Primary Hypothyroidism Presenting as Growth Delay and Pituitary Enlargement

Farley, John; Ryan, Edmond A.

doi:10.1017/s0317167100027153

Cited by 6 publications

(4 citation statements)

References 12 publications

(17 reference statements)

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“…Similar to our patient, some children with extremely elevated TSH levels have been reported to present with pituitary enlargement and growth failure without goiter [8]. Goiter is a well-established feature of chronic lymphocytic thyroiditis and is often the first presenting sign of disease in children.…”

Section: Discussionsupporting

confidence: 82%

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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Section: Discussionsupporting

confidence: 82%

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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“…Some patients with HAH, particularly children or adolescents, may be misdiagnosed as having a pituitary TSH-or prolactin-secreting adenoma (25)(26)(27)(28). In this connection, serum prolactin concentration may rise during a hypothyroidism state and patients with ''pseudoprolactinoma'' due to primary hypothyroidism have been operated on mistakenly (28).…”

Section: Discussionmentioning

confidence: 99%

“…Information on previous illnesses including primary headaches, family history of thyroid disease, and use of medications was added to the patient's files. On the basis of calculated body mass index (BMI) the patients were classified into four groups: low weight (<20), normal weight (20)(21)(22)(23)(24), overweight (25)(26)(27)(28)(29) and obese (>29).…”

Section: Commentsmentioning

confidence: 99%

Headache in recent onset hypothyroidism: Prevalence, characteristics and outcome after treatment with levothyroxine

2016

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Objective The objective of this article is to analyze the features of headache attributed to hypothyroidism (HAH), evaluate the differences between groups with and without HAH, between "overt" and "subclinical" hypothyroidism groups, and evaluate outcomes after levothyroxine treatment. Methods Patients with hypothyroidism were selected in a cross-sectional study, followed prospectively for 12 months, and classified as subclinical or overt hypothyroidism. The patients were divided into two groups: with and without HAH. Results HAH was reported by 73/213 (34%) patients, involving the following areas: fronto-orbital (49%), temporal (37%), and posterior part of the head (15%). The HAH features were as follows: pulsatile (63%), four to 72 hours' duration (78%), unilateral (47%), nausea/vomiting (60%), and moderate-severe intensity (72%). Hypothyroidism symptomatology was similar in both groups, except for a greater frequency of hoarseness in the group with HAH. Migraine history was more frequent in the patients with HAH (53% vs 38%, p < 0.05). The frequency of HAH was similar both in overt and subclinical hypothyroidism. After levothyroxine treatment 78% reported a decrease in HAH frequency. Subclinical and overt hypothyroid patients reported a similar alleviation of their headaches. Conclusion Patients with HAH may present with unilateral, pulsatile, episodic pattern, and nausea/vomiting, which is at odds with the criteria for HAH established by ICHD 3 beta. Not all individuals responded to levothyroxine, and patients with the subclinical form of hypothyroidism benefit from this treatment.

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“…Pregnancy, puberty, and endocrine disorders are all examples of physiological and pathological events that can cause pituitary hyperplasia [ 3 ]. Niepce noted the growth of the sella turcica in cretins with hypothyroidism in 1851, and this was the first description of pituitary hyperplasia following primary hypothyroidism [ 4 ]. Although this illness was previously thought to be unusual, it has recently received extensive reporting in the literature.…”

Section: Introductionmentioning

confidence: 99%

Pituitary Macroadenoma Secondary to Congenital Hypothyroidism With Growth Failure and Developmental Delay: A Rare Presentation

Lohiya¹,

Akhil²,

Ganvir³

et al. 2023

Cureus

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Reactive pituitary hyperplasia can develop as a pituitary (pseudo) macroadenoma in the case of primary hypothyroidism. Hypothyroidism-induced pituitary hyperplasia (PHPH) can be managed medically. Surgery should not be performed if this condition is misdiagnosed as an adenoma. Primary hypothyroidism is a wellknown cause of children's slow linear growth. Anterior pituitary enlargement is a rare symptom of severe or long-term illness (pituitary pseudotumor). Thyroid-stimulating hormone-secreting adenomas (TSHomas) are the rarest type of pituitary adenomas, with most endocrinologists seeing just a few cases throughout their lives. In most situations, the diagnosis is difficult, and patients may be referred after presenting with a condition of excessive thyroid-stimulating hormone secretion or a pituitary tumor.In this case study, we describe a 3.5-year-old girl who was referred to our hospital for a surgical assessment of a suspected pituitary neoplastic lesion. It was later determined that the suspected lesion was really pituitary hyperplasia brought on by primary hypothyroidism. Levothyroxine was started, and the dose was increased. The patient was advised to follow up to see if pituitary macroadenoma had responded to levothyroxine supplementation.Pituitary enlargement (pseudotumor of the pituitary gland) is a rare complication of primary hypothyroidism. Early diagnosis and treatment are critical for children with severe primary hypothyroidism to maintain their final height, as late diagnosis nearly always leads to a decline in adult stature. Pituitary macroadenoma secondary to severe hypothyroidism does not need risky and expensive surgical intervention. Because PHPH is rare in children, more credible information is needed to have a better knowledge of how the disease progresses and to develop scientific diagnostic criteria.

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Primary Hypothyroidism Presenting as Growth Delay and Pituitary Enlargement

Cited by 6 publications

References 12 publications

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

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

Headache in recent onset hypothyroidism: Prevalence, characteristics and outcome after treatment with levothyroxine

Pituitary Macroadenoma Secondary to Congenital Hypothyroidism With Growth Failure and Developmental Delay: A Rare Presentation

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