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 Primary Hypothyroidism Presenting as Growth Delay and Pituitary Enlargement

1988 ◽  
Vol 15 (1) ◽  
pp. 35-37 ◽  
Author(s):  
John D. Farley ◽  
Ellen L. Toth ◽  
Edmond A. Ryan
Keyword(s):  
Thyroid Disease ◽  
Visual Fields ◽  
Pituitary Surgery ◽  
Primary Hypothyroidism ◽  
Growth Delay ◽  
Pituitary Enlargement ◽  
Thyrotroph Hyperplasia

ABSTRACT:We report the case of a young boy being considered for pituitary surgery because of pituitary enlargement found during assessment of growth delay. There was no goitre but he was hypothyroid clinically and biochemically. The finding of an elevated TSH suggested primary thyroid disease with thyrotroph hyperplasia. Treatment with L-thyroxine resulted in prompt resolution of his pituitary enlargement and improvement in his visual fields.

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 Pituitary Hyperplasia in Severe Primary Hypothyroidism: A Case Report and Review of the Literature

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Prateek Shukla ◽  
Ketan R. Bulsara ◽  
Pooja Luthra
Keyword(s):  
Case Report ◽  
Thyroid Hormone ◽  
Replacement Therapy ◽  
Current Literature ◽  
Pituitary Surgery ◽  
Primary Hypothyroidism ◽  
Review Of The Literature ◽  
Pituitary Hyperplasia ◽  
Biochemical Evaluation

Pituitary hyperplasia is commonly present but remains largely undiagnosed in primary hypothyroidism. It is easily reversible with thyroid replacement therapy. If imaging is performed prior to biochemical evaluation, then patients may undergo pituitary surgery. We present the case of a 34-year-old female with profound primary hypothyroidism and secondary pituitary hyperplasia that resolved after thyroid hormone supplementation. We will discuss the current literature regarding pituitary hyperplasia in primary hypothyroidism in adults.

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 Macroadenoma and Severe Hypothyroidism: The Link between Brain Imaging and Thyroid Function

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Silvia Ciancia ◽  
Silvia Cesari ◽  
Barbara Predieri ◽  
Sergio Bernasconi ◽  
Lorenzo Iughetti
Keyword(s):  
Growth Hormone ◽  
Thyroid Function ◽  
Correct Diagnosis ◽  
Hormone Secretion ◽  
Growth Hormone Secretion ◽  
Brain Magnetic Resonance Imaging ◽  
Primary Hypothyroidism ◽  
Hormone Deficiency ◽  
Pituitary Macroadenoma ◽  
Pituitary Hyperplasia

In case of primary hypothyroidism, reactive pituitary hyperplasia can manifest as pituitary (pseudo) macroadenoma. We report the case of a 12-year-old boy who was evaluated for impaired growth velocity and increased body weight. Because of low insulin-like growth factor 1 levels and poor response to the growth hormone stimulation test, brain magnetic resonance imaging was performed and a pituitary macroadenoma was found. Treatment with levothyroxine was started, and thyroid function was evaluated approximately every 40 days to titrate the dosage. After few months of therapy, the size of the macroadenoma decreased and growth hormone secretion normalized. The pituitary returned to normal size in approximately 5 years. The boy went through puberty spontaneously and reached a normal adult height. In a patient affected by primary hypothyroidism, reactive pituitary hyperplasia can cause growth hormone deficiency; however, growth hormone secretion usually normalizes after starting levothyroxine treatment. Pituitary macroadenoma can be difficult to distinguish from severe pituitary hyperplasia; however, pituitary macroadenomas are rare in childhood, and our clinical case underlines how the hormonal evaluation is essential to achieve a correct diagnosis and prevent unnecessary surgery in a context of pituitary mass.

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 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.

Primary hypothyroidism followed by hyperthyroidism Five case reports

1984 ◽  
Vol 105 (2) ◽  
pp. 179-183 ◽  
Author(s):  
Ståle Skare ◽  
Harald M. M. Frey ◽  
Ragnvald Konow-Thorsen
Keyword(s):  
Case Reports ◽  
Primary Hypothyroidism ◽  
Graves Disease

Abstract. Five patients are described, who developed primary hypothyroidism between 25 and 57 years of age. They were all adequately treated with l-thyroxine. Graves' disease developed six months to 34 years later. Two had TSH binding inhibiting immunoglobulin (TBII) in their serum at this stage. All were treated with carbimazole, and 3 have experienced relapse upon withdrawal. Our patients are discussed in relation to the 16 cases previously reported. The pathogenesis of this condition is open to speculation.

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