Pituitary Hyperplasia from Primary Hypothyroidism

Shivaprasad, K S; Siddardha, Kollareddy

doi:10.1056/nejmicm1805378

Cited by 13 publications

(13 citation statements)

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“…30 Polycystic ovary syndrome has also been cited as a cause of pituitary hyperplasia, but this remains debatable. [31][32][33] In our study, there was no case of pituitary hypertrophy, whereas the study by Souteiro et al found that pituitary hypertrophy was the most common PI (29.3%) in patients aged 18 years or less. 2 This high figure might have been due to selection bias since the study population was from patients referred to a paediatric endocrinology clinic.…”

Section: Pituitary Hyperplasia and Hypertrophycontrasting

confidence: 73%

“…However, hypertrophy refers to a radiologic finding associated with normal hormonal function, whereas hyperplasia can be due to physiologic enlargement (such as pregnancy), or pathologic one caused by end organ failure (eg primary hypothyroidism or Addison's disease) 30 . Polycystic ovary syndrome has also been cited as a cause of pituitary hyperplasia, but this remains debatable 31‐33 …”

Section: Discussionmentioning

confidence: 99%

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Pituitary incidentalomas in paediatric population: Incidence and characteristics

Shareef

Nasrallah

AlArab

et al. 2020

Clinical Endocrinology

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ObjectiveTo determine the incidence of pituitary incidentalomas in the paediatric population and among its different age subgroups as well as to identify the characteristics of these lesions. Additionally, we aim to give a perspective on the management and follow‐up of these patients.Design and PatientsWe retrospectively studied MRI of children aged 18 years or below who underwent MRI with sellar region within their field of view between January 2010 and December 2018.MeasurementsPituitary lesions were considered incidental according to the definition by the Endocrine Society. We reported the size, location and signal characteristics of each lesion. Medical charts of the subjects were reviewed for age, sex, the MRI indication and the hormonal assays levels.ResultsWe identified 40 pituitary lesions of which 31 were incidental lesions. The incidence of pituitary incidentaloma in our cohort was 22 per 1000 patients with female predisposition ( 64.5%) and a mean age of 11 ± 6 years. Rathke's cleft cyst was the most prevalent lesion, accounting for 67.7% followed by cystic pituitary lesions and microadenomas. The most common indications for imaging were growth disturbance (12.9%) followed by headache (9.7%). Abnormal laboratory workup was present in 13% of the subjects. Incidental lesions were more common in the older age groups compared to young children.ConclusionIncidental pituitary lesions in the paediatric population are relatively infrequent and increases with age. Rathke's cleft cyst is the most common incidentally encountered pituitary lesion followed by cystic pituitary lesions and microadenomas.

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Section: Pituitary Hyperplasia and Hypertrophycontrasting

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Pituitary incidentalomas in paediatric population: Incidence and characteristics

Shareef

Nasrallah

AlArab

et al. 2020

Clinical Endocrinology

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“…Hyperprolactinaemia is typically mild with values <100 µg/L [47,48]. A further mechanism of hyperprolactinaemia secondary to untreated primary hypothyroidism is thyrotroph hyperplasia, which can mimic a pituitary adenoma and induce hyperprolactinaemia via the "stalk effect" [25,49].…”

Section: Primary Hypothyroidismmentioning

confidence: 99%

“…Karavitaki et al [42] in a series of 226 histologically proven NFAs showed that 99% of them had serum PRL of <2000 mU/L (~100 µg/L) suggesting that PRL above this limit is most likely consistent with a prolactinoma. Rarely, long-standing untreated primary hypothyroidism can cause significant lactotroph hyperplasia which may mimic a pituitary adenoma [49]. A proposed diagnostic algorithm for hyperprolactinaemia is shown in Figure 1.…”

Section: Diagnostic Algorithmmentioning

confidence: 99%

Hyperprolactinaemia

Samperi

Lithgow

Karavitaki

2019

JCM

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Hyperprolactinaemia is one of the most common problems in clinical endocrinology. It relates with various aetiologies (physiological, pharmacological, pathological), the clarification of which requires careful history taking and clinical assessment. Analytical issues (presence of macroprolactin or of the hook effect) need to be taken into account when interpreting the prolactin values. Medications and sellar/parasellar masses (prolactin secreting or acting through "stalk effect") are the most common causes of pathological hyperprolactinaemia. Hypogonadism and galactorrhoea are well-recognized manifestations of prolactin excess, although its implications on bone health, metabolism and immune system are also expanding. Treatment mainly aims at restoration and maintenance of normal gonadal function/fertility, and prevention of osteoporosis; further specific management strategies depend on the underlying cause. In this review, we provide an update on the diagnostic and management approaches for the patient with hyperprolactinaemia and on the current data looking at the impact of high prolactin on metabolism, cardiovascular and immune systems.

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“…Two mechanisms have been proposed to explain this observation. TRH (which is raised in the primary hypothyroidism) - medicated lactotrophic stimulation and the ‘Stalk effect’ from marked hyperplasia of thyrotrophic cells, which again is also a feature of the primary hypothyroidism (Shivaprasad and Siddardha, 2019).…”

Section: Where Is the Excess Prl Coming From?mentioning

confidence: 99%

Abnormalities of prolactin

Dinarkhail¹,

Maarij²

2020

InnovAiT

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Abnormalities of prolactin can present with a myriad of signs and symptoms that are difficult to distinguish from other pathologies within the constraints of a GP consultation. It is important to know when it is appropriate to check the prolactin level, how to interpret the result and what to do about abnormal results. Management is dependent on the underlying cause and clinical context. This article will address abnormalities of prolactin in a practical, step-by-step manner with the aim of providing a tool for use by GPs.

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Pituitary Hyperplasia from Primary Hypothyroidism

Cited by 13 publications

References 0 publications

Pituitary incidentalomas in paediatric population: Incidence and characteristics

Pituitary incidentalomas in paediatric population: Incidence and characteristics

Hyperprolactinaemia

Abnormalities of prolactin

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