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Primary hypothyroidism presenting as growth delay and pituitary enlargement
J D Farley1, E L Toth, E A Ryan
1Division of Endocrinology and Metabolism, University of Alberta, Edmonton, Canada.
Insights
A young boy
Area of Science:
- Pediatric Endocrinology
- Neuroendocrinology
Background:
- Growth delay in children necessitates comprehensive endocrine evaluation.
- Pituitary enlargement can be associated with various endocrine disorders.
- Congenital hypothyroidism requires timely diagnosis and management.
Observation:
- A pediatric patient presented with growth delay and pituitary enlargement.
- Clinical and biochemical hypothyroidism was noted, despite the absence of goiter.
- Elevated thyroid-stimulating hormone (TSH) levels suggested primary thyroid pathology.
Findings:
- The elevated TSH indicated thyrotroph hyperplasia secondary to primary hypothyroidism.
- Treatment with L-thyroxine led to a rapid decrease in pituitary size.
- Visual field deficits improved concurrently with pituitary volume reduction.
Implications:
- This case highlights the importance of evaluating thyroid function in children with pituitary enlargement and growth delay.
- Prompt treatment of primary hypothyroidism can reverse pituitary hyperplasia and associated symptoms.
- Non-invasive management of pituitary enlargement due to thyrotroph hyperplasia is possible with thyroid hormone replacement.
Abstract:
We report the case of a young boy being considered for pituitary surgery because of pituitary enlargement found during assessment of growth delay. There was no goitre but he was hypothyroid clinically and biochemically. The finding of an elevated TSH suggested primary thyroid disease with thyrotroph hyperplasia. Treatment with L-thyroxine resulted in prompt resolution of his pituitary enlargement and improvement in his visual fields.