Pituitary abnormalities detected by high resolution computed tomography with thin slices in primary hypothyroidism and Turner syndrome

Abstract

Pituitary hyperplasia, microadenoma or an empty sella was detected in three children with primary hypothyroidism and three with Turner syndrome with the use of high resolution contrast-enhanced computed tomography (CT) with thin slices. Hyperplasia or microadenoma of the pituitary gland frequently occurs secondary to primary hypothyroidism and gonadal dysgenesis, and recognition of these results may eliminate unnecessary surgery in favor of hormone replacement therapy. High resolution contrast-enhanced CT, especially coronal CT, with thin slices is very helpful in demonstrating these pituitary abnormalities.

Primary Hypothyroidism Presenting as Growth Delay and Pituitary Enlargement

“…3,4 The absence of a goitre should not rule out the possibility of primary hypothyroidism. [2][3][4][5][6][7][8] The positive thyroid antibodies further substantiated primary hypothyroidism in our patient and were indicative of Hashimoto's thyroiditis. Except for the elevated prolactin, a common finding in hypothyroidism, 10 the remainder of his pituitary function testing was normal.…”

Empty sella and primary autoimmune hypothyroidism

“…In fact, several authors show that primary hypothyroidism results in an increased pituitary mass, which reverses after thyroxine replacement therapy [4,[19][20][21][22], and reversal of the hyperprolactinemia or amenorrhea-galactorrhea syndrome that often accompanies it [23][24][25][26][27][28]. Similar cases have been described, such as macroadenoma or suprasellar mass [29][30][31][32][33][34][35][36][37], which also regressed with replacement therapy, although some cases required surgery when there was compression of the chiasma [8]. The progression of pituitary hyperplasia to ES has also been described by other authors [22,25].…”

Pituitary Hyperplasia in a Girl with Gonadal Dysgenesis and Primary Hypothyroidism

“…The pharyngeal hypophysis as an intermediate site of endocrine feedback loops is able to respond to subnormal function or failure of target organs [9], Reactive pituitary abnormalities have been reported in patients with prima ry hypogonadism like Klinefelter syndrome or Turner syndrome [5,6], primary hypothyroidism [l-5], primary adrenal insufficiency [8] and after adrenalectomy (Nelson syndrome) [7], Morphologically, various changes like pi tuitary enlargement due to cell hyperplasia or suprasellar masses and adenomas were described. These disorders may be clinically inapparent or cause endocrine changes by displacement of hormone-producing cells or by stalk compression, resulting in a decrease of prolactin-inhib iting dopamine.…”

“…Depending on size and localization, also neurological symptoms like visual field defect, acuity reduction, headache or ophthalmoplegia may be predom inating. Treatment of the primary endocrine deficiency was reported to cause an involution of the pituitary mass [1,2,5], but surgery may be necessary if hormone substi tution fails to induce tumor shrinkage.…”

“…It has been shown that the origin of ade nomas is monoclonal, and releasing hormones may in duce clonal expansion of a genomically altered cell [19,20]. However, adenomas have also been described after target organ failure [4][5][6][7], It has to be considered that his tological distinction of hyperplastic tissue from normal parenchyma or microadenoma may be difficult, especial ly in surgical material [21 ].…”