Primary central nervous system lymphoma in childhood presenting as progressive panhypopituitarism

We report a 15-year-old boy who had isolated central diabetes insipidus ini tially diagnosed at age 11 years. A brain magnetic resonance imaging (MRI) was normal at the time. At age 12 years, growth hormone (GH) testing was pe rformed because of a decline in linear growth rate and demonstrated GH defi ciency. After a repeat normal brain MRI, GH therapy was begun. Three years later. hormonal testing revealed prepubertal gonadotropins and low testoste rone levels, free thyroxine index. and morning cortisol levels. Repeat brai n MRI demonstrated a 9-mm enhancing lesion in the region of the pituitary s talk. The pathologic diagnosis was that of a high-grade malignant B-cell ly mphoma, suggestive of Burkitt lymphoma. Growth hormone therapy has not been associated with an increased incidence of lymphoma. This report underscore s the need for vigilance in follow-up brain imaging and hormonal evaluation in children with diabetes insipidus, especially those with evolving anteri or hormone deficiencies.