Larson Noelle S, Pinsker Jordan E
Department of Pediatrics, Division of Pediatric Endocrinology, Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, HI 96859, USA.
J Med Case Rep. 2013 May 31;7:149. doi: 10.1186/1752-1947-7-149.
Primary 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.
We 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.
In 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.
原发性甲状腺功能减退是儿童线性生长发育迟缓的一个众所周知的原因。在严重或长期的疾病中，一种罕见的发现是垂体增大（垂体假性肿瘤）。本病例突出了这一不常见的发现，讨论了在哪些临床情况下逐步增加左甲状腺素剂量可能是可取的，并回顾了以前尝试过的辅助治疗方法，这些方法旨在改善严重甲状腺功能减退患者的最终身高。
我们报告了一名13岁西班牙裔女孩的病例，她最初因线性生长发育迟缓及青春期延迟接受评估，结果发现因严重原发性甲状腺功能减退继发垂体增大。逐渐增加剂量的左甲状腺素治疗使她的症状恢复正常，并使垂体的异常表现完全消失，但随后她迅速经历青春期，成年身高仅为142厘米，显著低于根据其父母身高计算出的平均身高。
在严重原发性甲状腺功能减退且促甲状腺激素长期升高及存在垂体假性肿瘤的病例中，使用剂量逐渐增加的左甲状腺素逐步替代甲状腺激素可能有助于预防治疗并发症。儿童期甲状腺功能减退的早期识别和治疗对于正常生长至关重要，因为病程延长的儿童最终身高总是会受到影响。需要进一步研究以确定促性腺激素释放激素激动剂和重组人生长激素治疗在此情况下的潜在有益效果。
