Primary hypothyroidism in a child leads to pituitary hyperplasia
Cao, Junguo (First Hospital of Jilin University. Departments of Neurosurgery)
Lei, Ting (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Chen, Fan (First Hospital of Jilin University. Departments of Neurosurgery)
Zhang, Chaochao (First Hospital of Jilin University. Departments of Neurosurgery)
Ma, Chengyuan (First Hospital of Jilin University. Departments of Neurosurgery)
Huang, Haiyan (First Hospital of Jilin University. Departments of Neurosurgery)
Universitat Autònoma de Barcelona

Date:	2018
Abstract:	A sellar mass in children is most often seen in craniopharyngeal tumors, intracranial germ cell tumors, or pituitary adenomas. However, pituitary hyperplasia secondary to primary hypothyroidism (PHPH) is not commonly seen in children. A 10-year-old girl was admitted due to growth retardation and obesity for 4 years. On physical examination, the patient had a height of 118 cm, body weight of 46 kg, body mass index (BMI) of 33. 0 kg/m 2. After magnetic resonance imaging (MRI) and laboratory tests, her initial diagnosis was Hashimoto's thyroiditis, primary hypothyroidism, and reactive pituitary hyperplasia. She was treated with oral L-thyroxine tablets. After 6 months, physical examination showed a height of 125 cm, weight of 36 kg, BMI of 23. 0 kg/m 2. She developed well, with 12 cm of yearly growth thereafter. The diagnosis of PHPH in a child is very important and sometimes difficult. Based on the summary and analysis of previous cases, we can learn that the main manifestations of PHPH include growth arrest and obesity, perhaps accompanied by symptoms caused by a decreased thyroid hormone concentration and elevated prolactin (PRL) concentration. Intracranial MRI shows diffuse enlargement of the anterior lobe of the pituitary gland, with a dome-shaped blunt edge change. Thyroid hormone levels may decrease, whereas the thyroid stimulating hormone (TSH) level increases, commonly accompanied by an elevated PRL, reduced growth hormone (GH) levels, and positive findings of TPOAb and TGAb. Improvement of symptoms and the normalization of hormone levels as well as restoration of pituitary size can be achieved after treated with thyroid hormone replacement therapy. And a hasty decision on surgical resection should be avoided when the diagnosis is uncertain.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Pituitary adenoma ; Pituitary hyperplasia ; Primary hypothyroidism
Published in:	Medicine, Vol. 97 Núm. 42 (october 2018) , ISSN 1536-5964

DOI: 10.1097/MD.0000000000012703
PMID: 30334955

8 p, 382.1 KB

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