Pituitary hyperplasia in severe primary hypothyroidism: A ca
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Pituitary hyperplasia is a relatively common condition that occurs in both physiological and pathological states. Pregnancy is the most common condition associated with physiological pituitary enlargement, associated primarily with lactotroph hyperplasia. Pathological hyperplasia has been shown to be associated with end organ insufficiency from primary gonadal insufficiency, primary adrenal insufficiency, and primary hypothyroidism. Although traditionally thought to be uncommon, pituitary enlargement is common in primary hypothyroidism and has now been well documented in the literature.

This is an interesting case of a 34-year-old female with no prior diagnosis of hypothyroidism but a long history of hypothyroid symptoms, who presented with sudden onset of neurologic symptoms and an enlarged pituitary gland secondary to profound primary hypothyroidism. She was initially evaluated for surgery, for presumed diagnoses of pituitary macroadenoma; however prompt recognition of severe primary hypothyroidism causing pituitary hyperplasia prevented any unnecessary surgical intervention. She was started on levothyroxine and liothyronine replacement therapy. Six weeks after her initial presentation, laboratory evaluation showed improvement in thyroid function tests.

Conclusively, Pituitary hyperplasia in primary hypothyroidism is not uncommon and pituitary enlargement can be frequently observed on imaging. However, imaging with CT or MRI may not be able to reliably differentiate between an adenoma and hyperplasia and biochemical testing should guide diagnosis and management. Both radiographic imaging results and biochemical testing results are essential prior to proceeding with surgical intervention. Patients with hypothyroidism, who have pituitary enlargement incidentally diagnosed on brain imaging for other reasons, should be treated with thyroid hormone replacement and close follow-up and with repeat imaging.

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6614958/