Endocrine Abstracts

Introduction: There are several causes of sellar and suprasellar mass, and pituitary hyperplasia secondary to primary hypothyroidism has been reported in the literature.

Case report: 20-year-old patient, born from a consanguineous marriage, presenting with failure to thrive. Patient reporting no tumor syndrom. Clinical examination: Height at 88 cm (<-4 SD), weight at 18 kg (<3rd percentile), BMI at 23 kg/m2. TANNER at G2P0, micropenis length of 5 cm (<-2.5 DS), infantile voice, elf-like features, with periorbital puffiness, flat nasal bridge, short upturned nose with bulbous tips, large mouth with everted and broad lower lips. Patient with friendly behaviour. Thyroid not palpable, no clinical signs of pituitary hypersecretion. Paraclinical findings: TSHus >500 mIU/l (0.35-4.94) >100 times normal T4L: 2.81 pmol/l (10.6-19.4). IGF-1: 19.26 ng/ml (27-114). Cortisolemia before 10 hrs: 8.5 ng/dl (3.7-19.4) Prolactinemia: 118 ng/ml (3.6-19.4). Cervical ultrasound: heterogeneous thyroid gland without detectable nodules. Bone age: 1 year 6 months RISSER test: 0 Pituitary MRI: pituitary hypertrophy, without clearly detectable nodule. The patient benefited from a substitution by Levothyroxine and Somatostatin analogue with a good evolution.

Conclusion: Pituitary enlargement secondary to primary hypothyroidism should be considered as a differential diagnosis of solid pituitary masses, especially when associated with growth and pubertal retardation. Adequate care helps to avoid no need surgeries.