Abstract
IntroductionPrimary hypothyroidism is a well-known cause of poor linear growth in children. A rare finding with profound or long-standing disease is anterior pituitary enlargement (pituitary pseudotumor). This case highlights this uncommon finding, discusses clinical situations in which gradual dose escalation of levothyroxine may be advisable and reviews adjuvant therapies that have been previously attempted to improve final height in the setting of profound hypothyroidism.Case presentationWe report the case of a 13-year-old Hispanic girl initially evaluated for poor linear growth and delayed puberty, and found to have pituitary enlargement secondary to profound primary hypothyroidism. Treatment with progressive doses of levothyroxine normalized her symptoms and led to complete resolution of her pituitary findings, but she then rapidly progressed through puberty, achieving an adult height of only 142cm, significantly below her calculated mid-parental height.ConclusionsIn cases of severe primary hypothyroidism with prolonged elevation of thyroid-stimulating hormone and pituitary pseudotumor, gradual replacement of thyroid hormone with slowly escalating doses of levothyroxine may be beneficial to prevent complications of therapy. Early recognition and treatment of hypothyroidism during childhood is essential for normal growth, as final height is invariably compromised in children with prolonged disease. Additional study is needed to determine the potential beneficial effects of gonadotropin-releasing hormone agonist and recombinant human growth hormone treatment in this setting.
Highlights
Primary hypothyroidism is a well-known cause of poor linear growth in children
Recognition and treatment of hypothyroidism during childhood is essential for normal growth, as final height is invariably compromised in children with prolonged disease
The presentation of primary hypothyroidism in children is most often marked by poor linear growth [1], symptoms can be quite varied
Summary
Pituitary enlargement (pseudotumor of the pituitary gland) is a rare finding seen in prolonged and severe primary hypothyroidism. Diagnosis and treatment is essential to preserve final height in children with severe primary hypothyroidism, as late diagnosis almost invariably results in decreased adult stature. 8. Farley JD, Toth EL, Ryan EA: Primary hypothyroidism presenting as growth delay and pituitary enlargement. Ahmed M, Banna M, Sakati N, Woodhouse N: Pituitary gland enlargement in primary hypothyroidism: a report of 5 cases with follow-up data. Doi:10.1186/1752-1947-7-149 Cite this article as: Larson and Pinsker: Primary hypothyroidism with growth failure and pituitary pseudotumor in a 13-year-old female: a case report. JEP was a major contributor in writing the manuscript Both authors read and approved the final manuscript.
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