Dome-Shaped Pituitary Enlargement in Primary Hypothyroidism

Avoiding Neurosurgical Interventions

Authors

DOI:

https://doi.org/10.15605/jafes.035.02.14

Keywords:

pituitary adenomas, pituitary hyperplasia, dome-shaped enlargement, case report

Abstract

We describe three cases of primary hypothyroidism which presented initially to neurosurgery department with pituitary hyperplasia. We have found a novel pattern of ‘dome-shaped’ enlargement of pituitary in MRI of these patients. Out of these 3 patients, in two of them, the planned surgery was deferred when endocrinologists were consulted and the pituitary hyperplasia completely resolved with levothyroxine treatment. In the third case, pituitary surgery was already performed before endocrinology consultation and histopathology revealed thyrotroph hyperplasia.

The hyperplastic lesions described typically have a homogenous symmetrical ‘dome’ shaped architecture unlike the non-functioning pituitary adenoma (NFPA), which usually might often be of varying shapes and homogeneity. Analysis of pituitary images from similar case reports published in literature, also showed this typical ‘dome’ shaped pituitary enlargement. This imaging characteristic can be a clue to look for underlying hormone deficiency, especially in primary hypothyroidism. Therefore, a thorough endocrine evaluation especially looking for primary hypothyroidism in such dome-shaped pituitary lesions is mandatory to prevent unwarranted neuro-surgical intervention as treatment of primary hypothyroidism may result in resolution of the abnormal enlargement.

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Author Biographies

Satyam Chakraborty, Fortis Hospital, Kolkata, West Bengal

Department of Endocrinology, Institute of Neurosciences

Mona Tiwari, Fortis Hospital, Kolkata, West Bengal

Department of Radiology, Institute of Neurosciences

Kajari Bhattacharya, Fortis Hospital, Kolkata, West Bengal

Department of Endocrinology, Institute of Neurosciences

Kalyan Kumar Gangopadhyay, Fortis Hospital, Kolkata, West Bengal

Department of Endcrinology, Institute of Neurosciences

References

Fleseriu M, Karavitaki N. Non-functioning pituitary adenomas, not all the same and certainly not boring! Pituitary. 2018;21:109-10. https://doi.org/10.1007/s11102-018-0875-5.

Shukla P, Bulsara KR, Luthra P. Pituitary hyperplasia in severe primary hypothyroidism: A case report and review of the literature. Case Rep Endocrinol. 2019;2019:2012546. https://www.ncbi.nlm.nih.gov/pubmed/31341683. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6614958. https://doi.org/10.1155/2019/2012546.

Beck-Peccoz P, Brucker-Davis F, Persani L, Smallridge RC, Weintraub BD. Thyrotropin-secreting pituitary tumors. Endocr Rev. 1996;17(6):610-38. https://www.ncbi.nlm.nih.gov/pubmed/8969971. https://doi.org/10.1210/edrv-17-6-610.

Dutta D, Maisnam I, Ghosh S, Mukhopadhyay P, Satinath M, Chowdhury S. Panhypopituitarism with empty sella a sequel of pituitary hyperplasia due to chronic primary hypothyroidism. Indian J Endocrinol Metab. 2012;16 (Suppl 2): S282–4. https://www.ncbi.nlm.nih.gov/pubmed/23565400. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3603048. https://doi.org/10.4103/2230-8210.104060.

Ahmed M, Banna M, Sakati N, Woodhouse N. Pituitary gland enlargement in primary hypothyroidism: A report of 5 cases with follow-up data. Horm Res 1989;32(5-6):188-92. https://www.ncbi.nlm.nih.gov/pubmed/2634612. https://doi.org/10.1159/000181287.

Sarlis NJ, Brucker-Davis F, Doppman JL, Skarulis MC. MRI-demonstrable regression of a pituitary mass in a case of primary hypothyroidism after a week of acute thyroid hormone therapy. J Clin Endocrinol Metab. 1997;82(3):808-11. https://www.ncbi.nlm.nih.gov/pubmed/9062487. https://doi.org/10.1210/jcem.82.3.3796.

Passeri E, Tufano A, Locatelli M, Lania AG, Ambrosi B, Corbetta S. Large pituitary hyperplasia in severe primary hypothyroidism. J Clin Endocrinol Metab 2011;96(1):22-3. https://doi.org/10.1210/jc.2010-2011.

Franceschi R, Rozzanigo U, Failo R, Bellizzi M, Di Palma A. Pituitary hyperplasia secondary to acquired hypothyroidism: Case report. Ital J Pediatr 2011;37:15. https://www.ncbi.nlm.nih.gov/pubmed/21473748. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3079613.

https://doi.org/10.1186/1824-7288-37-15.

Cao J, Lei T, Chen F, Zhang C, Ma C, Huang H. Primary hypothyroidism in a child leads to pituitary hyperplasia: A case report and literature review. Medicine (Baltimore). 2018;97(42):e12703. https://www.ncbi.nlm.nih.gov/pubmed/30334955. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6211862. https://doi.org/10.1097/MD.0000000000012703.

Ben-Shlomo A, Melmed S. Hypothalamic regulation of anterior pituitary function. In the Pituitary, 4th ed.; 2017. https://doi.org/10.1016/B978-0-12-804169-7.00002-7.

Du J, Ji H, Jin J, Gao S, Yan X, Hu S. Pituitary adenoma secondary to primary hypothyroidism: Two case reports. Medicine (Baltimore). 2020;99(8):e19222. https://www.ncbi.nlm.nih.gov/pubmed/32080117. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7034716. https://doi.org/10.1097/MD.0000000000019222.

Published

2020-11-29

How to Cite

Chakraborty, S., Tiwari, M. ., Palui , R. ., Bhattacharya, K. ., & Gangopadhyay, K. K. . (2020). Dome-Shaped Pituitary Enlargement in Primary Hypothyroidism: Avoiding Neurosurgical Interventions. Journal of the ASEAN Federation of Endocrine Societies, 35(2), 238–243. https://doi.org/10.15605/jafes.035.02.14

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Case Series

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