MR imaging of pituitary hyperplasia in a child with growth arrest and primary hypothyroidism

Papakonstantinou, Olympia; Bitsori, María; Mamoulakis, Dimitrios; Bakantaki, Anna; Papadaki, Efrosini; Gourtsoyiannis, N.

doi:10.1007/s003300050087

Cited by 22 publications

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“…The mass was isointense on T1-weighted images and hyperintense on T2-weighted images. Gadolinium-enhanced MRI revealed a homogenously enhancing mass .These findings are similar to those described in a few studies undertaken in pediatric patients [14,15] . Without knowledge of the present patient's hormonal profile, this mass was first reported as a macroadenoma.…”

Section: Discussionsupporting

confidence: 88%

Spontaneous ovarian hyperstimulation syndrome and pituitary hyperplasia mimicking macroadenoma associated with primary hypothyroidism

Kanza¹

2013

WJR

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We report an unusual case of spontaneous ovarian hyperstimulation syndrome and pituitary hyperplasia mimicking macroadenoma in an adult, non-pregnant woman. Her condition was triggered by unrecognized primary hypothyroidism, which regressed after thyroid hormone replacement therapy. This case highlights the need for clinicians and radiologists to familiarize themselves with the clinical and imaging features detected in case of these complications of primary hypothyroidism, which are not well known in the medical and radiological profession. Such improved knowledge will help avoid delays in diagnosis, progression to lifethreatening complications, and unnecessary surgery.

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Section: Discussionsupporting

confidence: 88%

Spontaneous ovarian hyperstimulation syndrome and pituitary hyperplasia mimicking macroadenoma associated with primary hypothyroidism

Kanza¹

2013

WJR

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“…27 With the advent of computed tomography (CT) and MRI, direct visualization of the pituitary gland provided noninvasive volumetric confirmation of pituitary enlargement in patients with hypothyroidism and subsequent regression after thyroid hormone replacement therapy. 3,9,10,28 CT and MRI have proven to have a moderate specificity in diagnosing pituitary hyperplasia and distinguishing it from pituitary adenoma. Increased used of MRI in the evaluation of patients with menstrual irregularities, galactorrhea, and hyperprolactinemia will often lead to the need to differentiate between pituitary adenoma and hyperplasia.…”

Section: Discussionmentioning

confidence: 98%

“…17 Chronic autoimmune thyroiditis is the most common cause of primary hypothyroidism associated with pituitary hyperplasia both in adults and in children. 10 Pituitary hyperplasia secondary to hypothyroidism can present in various forms: salient features of hypothyroidism, irregular menses/ galactorrhea, or neurologic/visual presentations. 7,18 Previous studies reported a frequency of 58% to 80% menstrual irregularities in hypothyroid women.…”

Section: Discussionmentioning

confidence: 99%

“…Regression of pituitary enlargement and resolution of the clinical symptoms after levothyroxine replacement therapy almost always occurs. [7][8][9][10]30,31 Pituitary surgery in primary hypothyroidism should be indicated only to obtain a tissue diagnosis in the case of a pituitary mass not responding or worsening on levothyroxine replacement therapy. 29 In conclusion, pituitary MRI is used with increasing frequency in patients with menstrual irregularity, galactorrhea, and hyperprolactinemia.…”

Section: Discussionmentioning

confidence: 99%

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A Case of Pituitary Hyperplasia Secondary to Primary Hypothyroidism Presenting With Irregular Menses, Galactorrhea, and Hyperprolactinemia

Erem¹

2010

The Endocrinologist

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Pituitary thyrotroph hyperplasia secondary to primary hypothyroidism is a rare cause of pituitary enlargement. We report a case of pituitary hyperplasia in a young woman thought to have a pituitary macroadenoma with suprasellar extension. A 21-year-old woman was admitted to our hospital, complaining of menstrual irregularity and galactorrhea. Serum thyrotropin and prolactin were high, and serum-free thyroxine was low. Magnetic resonance imaging revealed symmetrical pituitary enlargement associated with contrast enhancement simulating macroadenoma. After adequate hormone replacement therapy with levothyroxine, both symptoms and pituitary hyperplasia regressed within 4 months. It is concluded that pituitary tumor associated with elevated thyroid stimulating hormone and low levels of free T4 should always be treated with replacement thyroxine before other diagnostic tests are ordered.Key Words: pituitary hyperplasia, primary hypothyroidism, MR imaging (The Endocrinologist 2010;20: 168 -170) P ituitary hyperplasia and sella turcica enlargement is often associated with long-standing primary hypothyroidism. 1-5 Thyrotroph cell hyperplasia is believed to be caused by the lost of the negative feedback exerted by thyroid hormones. 6 The large hyperplastic pituitary can mimic a pituitary tumor 3,7-10 with the presence of hyperprolactinemia due to stalk compression or the effects of increased hypothalamic thyrotropin-releasing hormone (TRH) on prolactin secretion. [11][12][13] Regression of the pituitary hyperplasia in patients with primary hypothyroidism follows thyroid hormone replacement therapy. 3,7-9, 14 We now report a case of a woman with primary hypothyroidism and magnetic resonance imaging (MRI) findings of a pituitary macroadenoma, which regressed after 4 months of thyroid hormone therapy. CASE REPORTA 21-year-old woman had a 2-year history of irregular menstrual cycles, galactorrhea, and headaches. The patient received no medications and did not smoke or use alcohol. There was no family history of thyroid disease, pituitary tumors, or infertility. Review of systems disclosed "lifelong" cold intolerance, fatigue, and constipation. Her blood pressure was 110/70 mm Hg, and heart rate was 74 per minute. Visual fields were grossly intact, and there was no proptosis. The thyroid gland was nonpalpable. Expressible galactorrhea was present. The skin was dry and cool. Routine laboratory tests and chest x-ray were normal. Antithyroglobulin antibody titer, 194 IU/mL (N Ͻ115); antithyroid peroxidase antibody titer, 99.9 IU/mL (N Ͻ34); serum thyroid-stimulating hormone (TSH) levels, 100 mIU/L (normal range, 0.27-4.2); serum total triiodothyronine (TT 3 ) was 0.81 ng/mL (normal range, 0.8 -2.0); serum total thyroxine (TT 4 ), 2.28 g/dL (normal range, 5.1-14.1); serum-free triiodothyronine (FT 3 ) was 2.29 pg/mL (normal range, 1.8 -4.6); and free thyroxine (FT 4 ) was 0.24 ng/dL (normal range, 0.9 -1.7). Prolactin (PRL) was 97 ng/mL (N: 3.4 -24.1); follicle-stimulating hormone, 2.67 mIU/mL (N: 1.5-12.4); luteinizing hormone,...

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“…Therefore, mild to moderate hyperprolactinemia may occur in about three-quarters of patients (8), and it was also demonstrated in our case. Children with pituitary hyperplasia mostly present with symptoms of hypothyroidism, like growth arrest and abnormal puberty, and rarely with neurological symptoms secondary to sellar expansion (3,9). In some cases as in our case, headache may be the main complaint (2,4).…”

Section: Discussionmentioning

confidence: 99%

Pituitary hyperplasia mimicking macroadenoma secondary to primary hypothyroidism

Toromanović

Tahirović

2016

Pedaiatr Today

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Objective -We aim to emphasize the importance of extensive endocrine workup in cases of pituitary masses. Case report -We report on a case of pituitary thyrotrophic hyperplasia in a 12-year-old girl who was thought to have a pituitary macroadenoma with suprasellar extension. The main complaint was headache, while other symptoms of hypothyroidism were present, but weren't recognised. Hormonal testing revealed low total thyroxine (<12.8 nmol/l) and high TSH (310.5 mIU/l) levels, and hyperprolactinemia (prolactin level at 1680 mIU/l). Based on the clinical history, laboratory data, and MRI, a diagnosis of pituitary hyperplasia secondary to primary hypothyroidism, consequent to chronic autoimmune thyroiditis, was made. Therapy with levothyroxine was initiated at 50 µg/day and gradually increased to 75 µg daily. After three months of thyroxine replacement, she was clinically and biochemically euthyroid. A follow-up MRI, 4 months after thyroxine replacement was initiated, showed complete resolution of the mass, and normal pituitary gland. Conclusion -Primary hypothyroidism should be considered in the differential diagnosis of pituitary masses. Multidisciplinary assessment in these cases will help to avoid delays in diagnosis and prevent unnecessary surgery.

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MR imaging of pituitary hyperplasia in a child with growth arrest and primary hypothyroidism

Cited by 22 publications

References 0 publications

Spontaneous ovarian hyperstimulation syndrome and pituitary hyperplasia mimicking macroadenoma associated with primary hypothyroidism

Spontaneous ovarian hyperstimulation syndrome and pituitary hyperplasia mimicking macroadenoma associated with primary hypothyroidism

A Case of Pituitary Hyperplasia Secondary to Primary Hypothyroidism Presenting With Irregular Menses, Galactorrhea, and Hyperprolactinemia

Pituitary hyperplasia mimicking macroadenoma secondary to primary hypothyroidism

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