HODGKIN'S DISEASE INVOLVING THE PITUITARY GLAND WITH DIABETES INSIPIDUS

Abstract

In a survey of the medical literature, only 4 cases of lympho-granuloma of the pituitary gland were found, 3 of which showed symptoms of diabetes insipidus. The present case showed enlarged lymph nodes in the neck, axillary, and inguinal regions. Polydypsia and polyuria were present. Autopsy revealed the enlarged lymph nodes, plus an intus-sception of the small intestine caused by a Hodgkin''s node. The pituitary gland was enlarged and histologically revealed Hodgkin''s Disease. The other cases reported were by Desbu-quois (1935) in France, Falta and Spitzenberger (1937) in Germany and Flose (1941) in Brazil. All the cases including the present one resulted in diabetes insipidus due to the destruction of the post. lobe of the pituitary gland, while the ant. lobe was intact or at least sufficiently functioning. The explanation for this is based on a hormonal control. It has been established that the ant. lobe contains a diuretic hormone and the post. lobe an anti-diuretic hormone which normally balance one another. In this case, the post. lobe involvement caused a diminution or total absence of the anti-diuretic hormone while the pars anterior was involved to a lesser degree, and still functioned sufficiently to allow the diuretic factor to act unchecked. This explains the reason for the polyuria. Diabetes insipidus may also result when the lesion is situated anywhere along the hypothalamico-hypophyseal tract. Fisher, Ingram and Ranson support the view that the disease is essentially a hormonal disturbance although the secretion of the anti -diuretic hormone is under the nervous control of the hypothalamus.