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Primary hypothalamic lymphoma with panhypopituitarism presenting as stiff-man syndrome.

Publication ,  Journal Article
Lee, MT; Lee, TI; Won, JG; Chau, WK; Yang, HJ; Li, JC; Lin, HD; Tang, KT
Published in: The American journal of the medical sciences
August 2004

We report an unusual case of primary hypothalamic lymphoma with hypopituitarism presenting as Stiff-man syndrome (SMS). A 64-year-old man was hospitalized due to a 3-week history of general weakness, anorexia, vomiting, weight loss, and muscle pain and spasms precipitated by motion and tactile stimuli resulting in muscle stiffness and difficulty in mobility. Physical examination revealed normal sensorimotor function and reflexes, except for bitemporal visual field defect. Routine laboratory and gastrointestinal examinations provided no remarkable clues. Endocrine assessment revealed low levels of morning cortisol, thyroxine, and anterior pituitary hormones but an increase in prolactin level. The patient's muscle pain and stiffness improved dramatically within 2 days after hydrocortisone therapy and thyroxine replacement. Magnetic resonance imaging (MRI) of the brain confirmed an 18-mm enhancing hypothalamic tumor with optic chiasm involvement, which proved to be a B-cell lymphoma. The results of the extensive studies for systemic lymphoma were negative, suggesting a primary hypothalamic lymphoma. The tumor regressed completely and was invisible on MRI scan after adjuvant radiotherapy. The patient's condition was satisfactory and there was no recurrence of SMS during the 2-year follow-up period. This case demonstrated that primary hypothalamic lymphoma complicated with adrenal insufficiency may manifest as SMS. Early diagnosis and prompt intervention can lead to a favorable outcome and reduce morbidity.

Duke Scholars

Published In

The American journal of the medical sciences

ISSN

0002-9629

Publication Date

August 2004

Volume

328

Issue

2

Start / End Page

124 / 128

Location

united states

Related Subject Headings

  • General & Internal Medicine
  • 11 Medical and Health Sciences
 

Citation

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MLA
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Lee, M. T., Lee, T. I., Won, J. G., Chau, W. K., Yang, H. J., Li, J. C., … Tang, K. T. (2004). Primary hypothalamic lymphoma with panhypopituitarism presenting as stiff-man syndrome. The American Journal of the Medical Sciences, 328(2), 124–128.
Lee, M. T., T. I. Lee, J. G. Won, W. K. Chau, H. J. Yang, J. C. Li, H. D. Lin, and K. T. Tang. “Primary hypothalamic lymphoma with panhypopituitarism presenting as stiff-man syndrome.The American Journal of the Medical Sciences 328, no. 2 (August 2004): 124–28.
Lee MT, Lee TI, Won JG, Chau WK, Yang HJ, Li JC, et al. Primary hypothalamic lymphoma with panhypopituitarism presenting as stiff-man syndrome. The American journal of the medical sciences. 2004 Aug;328(2):124–8.
Lee, M. T., et al. “Primary hypothalamic lymphoma with panhypopituitarism presenting as stiff-man syndrome.The American Journal of the Medical Sciences, vol. 328, no. 2, Aug. 2004, pp. 124–28.
Lee MT, Lee TI, Won JG, Chau WK, Yang HJ, Li JC, Lin HD, Tang KT. Primary hypothalamic lymphoma with panhypopituitarism presenting as stiff-man syndrome. The American journal of the medical sciences. 2004 Aug;328(2):124–128.
Journal cover image

Published In

The American journal of the medical sciences

ISSN

0002-9629

Publication Date

August 2004

Volume

328

Issue

2

Start / End Page

124 / 128

Location

united states

Related Subject Headings

  • General & Internal Medicine
  • 11 Medical and Health Sciences