Pituitary hyperplasia: an uncommon presentation of a common disease

[摘要] A 21-year-old woman presented with amenorrhea, bilateral galactorrhea and fatigue. Visual acuity and visual fields werenormal. Laboratory examination demonstrated hyperprolactinemia. Magnetic resonance imaging (MRI) of the pituitaryshowed a 19!17!12-mm sellar mass with supra- and parasellar extension, causing compression of the pituitary stalk andoptic chiasm. Further examinations confirmed mild hyperprolactinemia, strongly elevated TSH (O500 mU/l), low freethyroxine (FT4), hypogonadotropic hypogonadism and secondary adrenal insufficiency. Hydrocortisone and L-T4 replacementtherapy was started. Three months later, the galactorrhea had disappeared, thyroid function was normalized and MRIrevealed regression of the pituitary enlargement, confirming the diagnosis of pituitary hyperplasia (PH) due to primaryhypothyroidism. Subsequently, the menstrual cycle returned and the hypocortisolism normalized. This case demonstratesthat severe primary hypothyroidism may have an unusual presentation and should be considered in the differential diagnosisof pituitary enlargement associated with moderate hyperprolactinemia.

[学科分类] 血液学

[关键词] Adult;Female;White;Netherlands;Pituitary;Pituitary;Prolactin;TSH;Thyroxine (T4);Hypothyroidism;Pituitary hyperplasia;Pituitary adenoma;Hypogonadotrophic hypogonadism;Hypogonadism;Amenorrhoea (secondary);Adrenal insufficiency;Amenorrhoea;Galactorrhoea;Fatigue;Hypotension;MRI;BMI;Blood pressure;TSH;FT4;Metyrapone test dose;Hydrocortisone;Glucocorticoids;Levothyroxine;General practice;Unique/unexpected symptoms or presentations of a disease;August;2015