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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.
Summary
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.