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Primary hypothyroidism and pituitary insufficiency.

F B Gluck, M L Nusynowitz, M Montgomery

Southern Medical Journal

|December 1, 1978

Summary

A patient with hypothyroidism and sellar enlargement showed elevated thyroid-stimulating hormone (TSH). This suggests either a TSH-producing pituitary tumor or hyperplasia secondary to hypothyroidism.

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Area of Science:

Endocrinology
Pituitary Disorders
Thyroid Disorders

Background:

Primary hypothyroidism can lead to pituitary gland changes.
Sellar enlargement in the context of endocrine dysfunction requires careful evaluation.
Pituitary tropic hormone deficiencies are common in complex endocrine cases.

Observation:

A 40-year-old male presented with primary hypothyroidism and sellar enlargement.
Laboratory results indicated deficiency in all pituitary tropic hormones except for elevated thyroid-stimulating hormone (TSH).

Findings:

Thyrotropin-releasing hormone (TRH) stimulation confirmed the responsiveness of pituitary thyrotropic cells.
Administration of thyroxine effectively suppressed the elevated TSH levels.
These findings support two potential diagnoses: a TSH-producing pituitary adenoma or thyrotropic hyperplasia secondary to hypothyroidism.

Implications:

Distinguishing between a TSH-secreting adenoma and secondary thyrotropic hyperplasia is crucial for appropriate patient management.
The suppressibility of TSH by thyroxine suggests a complex interplay between the thyroid and pituitary axes.
Further investigation may be warranted to definitively diagnose the cause of sellar enlargement and hormonal imbalances.

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