A case of primary hypothyroidism with pituitary enlargement and abnormal secretion of growth hormone and prolactin

Abstract

A case of primary hypothyroidism accompanied by pituitary enlargement and pituitary dysfunction is documented. A 27-year-old woman was admitted to our hospital for further examination of pituitary enlargement. Endocrinological examination revealed that she had primary hypothyroidism. Her TSH level in serum was elevated to more than 300 microU/ml. She also had pituitary dysfunction such as hypersecretion of prolactin in response to TRH and paradoxical rise of GH to glucose load. Serum antibodies against the pituitary gland were negative. Magnetic resonance imaging (MRI) examination showed an enlarged pituitary gland extending to supraseller cistern, which was homogeneously enhanced after Gadolinium-DTPA treatment. Treatment with 50-100 micrograms of levothyroxine sodium normalized her thyroid function and secretion of GH and prolactin. In addition, periodic MRI examination demonstrated a gradual decrease in the size of the pituitary gland after the treatment. The above clinical course indicates that pituitary enlargement in this patient occurred as a result of primary hypothyroidism. The mechanism of the abnormal secretion of TSH, GH and prolactin secondary to primary hypothyroidism was discussed.