Central hypothyroidism in a pediatric case of primary acute monoblastic leukemia with central nervous system infiltration: A case report

Central nervous system (CNS) leukemia is a frequent diagnosis in pediatric acute myeloblastic leukemia (AML) and includes neural symptoms. However, CNS leukemia is rarely associated with central hypsothyroidism. A 2-year-old female with AML with MLL rearrangement presented with CNS infiltration. Lab...

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Bibliographic Details
Published in:Medicine (Baltimore) 2017-06, Vol.96 (26), p.e7329-e7329
Main Authors: Sato, Yuya, Koyama, Satomi, Kuwashima, Shigeko, Kato, Masaya, Okuya, Mayuko, Fukushima, Keitaro, Kurosawa, Hidemitsu, Arisaka, Osamu
Format: Article
Language:English
Subjects:
Central Nervous System Neoplasms - complications
Central Nervous System Neoplasms - diagnostic imaging
Central Nervous System Neoplasms - drug therapy
Central Nervous System Neoplasms - metabolism
Child, Preschool
Clinical Case Report
Diagnosis, Differential
Female
Humans
Hypothyroidism - complications
Hypothyroidism - diagnostic imaging
Hypothyroidism - drug therapy
Leukemia, Monocytic, Acute - complications
Leukemia, Monocytic, Acute - diagnostic imaging
Leukemia, Monocytic, Acute - drug therapy
Leukemia, Monocytic, Acute - pathology
Thyrotropin - blood
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Summary:Central nervous system (CNS) leukemia is a frequent diagnosis in pediatric acute myeloblastic leukemia (AML) and includes neural symptoms. However, CNS leukemia is rarely associated with central hypsothyroidism. A 2-year-old female with AML with MLL rearrangement presented with CNS infiltration. Laboratory tests suggested the presence of central hypothyroidism (thyroid-stimulating hormone [TSH]: 0.48 mIU/ml, normal range 0.7-6.4 mIU/ml; serum free thyroxine [FT4]: 0.62 ng/dl, normal range 0.8-2.2 ng/dl; free triiodothyronine: 1.57 pg/ml, normal range 2.7-5.6 pg/ml). Magnetic resonance imaging detected no lesions in the hypothalamus, pituitary, or thyroid. Levothyroxine (2.5 mg/kg/day) was administered together with chemotherapy and intrathecal injection of methotrexate, cytarabine, and hydrocortisone into the cerebrospinal fluid. The FT4 concentration increased after levothyroxine treatment, but later decreased after relapse of CNS leukemia. The TSH concentrations remained low. After remission of CNS leukemia, the TSH and FT4 concentrations quickly recovered to their normal ranges. We believe that the CNS leukemia directly affected TSH and thyroid hormone secretion in our patient.
ISSN:0025-7974
1536-5964
DOI:10.1097/MD.0000000000007329