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Primary Hypothyroidism with Markedly High Prolactin.
Mohd Saleem Ansari1, Mussa H Almalki2
1Obesity, Endocrine and Metabolism Center, King Fahad Medical City , Riyadh , Saudi Arabia.
Frontiers in Endocrinology
|May 21, 2016
Summary
Primary hypothyroidism can cause pituitary enlargement and elevated prolactin (PRL) due to thyrotropin-releasing hormone (TRH). Thyroid hormone replacement therapy resolved these symptoms, avoiding unnecessary treatments.
Area of Science:
- Endocrinology
- Neuroendocrinology
Background:
- Primary hypothyroidism leads to reduced thyroxine feedback, increasing thyrotropin-releasing hormone (TRH) production.
- TRH can stimulate pituitary lactotrophs, potentially causing mild prolactin (PRL) elevation and pituitary enlargement.
Observation:
- A 67-year-old female presented with a large pituitary mass and markedly elevated TSH and PRL levels.
- Distinguishing between a pituitary prolactinoma and secondary pituitary hyperplasia due to hypothyroidism was clinically challenging.
Findings:
- Thyroid hormone replacement therapy normalized PRL levels.
- This confirmed the pituitary mass and hyperprolactinemia were secondary to primary hypothyroidism.
Implications:
- Accurate diagnosis of secondary pituitary enlargement in hypothyroidism is crucial.
- Prompt thyroid hormone therapy can prevent misdiagnosis and unnecessary treatments like dopamine agonists.
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