Concurrent hypopituitarism and leukemic retinopathy in a child with B-precursor acute lymphoblastic leukemia and isolated central nervous system relapse

Hypopituitarism in leukemia is very rare. In addition, central nervous system (CNS) relapse and leukemic retinopathy in childhood acute lymphoblastic leukemia (ALL) have declined with the use of modern systemic chemotherapy that includes CNS prophylaxis. Here, we report the case of a 4-year-old girl who received chemotherapy and intrathecal therapy without CNS radiation after a diagnosis of B-precursor ALL without CNS involvement. Three months after chemotherapy completion, she presented with lower-extremity weakness and was diagnosed with an isolated CNS relapse. Concurrent hypopituitarism and leukemic retinopathy were also found. After receiving craniospinal radiotherapy and systemic chemotherapy, her retinopathy and vision improved. She is now in complete remission, and she is still on chemotherapy according to the guideline from the Pediatric Oncology Group. Although rare, hypopituitarism and leukemic retinopathy should be taken into consideration in patients with CNS involvement by leukemia.