CASE REPORTS   

Gazzetta Medica Italiana Archivio per le Scienze Mediche 2011 June;170(3):211-4

Copyright © 2011 EDIZIONI MINERVA MEDICA

language: English

Primary hypothyroidism simulating pituitary macroadenoma: a case report

De Paula S., Tavares A. B., Morais F., Vaisman M., Teixeira P.

Department of Endocrinology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil

It is well-known that pituitary can expand in cases of non- treated primary hypothyroidism. We present a case of a 27 year-old female patient with holocranial headache, menstrual irregularity, galactorrhea, decrease of visual acuity for the last 2 years and hyperprolactinemia that was initially evaluated by a Neurosurgery service. A magnetic resonance image (MRI) was requested, as the diagnostic hypothesis was pituitary non-functioning adenoma and hyperprolactinemia secondary to the compression of the pituitary stalk, and an expansive intra-sellar lesion was discovered. The endocrine evaluation evidenced symptoms and signs of hypothyroidism and the thyroid hormonal dosages confirmed the diagnosis of severe primary hypothyroidism. The adequate treatment with levothyroxine was initiated and normalization of the levels of thyrostimulating hormone (TSH) and free thyroxine (FT4) was achieved after 10 months of treatment. Galactorrhea and other symptoms, besides de hyperporlactinemia, disappeared. A new MRI was performed 5 months after euthyroidism restored, which evidenced a normal pituitary. It is essential to investigate hypothyroidism in pituitary masses and/or hyperprolactinemia, in order to avoid unnecessary surgical interventions.