Pituitary ‘pseudotumor’: an under-recognised complication of undertreated primary hypothyroidism

Pituitary Hyperplasia Due to Longstanding Primary Hypothyroidism: A Case Report and Comprehensive Review of the Literature

“…The literature search yielded 649 potentially relevant articles, spanning from January 1996 to December 2023. Following the removal of duplicates and the review of titles, abstracts, and full-length articles, we identified 55 articles [ 6 , 9 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 ,…”

“…The majority were treated by initiating or adjusting levothyroxine therapy. However, 11 patients were referred for neurosurgical intervention, i.e., in 8 cases, surgery was performed before any thyroid hormone replacement [ 6 , 9 , 13 , 22 , 39 , 44 , 63 ], while in 2 cases surgery became necessary due to worsening conditions or failure to achieve full normalization during levothyroxine treatment [ 25 , 51 ]. In one case, surgery was performed simultaneously with the initiation of levothyroxine therapy to prevent further visual field alterations [ 43 ].…”

“…In one case, surgery was performed simultaneously with the initiation of levothyroxine therapy to prevent further visual field alterations [ 43 ]. Histological examination revealed pituitary hyperplasia in five cases [ 6 , 9 , 13 , 44 , 63 ], while it allowed for the identification of pure (two cases) or multi-hormonal TSH-secreting adenoma (four cases) in the remaining six cases [ 22 , 25 , 39 , 43 , 51 ].…”

Systemic lupus erythematosus with hypothyroidism as the initial clinical manifestation: A case report

“…Primary hypothyroidism may also lead to pituitary feedback neoplasia, which is challenging to identify, and in the present case, it may not be excluded that the increase of pituitary hormone secretion was due to hypothyroidism or a pituitary tumor. Therefore, no specific treatment was provided and the patient was instructed to present for regular review to observe whether prolactin normalized under the control of primary hypothyroidism (59). After 3 months of thyroid hormone replacement therapy, the patient was followed up at the outpatient clinic and pituitary MRI revealed that the size of pituitary microadenoma decreased from 6.4 mm at the first presentation to 1.8 mm, and prolactin levels were significantly decreased from 1,280.90 to 794.9 mIU/l.…”