Category: Pituitary Disorders/Neuroendocrinology

Monitor: 17

17 - PITUITARY MACROADENOMA POSTED FOR TRANSPHENOIDAL SURGERY: PITUITARY THYROTROPH HYPERPLASIA

Thursday, Apr 25
11:30 AM – 12:00 PM

Objective : To describe a case of pituitary thyrotroph hyperplasia presenting as pituitary macroadenoma, posted for transphenoidal surgery. 


Methods :

A 27 year old male presented to the physician with giddiness x 6m, on and off headache x 6 m and feeling of compression in the throat x 1 m. He was diagnosed as suffering from migraine and CT brain suggested. ECG: Sinus bradycardia. MRI Brain revealed pituitary macroadenoma. Patient then came for neurosurgery to a premier institute and was then referred to Endocrine Department for evaluation.


Results :

MRI Pituitary: Pituitary macroadenoma; Focal lesion in sella and suprasellar cistern 16 x 11 x 15 mm; with compression of optic chiasm; posterior pituitary bright spot preserved.


Endocrinology: Goitre= Grade 1/2 firm; S T3= 0.39 (0.8-2 ng/ml); T4= 2.5 (4.5-12 mcg/dl); TSH> 150 (0.25-5 µIU/ml); FT4= 0.58 (0.7-1.8 ng/dl); TPO antibodies= 57 (<34); Prolactin= 55 (4-15ng/ml); S Cortisol [Random]= 17.8 (6-18 ug/dl). 


Visual fields= Normal


Diagnosis: Primary hypothyroidism with pituitary thyrotroph hyperplasia. Hashimoto’s thyroiditis. Surgery was withheld.


Treatment: Levothyroxine 150 mcg/day replacement.


Follow up MRI: (a) After a year – “Macroadenoma” - Mild reduction in the height of adenohypophysis [6 x 13 x 7 mm]; reduction in mass effect. Now assessed as “Pituitary Thyrotroph Hyperplasia”, with coincidental non-functioning pituitary adenoma. (b) After 2 years - Pituitary Normal ?


Discussion :

Primary hypothyroidism presenting as a “Pituitary mass” is rare, but well known entity.  Markedly elevated TSH, chronic headache, diplopia and diminution of vision, positive imaging findings – “pituitary tumor” are common features.  Hyperprolactinemia: Mild; secondary to untreated hypothyroidism; frequent concomitant of severe thyrotroph hyperplasia.


Conclusion :

Pituitary hyperplasia should be considered as a differential diagnosis of pituitary “tumours” with evidence of corresponding biochemical hormone elevations. Precise diagnosis of these cases, and also identification of accompanying “coincidental” non-functioning pituitary adenomas should also be kept in mind, while evaluating these cases so as to avoid unnecessary surgeries.


Pituitary hyperplasia: Thyrotroph cells become enlarged by lack of negative feedback; easily reversible upon thyroid replacement; Complete regression can be achieved with thyroxine replacement therapy; Adenoma formation may rarely be associated with any type of pituitary hyperplasia.

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Kavitha Muniraj

Consultant Faculty Endocrinology Diabetes
Samatvam Jnana Sanjeevini Diabetes Hospital and Medical Center
Bangalore, Karnataka, India

Designation: Consultant and Faculty; Director Medical ; Director Research; Trustee
Specialties: Endocrinology Diabetes; Clinical Research
Clinical Interests: Pituitary Adrenal disorders; Bone health; Cardiovascular Health; Thyroid dysfunction; Diabetes Pharmacotherapy; Clinical Pharmacology; Pharmacovigilance; Clinical research Safety and Audits

Babitha D. T

Consultant Faculty Endocrinology Diabetes
Samatvam Jnana Sanjeevini Diabetes Hospital and Medical Center
Bangalore, Karnataka, India

Designation: Consultant and Faculty
Specialties: Endocrinology, Diabetes
Clinical Interests: Endocrine disorders of pregnancy, Pregnancy Diabetes, Cardiovascular Health, Thyroid, Inpatient diabetes care and endocrine metabolic emergencies

Vasanthi Nath

Consultant Faculty Endocrinology Diabetes
Samatvam Jnana Sanjeevini Diabetes Hospital and Medical Center
Bangalore, Karnataka, India

Designation: Consultant and Faculty
Specialties: Endocrinology, Diabetes, Internal Medicine, Geriatrics
Clinical Interests: Neuroendocrinology and Neurometabolism, Metabolic Myopathies; Thyroid tumors, Geriatric Endocrinology, Inpatient Diabetes Care and Endocrine Emergencies; Type 1 diabetes across ages

Chandraprabha S

Consultant Faculty Endocrinology Diabetes
Samatvam Jnana Sanjeevini Diabetes Hospital and Medical Center
Bangalore, Karnataka, India

Designation: Consultant and Faculty
Specialties: Endocrinology Diabetes Metabolism
Clinical Interests: Pregnancy Diabetes, Pregnancy Thyroid Dysfunction, Women Health, Geriatric Endocrinology, Diabetes mellitus and Mental Health, Spiritual Medicine

Reshma B. Vijay

Consultant Faculty Endocrinology Diabetes
Samatvam Jnana Sanjeevini Diabetes Hospital and Medical Center
Bangalore, Karnataka, India

Designation: Consultant and Faculty
Specialties: Endocrinology Diabetes and Metabolism
Clinical Interests: Pediatric Endocrinology; Diabetes mellitus; Insulin Pumps, Continuous Glucose Monitoring and Artificial Pancreas; Growth and Puberty; Thyroid; Pituitary Adrenal disorders

Muralidhara Krishna

Consultant Faculty Endocrinology Diabetes Biochemistry
Samatvam Jnana Sanjeevini Diabetes Hospital and Medical Center
Bangalore, Karnataka, India

Designation: Consultant and Faculty: Endocrinology Diabetes Metabolism; Associate Professor: Clinical Biochemistry and Laboratory Medicine
Specialties: Endocrinology Diabetes Metabolism; Clinical Biochemistry
Clinical Interests: Diabetes mellitus; Thyroid Disorders; Obesity; Dyslipidemia.

Jayalakshmi T

Consultant Faculty Endocrinology Diabetes
Samatvam Jnana Sanjeevini Diabetes Hospital and Medical Center
Bangalore, Karnataka, India

Designation: Consultant and Faculty

Specialties: Endocrinology, Diabetes, Internal Medicine,
Clinical Interests: Diabetes mellitus, Cardiovascular Health, Thyroid, In Patient Diabetes Care, Endocrinology Metabolic emergencies and critical care

Nidhi Garg

Consultant Faculty Endocrinology Diabetes
Samatvam Jnana Sanjeevini Diabetes Hospital and Medical Center
bangalore, Karnataka, India

Designation: Senior Consultant and Faculty
Specialties: Diabetes and Metabolism
Clinical Interests: Comprehensive diabetes care, In-patient diabetes and metabolic care, Perioperative diabetes management, Diabetes and endocrine emergencies – Metabolic Intensive Care, Obesity management, Lipids and preventive cardiology, Gestational diabetes, Thyroid disorders, Type 1 diabetes across ages

Apoorva Govind

Consultant Faculty Endocrinology Diabetes
Samatvam Jnana Sanjeevini Diabetes Hospital and Medical Center
Bangalore, India

Designation: (a) Fellow: Endocrinology Diabetes Medicine, Samatvam Endocrinology Diabetes Centre and Jnana Sanjeevini Medical Centre and Diabetes Hospital ; (b) Co Investigator – Clinical Research, Samatvam Science and Research Center

Specialties: Endocrinology, Diabetes, Internal Medicine

Siddartha Dinesha

Resident, Medicine Diabetes Endocrinology
Samatvam Jnana Sanjeevini Diabetes Hospital and Medical Center

Designation: Resident: Medicine; Endocrinology Diabetes, Samatvam Endocrinology Diabetes Centre and Jnana Sanjeevini Medical Centre and Diabetes Hospital
Specialties: Endocrinology, Diabetes, Internal Medicine

MD Chitra

Consultant Faculty Endocrinology Diabetes
Samatvam Jnana Sanjeevini Diabetes Hospital and Medical Center

Designation: Consultant and Faculty; Trustee
Specialties: Endocrinology Diabetes; Clinical Research
Clinical Interests: Diabetes, Obesity, Dyslipidemia, Osteoporosis, Pituitary Adrenal disorders; Bone health; Cardiovascular Health; Thyroid dysfunction;

Vasudha Srikanth


India

Sathvik Reddy Chinna Bainagari

Resident Doctor
Samatvam jnana sanjeevini Diabetes hospital and medical center
Chittoor, Andhra Pradesh, India

Monica Narayanaswamy

Resident doctor
Samatvam jnana sanjeevini diabetes hospital and medical centre
Chintamani, India

Madhumati S Vaishnav

Scientist Faculty
Samatvam Jnana Sanjeevini Diabetes Hospital and Medical Center; CENSE Indian Institute of Science, India

B.Sc (Microbiology), University of Pune, India.
M.Sc (Microbiology), University of Pune, India.
Post Graduate Diploma in Clinical Research and Clinical Data Management, University of Pune, India
CDE (Certified Diabetes Educator - Counselor), Samatvam Institute of Medical Sciences, India

Namya Gaekwad

Sri Srikanta