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Pituitary hyperplasia in childhood primary hypothyroidism: a review
Shabal Sapkota1, Mitesh Karn2, Sulav Sapkota3
1Department of Neurosurgery, Gandaki Medical College Teaching Hospital and Research Center, Pokhara, Nepal. shabalsapkota@gmail.com.
Insights
Pituitary hyperplasia in children due to hypothyroidism is rare but treatable with thyroid hormone replacement therapy. Prompt diagnosis and treatment can resolve pituitary mass and related clinical issues.
Area of Science:
- Pediatric Endocrinology
- Neuroendocrinology
- Radiology
Background:
- Pituitary hyperplasia in pediatric patients secondary to primary hypothyroidism is infrequently reported.
- This condition may lead to unnecessary neurosurgical interventions due to its rarity and treatable nature.
Purpose of the Study:
- To provide a comprehensive summary of current research on pediatric pituitary hyperplasia associated with primary hypothyroidism.
- To elucidate the pathophysiology, clinical, biochemical, and radiological aspects of this condition.
- To offer recommendations for management and follow-up.
Main Methods:
- A systematic literature search was conducted using PubMed, PsycINFO, and Cochrane databases.
- Studies were filtered for English language, pediatric population (0-18 years), and CT/MRI confirmed findings.
- Data from 55 studies involving 110 patients were extracted and analyzed.
Main Results:
- The most common clinical presentations included growth retardation (78%), constipation (36%), and features of myxedema (18%).
- Mean pituitary height measured 13.48 mm (SD 4.72 mm).
- All patients experienced resolution of pituitary mass and abnormalities within 1-26 months (average 7.22 months) after thyroid hormone replacement therapy.
Conclusions:
- Pediatric pituitary hyperplasia secondary to primary hypothyroidism is a reversible condition with appropriate thyroid hormone replacement.
- Accurate diagnosis and timely medical management can prevent unnecessary surgical interventions.
- This review offers valuable insights for clinicians managing such cases.
Introduction:
Pituitary hyperplasia following primary hypothyroidism in pediatric age group population is considered rare with reports of unnecessary neurosurgical intervention for this medically treatable condition. Given the paucity of information on this topic, it is timely to provide clinicians with a comprehensive summary of available research.
Methods:
A search of published studies in Pubmed, PsychInfo and Cochrane Database with the terms "pituitary hyperplasia" or "pituitary hypertrophy" and "hypothyroidism" was performed and the results filtered for English language, pediatric (0-18 years) population and CT or MRI confirmed findings. 55 studies met the inclusion criteria. Data for a total of 110 patients with pituitary hyperplasia following primary hypothyroidism were extracted. The study population included 29 males and 81 females (M: F= 0.35:1). Patient age varied from 3 weeks to 18 years with a mean age of 10.22 years.
Results:
The most common clinical presentations included growth retardation, constipation and features of myxedema which were present in 78, 36 and 18 percent of children included in our review. Neuroimaging showed the mean (SD) pituitary height being 13.48 mm (4.72 mm). All of the patients achieved resolution of their pituitary mass and clinical as well as biochemical abnormalities 1 to 26 months after initiation of thyroid hormone replacement therapy, with an average time interval of 7.22 months. Our review has tried to delve in the pathophysiology as well as clinical, biochemical and radiological aspects of pediatric pituitary hyperplasia secondary to primary hypothyroidism and provide recommendations for treatment and follow-up. This may help anyone concerned gain a substantial knowledge on this topic.
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