Endocrine Abstracts

Aim: We report a child with reactive pituitary enlargement and microadenoma due to Hashimoto thyroiditis.We want to emphasize the importance of good endocrine evaluation in pediatric cases of pituitary adenomas

Case report: A 7 year 7 month old boy presented with mild symptoms of hypothyroidism. There was no feature in his past medical story.He had normal cognitive and neurological development. At physical examination his weight was 24 kg (0.06 SDS) and height was 122.5 cm (−0.20 SDS). His systemic evaluation was normal. In hormonal workup low free thyroxine (0.75 ng/dl) (0.82–1.62),low tiriiodotironin (0.99 pg/ml) (2.73–4.92) and high TSH (>150 mIU/ml)(0.8–5.4) levels, and hyperprolactinemia (prolactin level at 36.33 mIU/l), TSH reseptor antibody was 0.49, TGAb (>3000 mIU/ml), TMAb (>1000 mIU/ml) were obtained\. In ultrasonography thyroid gland was larger and heterogeneous images were seen. Hashimoto thyroiditis were diagnosed and Levotiroksin treatment (3 mcg/kg/g) was started and gradually increased.In follow up TSH was not suprese despite free t4 rise. Macro TSH was negative.Pituitary imaging was performed. The height of the pituitary was measured as 11.5 mm. It creates a slight pressure on the optical chiasm. Within the pituitary, there is a region of 6×9 mm in diameter with low contrast.It was reported as microadenoma. Then treatment was planned as L-tiriiodotironin (12.5 mcg/day) and dose adjustment done according to hormone levels.After 1 month in pituitary imaging, the height of the pituitary was measured as 6.6 mm,staining was homogeneous and no mass was seen. TSH level was depressed. (TSH: 47.64 mIU/ml, FT4: 1.15 ng/dl). The patient’s treatment and follow-up continues

Conclusion: Based on the clinical and laboratory data a diagnosis of pituitary microadenoma secondary to chronic autoimmune thyroiditis was made. Primary hypothyroidism should be considered in the differential diagnosis of pituitary masses