scholarly journals Pituitary hyperplasia: case series and literature review of an under-recognised and heterogeneous condition

2015 ◽  
Vol 2015 ◽  
Author(s):  
Sunita M C De Sousa ◽  
Peter Earls ◽  
Ann I McCormack
Keyword(s):  
Polycystic Ovary ◽  
Case Series ◽  
Primary Hypothyroidism ◽  
List Type ◽  
Close Monitoring ◽  
Gnrh Analogues ◽  
Pituitary Hyperplasia ◽  
Pituitary Enlargement ◽  
And Gender ◽  
Trophic Hormone

Summary Pituitary hyperplasia (PH) occurs in heterogeneous settings and remains under-recognised. Increased awareness of this condition and its natural history should circumvent unnecessary trans-sphenoidal surgery. We performed an observational case series of patients referred to a single endocrinologist over a 3-year period. Four young women were identified with PH manifesting as diffuse, symmetrical pituitary enlargement near or touching the optic apparatus on MRI. The first woman presented with primary hypothyroidism and likely had thyrotroph hyperplasia given prompt resolution with thyroxine. The second and third women were diagnosed with pathological gonadotroph hyperplasia due to primary gonadal insufficiency, with histopathological confirmation including gonadal-deficiency cells in the third case where surgery could have been avoided. The fourth woman likely had idiopathic PH, though she had concomitant polycystic ovary syndrome which is a debated cause of PH. Patients suspected of PH should undergo comprehensive hormonal, radiological and sometimes ophthalmological evaluation. This is best conducted by a specialised multidisciplinary team with preference for treatment of underlying conditions and close monitoring over surgical intervention. Learning points Normal pituitary dimensions are influenced by age and gender with the greatest pituitary heights seen in young adults and perimenopausal women. Pituitary enlargement may be seen in the settings of pregnancy, end-organ insufficiency with loss of negative feedback, and excess trophic hormone from the hypothalamus or neuroendocrine tumours. PH may be caused or exacerbated by medications including oestrogen, GNRH analogues and antipsychotics. Management involves identification of cases of idiopathic PH suitable for simple surveillance and reversal of pathological or iatrogenic causes where they exist. Surgery should be avoided in PH as it rarely progresses.

scholarly journals Pituitary hyperplasia: an uncommon presentation of a common disease

2015 ◽  
Vol 2015 ◽  
Author(s):  
C P Neves ◽  
E T Massolt ◽  
R P Peeters ◽  
S J Neggers ◽  
W W de Herder
Keyword(s):  
Differential Diagnosis ◽  
Thyroid Function ◽  
Hormone Replacement ◽  
Primary Hypothyroidism ◽  
Common Disease ◽  
Pituitary Hormone ◽  
List Type ◽  
Pituitary Mass ◽  
Pituitary Hyperplasia ◽  
Pituitary Enlargement

Summary A 21-year-old woman presented with amenorrhea, bilateral galactorrhea and fatigue. Visual acuity and visual fields were normal. Laboratory examination demonstrated hyperprolactinemia. Magnetic resonance imaging (MRI) of the pituitary showed a 19×17×12-mm sellar mass with supra- and parasellar extension, causing compression of the pituitary stalk and optic chiasm. Further examinations confirmed mild hyperprolactinemia, strongly elevated TSH (>500 mU/l), low free thyroxine (FT4), hypogonadotropic hypogonadism and secondary adrenal insufficiency. Hydrocortisone and l-T4 replacement therapy was started. Three months later, the galactorrhea had disappeared, thyroid function was normalized and MRI revealed regression of the pituitary enlargement, confirming the diagnosis of pituitary hyperplasia (PH) due to primary hypothyroidism. Subsequently, the menstrual cycle returned and the hypocortisolism normalized. This case demonstrates that severe primary hypothyroidism may have an unusual presentation and should be considered in the differential diagnosis of pituitary enlargement associated with moderate hyperprolactinemia. Learning points One should always try to find one etiology as the common cause of all the clinical findings in a pathologic process. Amenorrhea, galactorrhea and fatigue may be the only presenting clinical manifestations of primary hypothyroidism. Not every patient with galactorrhea, hyperprolactinemia and a pituitary mass has a prolactinoma. Primary hypothyroidism should always be considered in the differential diagnosis of hyperprolactinemia associated with pituitary enlargement and pituitary hormone(s) deficiency(ies). When PH due to primary hypothyroidism is suspected, thyroid hormone replacement should be started and only regression of pituitary enlargement on MRI follow-up can confirm the diagnosis. Examination of thyroid function in patients with a pituitary mass may avoid unnecessary surgery.

scholarly journals Pituitary Hyperplasia: To Operate or Not to Operate, That Is the Question

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A599-A599
Author(s):  
Aakash Rajwani ◽  
Luma Ghalib
Keyword(s):  
Imaging Techniques ◽  
Post Partum ◽  
Hormone Replacement ◽  
Mass Effect ◽  
Primary Hypothyroidism ◽  
Absolute Increase ◽  
Pituitary Hyperplasia ◽  
Imaging Results ◽  
History Of ◽  
Pituitary Enlargement

Abstract Pituitary hyperplasia is defined as an absolute increase in the number of one or more adenohypophyseal cell subtypes, manifesting radiologically as pituitary enlargement beyond what is considered normal. It has been noted in certain physiological conditions like pregnancy however can also be seen in pathological conditions with end organ insufficiency like severe hypothyroidism. 21- year old female with a past medical history of Primary Hypothyroidism secondary to Hashimoto’s thyroiditis presented initially for evaluation of worsening headache and blurry vision. She was diagnosed with hypothyroidism at 10 years of age and had an extensive family history of hypothyroidism. At the time of presentation, she was 11 months post- partum and had been on and off her levothyroxine supplementation, having stopped it completely for a few months after delivery. MRI brain showed an 18 mm homogeneously enhancing intrasellar mass with suprasellar extension. She was referred to Neurosurgery for further evaluation. Workup revealed a TSH >100 (0.27 - 4.2 mIU/L) and FT4 <0.4 (0.8 - 2 ng/dL). In the context of severe untreated hypothyroidism and MRI findings consistent with pituitary hyperplasia with abutment but no mass effect on the optic apparatus, initial plan was to treat the hypothyroidism medically and observe closely. Patient was started on levothyroxine supplementation. Her TSH improved to 3.367 (0.550 - 4.780 uIU/mL) and FT4 to 2.00 (0.89 - 1.76 ng/dL), ηοωεϖερ she continued to have worsening of visual symptoms. Surgery was considered to decompress the optic nerve, but pre-operative MRI showed a significant decrease in size of the pituitary gland with decreased suprasellar bulging and no mass effect on the optic chiasm. Surgery was subsequently cancelled. Prolonged primary hypothyroidism leads to pituitary hyperplasia due to loss of negative feedback from lack of circulating T4 and T3, leading to excessive TRH secretion from the hypothalamus. The high TRH can lead to thyrotroph as well as lactotroph hyperplasia. Subsequently patients can present with headache, vision changes along with signs and symptoms of hypothyroidism and increased prolactin secretion. It is important to differentiate hyperplasia from other sellar lesions like pituitary macroadenoma or hypophysitis. Patients with hypothyroidism, who have pituitary enlargement diagnosed on brain imaging, should be promptly diagnosed and treated with thyroid hormone replacement. With a higher frequency and improved quality of imaging techniques, we are increasingly coming across scenarios of abnormal findings on imaging. Correlation of radiographic imaging results with a thorough history and biochemical testing is essential prior to proceeding with surgical intervention.

scholarly journals SUN-290 Pituitary Hyperplasia Due to Uncontrolled Primary Hypothyroidism: Case Series and Literature Review

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Juan Pablo Godoy Alonso ◽  
Germán González de la Cruz ◽  
Marlon Vladimir Vázquez-Aguirre ◽  
Andrea Rocha Haro ◽  
Karla Krystel Ordaz Candelario ◽  
...  
Keyword(s):  
Pituitary Gland ◽  
Feedback Inhibition ◽  
Case Series ◽  
Optic Chiasm ◽  
Primary Hypothyroidism ◽  
Autoimmune Hypothyroidism ◽  
Hormonal Replacement ◽  
Pituitary Hyperplasia ◽  
History Of

Abstract Background: Pituitary hyperplasia secondary to primary hypothyroidism results from the loss of thyroxine feedback inhibition and the subsequent overproduction of TSH. Case 1: A 18-year-old female presented with a chronic history of spontaneous galactorrhea, headache and malaise. Autoimmune primary hypothyroidism was diagnosed, with elevated TSH of 490 mIU/L (0.3-5) and low fT4 of 0.33 ng/dL (0.63-1.34). Pituitary MRI showed an enlarged pituitary with compression of the optic chiasm. Hormonal replacement with levothyroxine 75 mcg qd was started. Five months later she was asymptomatic, and normal TSH (1.64 mIU/L) and fT4 (0.9 ng/dL) levels. A new MRI revealed normal size of pituitary gland, with no compression of the optic chiasm and an intact infundibulum. Case 2: A 24-year-old female with type 1 diabetes and autoimmune primary hypothyroidism, presented with a five-year history of galactorrhea and oligomenorrhea. She was treated with insulin glargine 20U qd, and levothyroxine 200 mcg/day. However, patient’s adherence was bad. She consulted a primary health physician who suspected a prolactinoma after high prolactin levels (77.65, normal 2.64-13.13 ng/mL). Cabergoline was started without any clinical improvement. She then was referred to our service for follow-up. TSH results showed 500 mIU/L, with low fT4 (0.08 ng/dL). Prolactin levels was normal. Pituitary MRI revealed diffuse enlargement of the gland, with compression of infundibulum and optic chiasm. Treatment was modified to levothyroxine/liothyronine 100/20mcg 1 ½ tablet qd. After 7 months, we confirmed normal TSH (0.76 mIU/L) and fT4 (1.23 ng/dL), and the patient was asymptomatic. After 17 months, new MRI showed normal pituitary gland without any compression. Case 3: A 23-year-old female with a history of Addison′s disease and hypothyroidism diagnosed at age 17 presented with a 6-month history of somnolence, fatigue, headache and amenorrhea. She was previously treated with hydrocortisone 25mg/day, fludrocortisone 0.1mg/day, and levothyroxine 200mcg/day. Patient’s adherence was bad, and multiple hospitalizations because of adrenal crises were reported. Her initial hormonal evaluation revealed high TSH of 460 mIU/L and low fT4 of 0.25 ng/dL, mild hyperprolactinemia (32.16 ng/mL), and very high ACTH levels (2,700 pg/mL, normal 10-100). Pituitary MRI revealed an enlarged pituitary with mild compression of the optic chiasm. Hormonal replacement was modified to fasting levothyroxine alternating 200mcg and 300mcg qd. Her last follow-up showed normal TSH (0.53 mIU/L) and fT4 (1.18 ng/dL) levels. New MRI showed normal pituitary size Conclusion: We presented three young women, with autoimmune hypothyroidism, who developed pituitary hyperplasia and responded to proper hormonal replacement normalizing pituitary size. Reference: Endocrinol Diabetes Metab Case Rep. 2015; 2015: 150056.

scholarly journals Effect of once weekly oral levothyroxine therapy

2021 ◽  
Vol 2021 ◽  
Author(s):  
Andrea del Toro-Diez ◽  
Ernesto Solá-Sánchez ◽  
Michelle Mangual-García
Keyword(s):  
Case Series ◽  
Cost Effective ◽  
Primary Hypothyroidism ◽  
Endocrine Disorders ◽  
List Type ◽  
Common Cause ◽  
Cost Effective Approach ◽  
Alternative Approach ◽  
Learning Points ◽  
Tsh Levels

Summary Primary hypothyroidism is one of the most common endocrine disorders with widely available treatment. A minority of patients remain with uncontrolled hypothyroidism despite therapy. The objective of this case series was to demonstrate that medication non-adherence, rather than malabsorption, should be sought as the most common cause of unsuppressed TSH levels in patients receiving treatment for this condition. Non-adherence is often considered as a diagnosis of exclusion. Nonetheless, a diagnosis of malabsorption requires a more extensive workup, including imaging and invasive procedures, which increase healthcare costs and burden to the patient. The findings of this study allow for a cost-effective approach to uncontrolled hypothyroidism. Learning points Medication non-adherence is a common cause of insuppressible TSH levels. Once weekly levothyroxine is an alternative approach to non-compliant patients. Assessing compliance is more cost-effective and less burdensome than testing for malabsorption.

scholarly journals Dome-Shaped Pituitary Enlargement in Primary Hypothyroidism: Avoiding Neurosurgical Interventions

2020 ◽  
Vol 35 (2) ◽  
pp. 238-243
Author(s):  
Satyam Chakraborty ◽  
◽  
Mona Tiwari ◽  
Rajan Palui ◽  
Kajari Bhattacharya ◽  
...  
Keyword(s):  
Case Reports ◽  
Pituitary Surgery ◽  
Primary Hypothyroidism ◽  
Hormone Deficiency ◽  
Homogeneity Analysis ◽  
Imaging Characteristic ◽  
Pituitary Hyperplasia ◽  
Pituitary Enlargement ◽  
Levothyroxine Treatment ◽  
Thyrotroph Hyperplasia

We describe three cases of primary hypothyroidism which presented initially to neurosurgery department with pituitary hyperplasia. We have found a novel pattern of ‘dome shaped’ enlargement of pituitary in MRI of these patients. Out of these 3 patients, in two of them, the planned surgery was deferred when endocrinologists were consulted and the pituitary hyperplasia completely resolved with levothyroxine treatment. In the third case, pituitary surgery was already performed before endocrinology consultation and histopathology revealed thyrotroph hyperplasia. The hyperplastic lesions described typically have a homogenous symmetrical ‘dome’ shaped architecture unlike the non-functioning pituitary adenoma (NFPA), which usually might often be of varying shapes and homogeneity. Analysis of pituitary images from similar case reports published in literature, also showed this typical ‘dome’ shaped pituitary enlargement. This imaging characteristic can be a clue to look for underlying hormone deficiency, especially in primary hypothyroidism. Therefore, a thorough endocrine evaluation especially looking for primary hypothyroidism in such dome shaped pituitary lesions are mandatory to prevent unwarranted neuro-surgical intervention as treatment of primary hypothyroidism may result in resolution of the abnormal enlargement.

scholarly journals Hypothyroidism presenting with development delay, failure to thrive, and pituitary adenoma

2017 ◽  
Vol 4 (5) ◽  
pp. 1906
Author(s):  
Jatinder Singh ◽  
Vaneeta Bhardwar ◽  
Daaman Mittal
Keyword(s):  
Pituitary Adenoma ◽  
Hormone Replacement ◽  
Pituitary Tumors ◽  
Failure To Thrive ◽  
Primary Hypothyroidism ◽  
Pituitary Hyperplasia ◽  
Development Delay ◽  
Pituitary Enlargement ◽  
Ct And Mri

Pituitary enlargement secondary to primary hypothyroidism (PH) is a known but uncommon occurrence, and is also difficult to distinguish on CT and MRI from primary pituitary tumors. Following adequate hormone replacement with L-thyroxine, both symptoms and pituitary hyperplasia are reported to regress within a few months. It is important to recognize this condition so as to avoid unnecessary surgery.

Sex and Gender Differences in Rilpivirine based ART - Data from the HIVCENTER Frankfurt

2019 ◽  
Vol 17 (5) ◽  
pp. 368-374
Author(s):  
G. Schüttfort ◽  
K. Philipp ◽  
P. de Leuw ◽  
E. Herrmann ◽  
G. Kann ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Virologic Failure ◽  
Response Rates ◽  
Virologic Response ◽  
Close Monitoring ◽  
Sex And Gender ◽  
Overall Response ◽  
Number Of Patients ◽  
And Gender ◽  
Gender Specific

Objectives: While Rilpivirine has shown high overall response rates in treatment-naïve patients without sex and gender specific differences in clinical trials, Sex and gender specific data in treatment experienced patients receiving rilpivirine are still limited. We conducted a 48 week efficacy and safety analysis in naïve and treatment experienced men and women using retrospective data from the HIVCENTER Frankfurt. Materials and methods: In this retrospective observational study data of all patients who received a rilpivirine based regimen at the HIVCENTER between March 2011 and December 2015 were analyzed. Primary endpoint was the proportion of patients with any discontinuation until week 48. Virologic response rates (FDA snapshot analysis; HIV-1 RNA <50 copies/mL) were assessed at week 48. Results: 194 patients (34% female) were included in the analysis. 74% were treatment-experienced and 26% naïve, respectively. Discontinuations were observed in 31 (15.9%) patients. Regarding sex differences, the proportion of discontinuations was significantly higher in women than in men (24.2% vs. 11.7%; p=0.024; ODDS-Ratio = 2.41; CI 1.12 – 5.18). Virologic failure occurred in 8 PLWHIV (4.1%). Conclusions: While virologic overall response rates to rilpivirine based ART were high for both treatment-experienced and -naïve patients the proportion of discontinuations was significantly higher in women (24.2% vs. 11.7%; p = 0.024; ODDS-Ratio = 2.41; CI 1.12 – 5.18). Although the total number of patients with virologic failure was low (4.1%), the higher rate of ART discontinuations in female patients receiving RPV require close monitoring in the first months of treatment addressing special needs of women living with HIV.

scholarly journals Effects of the COVID-19 Epidemic on Hospital Admissions for Non-Communicable Diseases in a Large Italian University-Hospital: A Descriptive Case-Series Study

2021 ◽  
Vol 10 (4) ◽  
pp. 880
Author(s):  
Caterina Caminiti ◽  
Giuseppe Maglietta ◽  
Tiziana Meschi ◽  
Andrea Ticinesi ◽  
Mario Silva ◽  
...  
Keyword(s):  
Hospital Admissions ◽  
Case Series ◽  
Communicable Diseases ◽  
University Hospital ◽  
Negative Consequences ◽  
Non Communicable Diseases ◽  
Case Series Study ◽  
And Gender ◽  
Long Term Impact ◽  
Series Study

Background: Concern is growing about the negative consequences that response measures to the COVID-19 epidemic may have on the management of other medical conditions. Methods: A retrospective descriptive case-series study conducted at a large University-hospital in northern Italy, an area severely hit by the epidemic. Results: Between 23 February and 14 May 2020, 4160 (52%) COVID-19 and 3778 (48%) non-COVID-19 patients were hospitalized. COVID-19 admissions peaked in the second half of March, a period characterized by an extremely high mortality rate (27.4%). The number of admissions in 2020 was similar to 2019, but COVID-19 patients gradually occupied all available beds. Comparison between COVID-19 and non-COVID-19 admissions in 2020 revealed significant differences concerning all age classes and gender. Specifically, COVID-19 patients were older, predominantly male, and exhibited more comorbidities. Overall, admissions for non-communicable diseases (NCDs) in 2020 vs. 2019 dropped by approximately one third. Statistically significant reductions were observed for acute myocardial infarction (−78, −33.9%), cerebrovascular disease (−235, −41.5%), and cancer (−368, −31.9%). While the first two appeared equally distributed between COVID-19 and non-COVID-19 patients, chronic NCDs were statistically significantly more frequent in the former, except cancer, which was less frequent in COVID-19 patients. Conclusions: Prevention of collateral damage to patients with other diseases should be an integral part of epidemic response plans. Prospective cohort studies are needed to understand the long-term impact.

Ultrasound Biomicroscopy Documented Anterior Uveal Melanoma Regression after Ruthenium-106 Plaque Therapy

2021 ◽  
pp. 1-9
Author(s):  
Biljana Kuzmanović Elabjer ◽  
Mladen Bušić ◽  
Andrej Pleše ◽  
Mirjana Bjeloš ◽  
Daliborka Miletić ◽  
...  
Keyword(s):  
Uveal Melanoma ◽  
Tumor Regression ◽  
Corneal Thickness ◽  
Case Series ◽  
Ultrasound Biomicroscopy ◽  
Close Monitoring ◽  
Single Institution ◽  
Retrospective Case ◽  
Caucasian Patients

<b><i>Introduction:</i></b> Ultrasound biomicroscopy (UBM) is the only widely used method for the evaluation of anterior uveal melanoma (AUM). <b><i>Objective:</i></b> Documentation of regression of AUM treated with ruthenium-106 (Ru-106) plaque types CCB and CCC using UBM. <b><i>Methods:</i></b> This single institution-based retrospective case series involved 10 Caucasian patients with AUM followed after brachytherapy with UBM from January 2014 until February 2019. The largest prominence of the tumor perpendicular to the sclera or the cornea (including scleral/corneal thickness) (<i>D</i>) and the largest basal dimension (<i>B</i>) were measured in millimeters with UBM for all patients prior to the brachytherapy and at 4-month interval follow-up. Tumor regression was calculated as a percentage of decrease in the initial <i>D</i> and <i>B</i> values. <b><i>Results:</i></b> The study involved 10 patients with a mean age of 64.4 years (yr) (range 46–80 yr). <i>D</i> ranged from 1.82 to 5.5 mm (median 2.99 mm) and <i>B</i> from 2.32 to 12.38 mm (median 4.18 mm). The apical radiation dose in all patients was 100 Gy. The median follow-up was 42.02 months. Regression for <i>D</i> was 21.11 ± 13.66%, 31.09 ± 14.66%, and 34.92 ± 19.86% at 1st, 2nd, and 3rd year of the follow-up, respectively, while for <i>B</i> it was 21.58 ± 16.05%, 28.98 ± 17.71%, and 32.06 ± 18.96%, respectively. Tumor recurrence was documented in 2/10 patients. <b><i>Conclusion:</i></b> The major regression of AUM, treated with Ru-106 plaque types CCB and CCC, was documented in the first 2 years after brachytherapy in our study group. In the following years, only minimal regression was documented that warns of the need for close monitoring and active search for local recurrences.

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