Secondary Pituitary Hyperplasia Induced by Hashimoto's Thyroiditis Related Hypothyroidism: A Case Report

Abstract

Pituitary hyperplasia associated with untreated primary hypothyroidism in children is a rare condition. There are only a few reports on this condition in children, and especially when pituitary hyperplasia is accompanied with Hashimoto thyroiditis and growth arrest. Here, we describe an unusual association of pituitary hyperplasia with hypothyroidism and growth retardation, and this was all caused by Hashimoto thyroiditis. Hormonal testing showed a low thyroxine level and a high thyroid stimulating hormone level, elevated anti-thyroglobulin, low growth hormone levels and prepubertal levels of gonadotropins. A large intrasellar mass expanding beyond the sella turcica was detected on magnetic resonance imaging (MRI). Homogeneous contrast enhancement of mass highly suggested that it was a pituitary hyperplasia rather than a pituitary tumor. Therapy with L-thyroxine resulted in rapid improvement of the clinical signs, including renewed growth, normalization of the hormone levels and resolution of the pituitary hyperplasia on MRI within 90 days. In children, prolonged unrecognized primary hypothyroidism might be accompanied by growth deficiency and pubertal disharmony.

Pituitary macroadenoma secondary to Hashimoto’s thyroiditis: inadvertent diagnosis in a pre-pubertal girl

“…A 15-year-old boy with short stature and increased weight gain, who was found to have primary hypothyroidism (thyroid-stimulating hormone [TSH] >100 mIU/mL, free T4 = 0.64 pmol/L), with elevated anti-TPO antibodies (>3000 IU/mL) was described. 3 His neuroimaging was suggestive of a pituitary macroadenoma, without any evidence of focal neurological deficit and normal levels of pituitary hormones except for mild elevation of prolactin (21.02 µg/L) as in our patients. He was started on oral levothyroxine (100 mcg/day), following which thyroid function tests and prolactin levels normalised, and repeat neuroimaging showed reduction of pituitary size to normal.…”

Pituitary Hyperplasia Secondary to Hypothyroidism Caused by Hashimoto's Thyroiditis in a Female Adolescent

“…From a review of previously published case reports in Korean children, we found six cases that affected 4 boys and 2 girls [10][11][12][13][14] . The mean age was 8 years and 6 months, ranging between 2 and 15 years, and all patients were initially referred to a endocrinologist for growth arrest.…”