Large Pituitary Hyperplasia in Severe Primary Hypothyroidism

摘要

A23-yr-oldRomaniangirlpresentedwitha7-monthhis-tory of polymenorrhea, fatigue, headache, slowedmentation, and weight gain. She had facial and peripheraledema, dry skin, and fine scalp hair. Bradycardia and peri-cardial effusion at echocardiography were observed. Hor-monal tests revealed a severe primary hypothyroidism(PH) (TSH, 1578 ? U/ml; free T 4 , ?0.3 ng/ml), mildhyperprolactinemia (113 ng/ml), and partial ACTH de-ficiency.Thyroidultrasoundexaminationshowedasmalldyshomogeneous and pseudonodular gland, whereas thy-roidautoantibodieswereabsent.Magneticresonanceimag-ing(MRI)revealedalargesellarandsuprasellarmass(23?23?10mm)thatbilaterallycompressedthecavernoussinusandstretchedtheopticchiasm(Fig.1,AandB).Thepatientwas replaced with 37.5 mg/d cortisone acetate and L -T 4 (ti-tration up to 100 ? g/d). Two months later, normal mensesresumed,serumfreeT 4 andTSHlevelsnormalized,andpro-lactinemia declined to 50 ng/ml, whereas subclinical hypo-adrenalism persisted. MRI study documented the completeshrinkage of the pituitary lesion (Fig. 1, C and D).