Evidence map›Paper›PMID 31610524›Full record

ArticleEndocrinology, diabetes & metabolism case reports2019

Methotrexate-associated lymphoproliferative disorder with hypopituitarism and central diabetes insipidus.

Misaki Aoshima, Koji Nagayama, Kei Takeshita, Hiroshi Ajima, Sakurako Orikasa, Ayana Iwazaki, Hiroaki Takatori, Yutaka Oki

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Endocrinology, diabetes & metabolism case reports, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
0.3field-weighted citation impact, top 37% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 6 citations in OpenAlex.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 3 institutions in 1 country.

Misaki AoshimaDepartments of Endocrinology Diabetes and Metabolism, Hamamatsu Medical Center, Hamamatsu, Shizuoka, Japan.
Koji NagayamaDepartments of Endocrinology Diabetes and Metabolism, Hamamatsu Medical Center, Hamamatsu, Shizuoka, Japan.
Kei TakeshitaDepartments of Endocrinology Diabetes and Metabolism, Hamamatsu Medical Center, Hamamatsu, Shizuoka, Japan.
Hiroshi AjimaDepartments of Endocrinology Diabetes and Metabolism, Hamamatsu Medical Center, Hamamatsu, Shizuoka, Japan.
Sakurako OrikasaDepartments of Endocrinology Diabetes and Metabolism, Hamamatsu Medical Center, Hamamatsu, Shizuoka, Japan.
Ayana Iwazaki²Departments of Endocrinology Diabetes and Metabolism, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan.
Hiroaki TakatoriDepartment of Rheumatology, Hamamatsu Medical Center, Hamamatsu, Shizuoka, Japan.
Yutaka OkiDepartment of Family and Community Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.
Hamamatsu Medical Center · JPHamamatsu University School of Medicine · JPSeirei Hamamatsu General Hospital · JP

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

summaryPatients treated with immunosuppressive drugs, especially methotrexate (MTX), rarely develop lymphoproliferative disorders (LPDs), known as MTX-related LPD (MTX-LPD). The primary site of MTX-LPD is often extranodal. This is the first reported case of MTX-LPD in the pituitary. A 65-year-old woman was admitted to our hospital with symptoms of oculomotor nerve palsy and multiple subcutaneous nodules. She had been treated with MTX for 11 years for rheumatoid arthritis. Computed tomography showed multiple masses in the orbit, sinuses, lung fields, anterior mediastinum, kidney, and subcutaneous tissue. Brain magnetic resonance imaging revealed a sellar mass. She was diagnosed with hypopituitarism and central diabetes insipidus based on endocrine examination. Although pituitary biopsy could not be performed, we concluded that the pituitary lesion was from MTX-LPD, similar to the lesions in the sinuses, anterior mediastinum, and subcutaneous tissue, which showed polymorphic LPD on biopsy. MTX was discontinued, and methylprednisolone was administered to improve the neurologic symptoms. After several weeks, there was marked improvement of all lesions, including the pituitary lesion, but the pituitary function did not improve. When pituitary lesions are caused by MTX-LPD, the possibility of anterior hypopituitarism and central diabetes insipidus needs to be considered. Further studies are needed to investigate the effectiveness of early diagnosis and treatment of MTX-LPD in restoring pituitary dysfunction. LEARNING POINTS: Pituitary lesions from MTX-LPD may cause hypopituitarism and central diabetes insipidus. Pituitary metastasis of malignant lymphoma and primary pituitary lymphoma, which have the same tissue types with MTX-LPD, have poor prognosis, but the lesions of MTX-LPD can regress only after MTX discontinuation. In cases of pituitary lesions alone, a diagnosis of MTX-LPD may be difficult, unless pituitary biopsy is performed. This possibility should be considered in patients treated with immunosuppressive drugs. Pituitary hypofunction and diabetes insipidus may persist, even after regression of the lesions on imaging due to MTX discontinuation.

Indexed as

2019ACTHAnti-citrullinated protein antibodyAsian - JapaneseBiopsyCD-20*CD-30*CD-79 alpha*CortisolC-reactive proteinCreatinineCT scanDDAVP test*DesmopressinDiabetes insipidusDiabetes insipidus - neurogenic/centralEpstein-Barr virus*Facial palsyFacies - abnormalFemaleFSHFT3FT4GeriatricHaematoxylin and eosin stainingHistopathologyHypopituitarismHypotonic saline infusion*Iatrogenic disorderIGF1Immunosuppressants*Interstitial lung disease*JapanKrebs von den Lungen 6*Lactate dehydrogenaseLHLung biopsy*Lymphoproliferative disorders*Matrix metalloproteinase 3*Methotrexate*MethylprednisoloneMRIMydriasisNew disease or syndrome: presentations/diagnosis/managementOctoberOculomotor nerve palsy*Ophthalmalgia*PituitaryPrednisoloneProlactinPtosisRheumatoid arthritisSerum osmolalitySinus biopsy*Skin biopsySoluble IL-2 receptor*SplenomegalySubcutaneous nodules*Thyroid antibodiesThyroxine (T4)Triiodothyronine (T3)TSHUrine osmolality

Identifiers

PMID31610524
PMCPMC6790894
OpenAlexW2981281391

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.