LH, PTH, Thyroxine (T4), TSH, Condition/ Syndrome, Hypercalcaemia, Hypopituitarism, Lymphadenopathy, Patient Demographics, Age, Adolescent/young adult, Gender, Female, Ethnicity, White, Country of Treatment, Belgium, Diagnosis and Treatment, Signs and Symptoms, Fatigue, Headache, Hypercalcaemia, Hypopituitarism, Lymphadenitis, Sarcoidosis, Investigation, 25-hydroxyvitamin-D3, ACTH, Cortisol (9am), C-reactive protein, CT scan, FSH, FT4, Haematoxylin and eosin staining, Histopathology, IGF1, Immunohistochemistry, LH, MRI, PET scan, PTH, TSH, X-ray, Intervention, Chemotherapy, Medication, Dacarbazine, Glucocorticoids, Hydrocortisone, Levothyroxine, Methylprednisolone, Related Disciplines, General practice, Publication Details, Case Report Type, New disease or syndrome: presentations/diagnosis/management
DOI:
https://doi.org/10.1530/EDM-19-0091
Volume/Issue:
Volume 2019: Issue 1
Open access