Primary hypothyroidism with growth failure and pituitary pseudotumor in a 13-year-old female: a case report

Abstract

IntroductionPrimary hypothyroidism is a well-known cause of poor linear growth in children. A rare finding with profound or long-standing disease is anterior pituitary enlargement (pituitary pseudotumor). This case highlights this uncommon finding, discusses clinical situations in which gradual dose escalation of levothyroxine may be advisable and reviews adjuvant therapies that have been previously attempted to improve final height in the setting of profound hypothyroidism.Case presentationWe report the case of a 13-year-old Hispanic girl initially evaluated for poor linear growth and delayed puberty, and found to have pituitary enlargement secondary to profound primary hypothyroidism. Treatment with progressive doses of levothyroxine normalized her symptoms and led to complete resolution of her pituitary findings, but she then rapidly progressed through puberty, achieving an adult height of only 142cm, significantly below her calculated mid-parental height.ConclusionsIn cases of severe primary hypothyroidism with prolonged elevation of thyroid-stimulating hormone and pituitary pseudotumor, gradual replacement of thyroid hormone with slowly escalating doses of levothyroxine may be beneficial to prevent complications of therapy. Early recognition and treatment of hypothyroidism during childhood is essential for normal growth, as final height is invariably compromised in children with prolonged disease. Additional study is needed to determine the potential beneficial effects of gonadotropin-releasing hormone agonist and recombinant human growth hormone treatment in this setting.

Primary hypothyroidism with pituitary hyperplasia characterized by hypogonadotropic hypogonadism: a case report and review of the literature

“…Conversely, the lack of negative feedback in the continuous reduction of thyroid hormone causes excessive secretion of TRH, and conduce to a proliferation of TSH secreting cells, which results in compensatory enlargement of the pituitary gland (10). Long-term primary hypothyroidism-induced pituitary hyperplasia has been confirmed by many studies (7,(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25).…”

“…The full text was read, and 18 studies that met the inclusion criteria were selected for the final literature review. We reviewed 18 case reports of children or adolescents with short stature or hypogonadotropic hypogonadism from 2001 to 2019 (Table 4) (7,(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25). Of these, 17 studies reported delayed bone age and growth retardation (7,(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)25), but only 6 studies measured GH, with 5 studies reporting a decrease in GH (10,12,18,19,25).…”

Massive pericardial effusion and short stature caused by autoimmune hypothyroidism in a 9-year-old girl

“…The HSDS increased rapidly during the first year, but then HSDS slowly progressed during the next half year with rapid bone age progression. Case reports of prolonged primary hypothyroid girl with growth failure and delayed puberty showed incomplete recovery of growth potential with only thyroxine therapy 5 6) . The deficit in adult stature correlated with the duration of the hypothyroid state before treatment, so it is recommended to use a lower than usual replacement dosage of levothyroxine and/or to consider delaying puberty and epiphyseal fusion pharmacologically 1) .…”

“…The most common and prominent manifestation of chronic acquired hypothyroidism in children is profound growth failure, which is severe and progressive 4) . Thyroxine supplementation improves all the clinical signs and symptoms except for growth failure 5 6) . Accelerated growth often does not result in restoration of full growth potential, due to the rapid increase in skeletal age during the first 18 months of treatment 4) .…”

Case Report: Pituitary Morphology and Function Are Preserved in Female Patients With Idiopathic Intracranial Hypertension Under Pharmacological Treatment

“…Only a few studies, mostly conducted in children, investigated the hormonal axes in patients affected by IIH, reporting isolated pituitary alterations such as GH deficiency (GHD) or central hypothyroidism (7)(8)(9). Full restoration of the pituitary function occurred upon treatment with acetazolamide or lumboperitoneal shunting (10,11).…”