Diffuse large B cell lymphoma with bilateral adrenal and hypothalamic involvement: A case report and literature review

Table 1 Results of laboratory test on admission

	Values	Reference range
Alanine aminotransferase (U/L)	232.8	0-40
Aspartate aminotransferase (U/L)	99.3	0-40
Glutamyl transferase (U/L)	1194.9	0-50
Alkaline phosphatase (U/L)	254.8	0-130
Total bilirubin (μmol/L)	28.6	0-21
Direct bilirubin (μmol/L)	14.2	0-8.6
Platelet (109/L)	48	100-300
Red blood cell (1012/L)	5.98	4.3-5.9
White blood cell (109/L)	11.4	3.5-10
Fibrinogen (g/L)	7.22	2.0-4.0
D-dimer (μg/mL)	0.92	0-0.5
Lactate dehydrogenase (U/L)	290.9	40-250
β2-microglobulin (mg/dL)	0.377	0.07-0.18

Table 2 Results of pituitary-adrenal function test

	0 AM	8 AM	4 PM
Cortisol (nmol/L)	109.9	116.17	98.05
ACTH (pmol/L)	8.88	4.31	8.15

ACTH: Adrenocorticotrophic hormone.

Table 3 Results of pituitary-thyroid function test and pituitary-gonadal function test

	Values	Reference range
Pituitary-thyroid axis function
Total thyroxine (nmol/L)	41.1	55.34-160.88
Triiodothyronine (nmol/L)	1.20	1.01-2.95
Free triiodothyronine (pmol/L)	2.59	2.76-6.3
Free thyroxine (pmol/L)	8.41	10.42-24.32
Thyroid stimulating hormone (mU/L)	0.17	0.35-5.5
Pituitary-gonadal axis function
Testosterone (nmol/L)	0.75	14-25.4
Luteinizing hormone (IU/L)	< 0.07	1.5-9.3
Follicle stimulating hormone (IU/L)	0.52	1.4-18.1
Prolactin (nmol/L)	19.12	2.1-17.7

Table 4 Time line

Data
2017-08-03	Admitted with bilateral adrenal occupying lesions and fever
2017-08-04	Laboratory examinations: Impaired liver function, decreased platelet count, and elevated LDH and β2-MG
2017-08-07	Decreased cortisol and ACTH
2017-08-09	Decreased TSH, FT3, FT4, LH, FSH, and testosterone
2017-08-10	MRI: A hypothalamic space occupying lesion; physical examination: rash and enlarged left supraclavicular lymph nodes; diagnosed with anterior pituitary hypofunction; treated with hydrocortisone
2017-08-11	Fever disappeared
2017-08-14	Low specific gravity urine and hypernatremia; diagnosed with panhypopituitrism; treated with desmopressin acetate and prednisone acetate
2017-08-15	Symptoms of polyuria and thirst were relieved; Biopsy: DLBCL
2017-08-17	PET/CT: high metabolism in bilateral adrenal glands, the sellar area, left supraclavicular lymph nodes, retroperitoneal lymph nodes, left tonsil, and left testis
2017-08-22	Started R-CHOP immunochemotherapy
2017-12-15	PET/CT: All lesions disappeared
2018-05-17	Treated with autologous stem cell transplantation

LDH; Lactate dehydrogenase; ACTH: Adrenocorticotrophic hormone; DLBCL: Diffuse large B cell lymphoma; PET/CT: Positron emission tomography/computed tomography.