Lymphoma Manifested by Hypercortisolism and Pituitary Tumor: A Case Report and Literature Review

目的：探讨1例以皮质醇增多症、垂体瘤表现的弥漫性大B细胞淋巴瘤的临床特征及相关治疗经验。方法：回顾性分析1例以皮质醇增多症、垂体瘤表现的弥漫性大B细胞淋巴瘤患者的临床资料，内分泌腺相关激素水平减低，MRI检查提示垂体右侧、胼胝体体部异常信号影，CT显示双侧肾上腺增粗，住院行骨髓穿刺及肾上腺穿刺活检。结果：病理检查结果为弥漫性大B细胞淋巴瘤。经过规律化疗，在未经甲状腺激素和性腺激素替代治疗下，患者的垂体–甲状腺轴和垂体–性腺轴激素水平均恢复正常。随访1年，疗效评估CR。结论：肾上腺淋巴瘤合并垂体ACTH瘤实属罕见，二者对肾上腺皮质激素水平均有较大影响，临床诊断难度大。除了常规的影像学和病理检查外，还需要多学科联合会诊，内分泌功能试验也必不可少。Objective: To investigate the clinical features and treatment experience of 1 case of diffuse large B-cell lymphoma with hypercortisolism and pituitary tumor. Methods: The clinical data of a patient with diffuse large B-cell lymphoma presented with hypercortisolism and pituitary tumor were retrospectively analyzed. The endocrine gland related hormone levels were reduced, MRI showed abnormal signal signals in the right pituitary body and corpus callosum, and CT showed bilateral adrenal hyperplasia. Results: The pathological examination showed diffuse large B-cell lymphoma. After regular chemotherapy, the pituitary-thyroid axis and pituitary-gonadal axis hormone levels returned to normal without thyroid hormone and gonadal hormone replacement therapy. The follow-up was 1 year and the efficacy was evaluated CR. Conclusion: Adrenal lymphoma complicated with pituitary ACTH tumor is rare, both of which have great influence on the level of adrenocortical hormone and are difficult to diagnose clinically. In addition to routine imaging and pathological examination, multidisciplinary consultation is also required, and endocrine function tests are also essential.