J Korean Endocr Soc.  2010 Mar;25(1):72-77. 10.3803/jkes.2010.25.1.72.

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

• Kim KJ
• Kim HM
• Kwon O
• Park EY
• Lee YH
• Hong JW
• Wi J
• Lee EJ

• KMID: 2177866
• DOI: http://doi.org/10.3803/jkes.2010.25.1.72

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. Physicians must be aware of pituitary hyperplasia in these cases.

Keyword

Growth retardation; Hypothyroidism; Pituitary hyperplasia

MeSH Terms

Autoantibodies
Child
Gonadotropins
Growth Hormone
Hashimoto Disease
Humans
Hyperplasia
Hypothyroidism
Magnetic Resonance Imaging
Pituitary Neoplasms
Sella Turcica
Thyroid Gland
Thyroiditis
Thyrotropin
Thyroxine
Autoantibodies
Gonadotropins
Growth Hormone
Thyrotropin
Thyroxine

Figure

• 

  Fig. 1 Brain magnetic resonance imaging (MRI) before treatment and after treatment. Interval change of brain MRI at presentation (A, B) and after 3 months of thyroxine treatment (C, D) (Enlarged pituitary glands with homogeneous pituitary tissue mimicking a pituitary macroadenoma).

Reference

1. Freda PU, Post KD. Differential diagnosis of sellar masses. Endocrinol Metab Clin North Am. 1999. 28:81–117.

2. Atchison JA, Lee PA, Albright AL. Reversible suprasellar pituitary mass secondary to hypothyroidism. JAMA. 1989. 262:3175–3177.

3. Khawaja NM, Taher BM, Barham ME, Naser AA, Hadidy AM, Ahmad AT, Hamamy HA, Yaghi NA, Ajlouni KM. Pituitary enlargement in patients with primary hypothyroidism. Endocr Pract. 2006. 12:29–34.

4. Khalil A, Kovacs K, Sima AA, Burrow GN, Horvath E. Pituitary thyrotroph hyperplasia mimicking prolactin-secreting adenoma. J Endocrinol Invest. 1984. 7:399–404.

5. Torpiano J, Vanderpump M, Stanhope R. The management of sellar masses: not all pituitary tumours require surgery for diagnosis and/or therapy. J Pediatr Endocrinol Metab. 2004. 17:663–664.

6. Sarlis NJ, Brucker-Davis F, Doppman JL, Skarulis MC. MRI-demonstrable regression of a pituitary mass in a case of primary hypothyroidism after a week of acute thyroid hormone therapy. J Clin Endocrinol Metab. 1997. 82:808–811.

7. Brucker-Davis F, Oldfield EH, Skarulis MC, Doppman JL, Weintraub BD. Thyrotropin-secreting pituitary tumors: diagnostic criteria, thyroid hormone sensitivity, and treatment outcome in 25 patients followed at the National Institutes of Health. J Clin Endocrinol Metab. 1999. 84:476–486.

8. Gesundheit N, Petrick PA, Nissim M, Dahlberg PA, Doppman JL, Emerson CH, Braverman LE, Oldfield EH, Weintraub BD. Thyrotropin-secreting pituitary adenomas: clinical and biochemical heterogeneity: case reports and follow-up of nine patients. Ann Intern Med. 1989. 111:827–835.

9. Peyster RG, Hoover ED, Viscarello RR, Moshang T, Haskin ME. CT appearance of the adolescent and preadolescent pituitary gland. Am J Neuroradiol. 1983. 4:411–414.

10. Elster AD, Chen MY, Williams DW 3rd, Key LL. Pituitary gland: MR imaging of physiologic hypertrophy in adolescence. Radiology. 1990. 174:681–685.

11. Joshi AS, Woolf PD. Pituitary hyperplasia secondary to primary hypothyroidism: a case report and review of the literature. Pituitary. 2005. 8:99–103.

12. Desai MP, Mehta RU, Choksi CS, Colaco MP. Pituitary enlargement on magnetic resonance imaging in congenital hypothyroidism. Arch Pediatr Adolesc Med. 1996. 150:623–628.

13. Grubb MR, Chakeres D, Malarkey WB. Patients with primary hypothyroidism presenting as prolactinomas. Am J Med. 1987. 83:765–769.

14. Raber W, Gessl A, Nowotny P, Vierhapper H. Hyperprolactinaemia in hypothyroidism: clinical significance and impact of TSH normalization. Clin Endocrinol (Oxf). 2003. 58:185–191.

15. Ozbey N, Sariyildiz E, Yilmaz L, Orhan Y, Sencer E, Molvalilar S. Primary hypothyroidism with hyperprolactinaemia and pituitary enlargement mimicking a pituitary macroadenoma. Int J Clin Pract. 1997. 51:409–411.

16. Nomikos P, Buchfelder M, Fahlbusch R. Current management of prolactinomas. J Neurooncol. 2001. 54:139–150.

17. Hung W, Fitz CR, Lee ED. Pituitary enlargement due to lingual thyroid gland and primary hypothyroidism. Pediatr Neurol. 1990. 6:60–62.

18. Kim DH, Chung SC, Kim HS. Two cases of pituitary hyperplasia secondary to primary hypothyroidism mimicking pituitary tumor. J Korean Soc Pediatr Endocrinol. 1997. 2:241–247.

19. Samaan NA, Osborne BM, Mackay B, Leavens ME, Dulleo TM, Halmi NS. Endocrine and morphologic studies of pituitary adenomas secondary to primary hypothyroidism. J Clin Endocrinol Metab. 1977. 45:903–911.