Pituitary hyperplasia resulting from primary hypothyroidism

Abstract

We report an unusual case of pituitary hyperplasia secondary to primary hypothyroidism clinically masquerading pituitary apoplexy. A 22-year-old female presented with intermittent headache, easy fatigability, facial puffiness, coarseness of facial features, and hoarseness of voice for six months duration. Diplopia and diminution of vision was also observed for the last 15 days. Brain imaging findings showed pituitary enlargement, the thyroid function test were suggestive of primary hypothyroidism. Patient did well with thyroid hormone replacement therapy.

Primary hypothyroidism masquerading pituitary macroadenoma

“…(4,6,(18)(19)(20)(21)(22) Detail thyroid functions are the mainstay of diagnosis as it will show decrease in the levels of serum T3 and T4 but greatly elevated serum TSH levels. (2,3,6) One the diagnosis of pituitary hyperplasia secondary to primary hypothyroidism is suspected the patients can be managed with adequate hormone replacement with L-thyroxine (25 to 300 mcg/day) and in most of the cases this will result in relief of symptoms and regression of pituitary hyperplasia within a few months. (1-4, 6-8 …”

“…(11) Clinically the patients with pituitary hyperplasia can present with headache, visual symptoms and features of hypothyroidism. (1,3,7,14) It is important to understand that the headache may be due to hypothyroidism, although the exact underlying mechanism is not clear. (7) In many cases pituitary hyperplasias may be clinically silent and focal pituitary hyperplasia can be an incidental finding at autopsy.…”

“…(1)(2)(3)(4)(5)(6)(7)(8) In present article, we report a case of severe hypothyroidism presenting with diffuse enlargement of pituitary gland and hyperprolactinemia.…”

New Daily Persistent Headache Caused by a Multinodular Goiter and Headaches Associated With Thyroid Disease

“…MRI of the brain when obtained on patients with primary hypothyroidism can uncommonly show pituitary hyperplasia due to enlargement of thyrotroph cells due to lack of negative feedback which can be confused with a macroadenoma …”

Maternal-Fetal Thyroid Interactions

“…Some of these genes only respond to thyroid status for a short and specific period during development, a feature that is typical for many TH target genes in brain [122]. Interestingly, a reduction or absence of TH during brain maturation yields molecular, morphological and functional alterations in the cerebral cortex, hippocampus and cerebellum [123][124][125][126][127][128][129][130][131][132].…”