Primary hypothyroidism in a child simulating a prolactin-secreting adenoma

Alves, Crésio; Alves, Ana Carolina Araruna

doi:10.1007/s00381-008-0689-2

Cited by 20 publications

(9 citation statements)

References 18 publications

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“…9 The diffuse pituitary enlargement associated with severe primary hypothyroidism is reversible with appropriate thyroid hormone treatment. 10,11 In our reported patient, regression of her pituitary adenoma with levothyroxine treatment supports the hypothesis of pituitary hyperplasia secondary to primary hypothyroidism. Our case emphasize the importance of checking thyroid function tests in patients with hyperprolactinemia and/or pituitary adenoma.…”

Section: Discussionsupporting

confidence: 82%

A child with three rare presentations of a common disease

Khadora¹

2020

JPNC

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Autoimmune thyroiditis (Hashimoto thyroiditis) is the commonest thyroid disorder in childhood. It is associated with antibodies against thyroglobulin and thyroperoxidase with lymphocytic infiltration in the thyroid tissue. It may be associated with primary hypothyroidism, transient hyperthyroidism or an euthyroid state. It typically affects females-5 times more commonly than males. We aim to describe three rare presentations of a common disease (Hashimoto thyroiditis) in the same child and to discuss its clinical course and response to L-Thyroxin replacement during two years of treatment. We report an eleven years six months old female child, with severe long standing acquired primary hypothyroidism due to Hashimoto thyroiditis, who had, in addition to the typical hypothyroidism symptoms, three rare presentations at the same time including Hashimoto encephalopathy, gonadotropin independent precocious puberty and pituitary adenoma. She was treated with L-Thyroxin only with significant improvement and regression of her symptoms.

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Section: Discussionsupporting

confidence: 82%

A child with three rare presentations of a common disease

Khadora¹

2020

JPNC

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“…In some cases, the extremely elevated thyrotropin-releasing hormone levels seen in prolonged primary hypothyroidism can lead to the rare finding of anterior pituitary enlargement (pseudotumor of the pituitary gland) [2]. Sometimes there is hyperplasia of not just thyrotrophs, but lactotrophs as well, causing hyperprolactinemia [3]. A prolactin level was not measured in our patient but hyperprolactinemia could explain in part her delayed puberty.…”

Section: Discussionmentioning

confidence: 91%

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

Larson

Pinsker

2013

J Med Case Reports

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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.

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“…The elevated prolactin level in our patient can be explained by a central mechanism because elevated thyrotropin-releasing hormone results in lactotroph hyperplasia. 4 In contrast, the elevation in α-fetoprotein is via a noncentral mechanism. During the fetal life, rising levels of T3 at the end of the first trimester leads to a pretranslational switch in the liver from α-fetoprotein production to albumin production.…”

Section: Discussionmentioning

confidence: 99%

Headache, Elevated Tumor Markers, and Pituitary Mass

Shanker

Janss

Patterson

2014

Clin Pediatr (Phila)

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A 12-year-old Caucasian female was admitted for evaluation of severe headaches progressively increasing in intensity, radiating to neck for the past 1 month. The history was significant for decreased energy level, difficulty in concentrating for past 6 weeks, slow linear growth, and excessive weight gain (4 inches increase in height and 30 pounds of weight gain over the past 3 years) and intermittent bilateral knee pain. There was no history of fever, rash, vomiting, and changes in bowel habits, temperature intolerance, or difficulty in vision. One week prior to admission, she came to emergency room with the complaint of headaches, was sent home on pain relieving medications after ensuring computed tomography of the brain was negative for intracranial bleed.Family history included type 1 diabetes mellitus and hypothyroidism in mother since she was a child and paternal grandfather had hyperthyroidism. Physical exam revealed height of 145.4 cm (14th percentile), weight of 66 kg (96th percentile) and obesity with a body mass index of 31.5 kg/m 2 . She had a heart rate of 70 beats per minute, respiratory rate of 16 per minute, blood pressure of 93/64 mm Hg, and oxygen saturation of 100%. She had normal visual fields. Her skin was dry and there was loss of lateral third of eye brows bilaterally. Abdominal examination did not reveal liver enlargement. Both breasts and pubic hair were Tanner stage 1. There were no signs of meningeal irritation, normal strength in all 4 limbs with normal gait and coordination.On admission, initial computed tomography of the brain revealed a mass in the pituitary region. This was confirmed with contrast-enhanced magnetic resonance imaging, demonstrating homogeneous enlargement of the pituitary gland measuring 17 mm × 14 mm × 9 mm with compression of optic nerves bilaterally. Laboratory testing done for evaluation of intracranial mass, showed an elevated α-fetoprotein 7.6 ng/mL (normal 0.6-5.6 ng/ mL), prolactin 67.6 ng/mL (normal 4.6-49.1 ng/mL), and a normal quantitative β-human chorionic gonadotropin( < 1.20 mIU/mL). She also had mildly elevated liver functions with aspartate aminotransferase of 42 U/L (normal 17-33 U/L) and alanine aminotransferase of 49 U/L (normal 6-35 U/L). Cerebrospinal fluid analysis showed mildly elevated protein level of 70 mg/dL, normal glucose and negative for α-fetoprotein.Additional testing showed very elevated thyroid-stimulating hormone (TSH > 1000 µIU/mL), low free T4 (<0.40 ng/dL), and positive thyroid peroxidase antibodies. She had a delayed bone age on hand radiograph and normal bilateral hip radiograph. Ultrasound of abdomen showed increased echogenicity of the liver with diminished periportal visualization suggestive of fatty infiltration and ultrasound pelvis revealed multiple ovarian cysts.In view of elevated TSH, low free T4, and positive thyroid autoantibodies, she was diagnosed with profound primary hypothyroidism secondary to Hashimoto's thyroiditis and pituitary hyperplasia due to hypothyroidism. Elevated α-fetoprotein and prolactin, fatty liv...

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Primary hypothyroidism in a child simulating a prolactin-secreting adenoma

Abstract: This paper illustrates the importance of thyroid function investigation in patients with hyperprolactinemia and possible prolactinoma in order to avoid unnecessary surgery.

Cited by 20 publications

References 18 publications

A child with three rare presentations of a common disease

A child with three rare presentations of a common disease

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

Headache, Elevated Tumor Markers, and Pituitary Mass

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