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      An Unusual Pituitary Mass Revealing a Primary Hypothyroidism!

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          Abstract

          Autoimmune hypothyroidism is a common medical condition. Its revelation by thyrotrophic hyperplasia is an unusual and may be misdiagnosed as a pituitary adenoma. A 35-year-old man is referred to us for endocrinological assessment before surgery of a pituitary macroadenoma with bitemporal hemianopsia. Biological data reveal profound primary hypothyroidism. With thyroid hormone substitution, the thyroid function was normalized. Follow-up magnetic resonance imaging, showed the complete shrinkage of the pituitary mass attesting of a thyrotrophic pituitary hyperplasia. This case highlights the importance of a multidisciplinary assessment of pituitary masses to avoid unnecessary surgery and to prevent consequences of sellar masses.

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          Most cited references 9

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          Modern imaging of the pituitary.

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            Pituitary hyperplasia mimicking pituitary macroadenoma in two adolescent patients with long-standing primary hypothyroidism: case reports and review of literature.

            We report two cases with primary autoimmune hypothyroidism and an ectopic thyroid gland causing pituitary enlargement mimicking pituitary macroadenoma. One of the cases presented with complaints of headache and short stature and the other case with a complaint of menorrhagia. In both cases, the pituitary mass and symptoms resolved with levothyroxine replacement. Normal menses resumed. However, pituitary dynamic tests revealed persistent growth hormone and gonadotropin deficiency in one case and growth hormone deficiency in the other. To our knowledge, this is the first report in an adolescent of hypogonadotropic hypogonadism, growth hormone deficiency, and menorrhagia associated with pituitary hyperplasia secondary to primary hypothyroidism. The recognition of the association between reversible pituitary hyperplasia and primary hypothyroidism might eliminate unnecessary surgery.
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              Pituitary Gland Enlargement in Primary Hypothyroidism: A Report of 5 Cases with Follow-Up Data

              Five female patients with primary hypothyroidism and radiological evidence of a pituitary enlargement were studied before and after a mean of 30 months (range 12–83 months) treatment with thyroxine (T 4 ). Before treatment, serum thyroid-stimulating hormone (TSH) levels were elevated in every patient (mean 392 mU/l, range 240–475) and prolactin levels in 4 (mean 79 µg/l, range 48–143 µg/l). CT scanning confirmed the presence of pituitary enlargement in the 4 patients studied, which was suprasellar in 3. The remaining patient had an enlarged fossa on a lateral skull radiograph. During treatment with T 4 , TSH and prolactin levels were normal in all. Complete disappearance of the enlargement was seen on follow-up scans in all patients and 1 developed an empty sella. The induction of a pituitary enlargement by primary hypothyroidism results from reversible hyperplasia of both the TSH and prolactin-secreting cells in most instances. Occasionally, however, hyperplasia of the thyrotrophs can occur in isolation and an empty sella can occur after successful treatment with T 4 . Thyroid function tests should be obtained in all hyperprolactinemic patients.
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                Author and article information

                Journal
                Clin Pract
                Clin Pract
                CP
                Clinics and Practice
                PAGEPress Publications, Pavia, Italy
                2039-7275
                2039-7283
                31 March 2015
                28 January 2015
                : 5
                : 1
                Affiliations
                Endocrinology Department, Hôpital Militaire d’Instruction Mohammed V , Rabat, Morocco
                Author notes
                Hôpital Militaire d’Instruction Mohammed V, Avenue des FAR, Hay-Riad, CP 10100 Rabat, Morocco. 00212667070805. moumen2105@ 123456gmail.com

                Contributions: the authors contributed equally. The manuscript has been read and approved by all the authors.

                Conflict of interest: the authors declare no conflict of interest.

                Article
                10.4081/cp.2015.733
                4387347
                ©Copyright A. Moumen et al.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Page count
                Figures: 2, Tables: 0, Equations: 0, References: 10, Pages: 3
                Categories
                Case Report

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