Chakraborty Satyam, Tiwari Mona, Palui Rajan, Bhattacharya Kajari, Gangopadhyay Kalyan Kumar
Department of Endocrinology, Institute of Neurosciences, Fortis Hospital, Kolkata, West Bengal, India.
Department of Radiology, Institute of Neurosciences, Kolkata, West Bengal, India.
J ASEAN Fed Endocr Soc. 2020;35(2):238-243. doi: 10.15605/jafes.035.02.14. Epub 2020 Nov 29.
We describe three cases of primary hypothyroidism which presented initially to neurosurgery department with pituitary hyperplasia. We have found a novel pattern of 'dome-shaped' enlargement of pituitary in MRI of these patients. Out of these 3 patients, in two of them, the planned surgery was deferred when endocrinologists were consulted and the pituitary hyperplasia completely resolved with levothyroxine treatment. In the third case, pituitary surgery was already performed before endocrinology consultation and histopathology revealed thyrotroph hyperplasia. The hyperplastic lesions described typically have a homogenous symmetrical 'dome' shaped architecture unlike the non-functioning pituitary adenoma (NFPA), which usually might often be of varying shapes and homogeneity. Analysis of pituitary images from similar case reports published in literature, also showed this typical 'dome' shaped pituitary enlargement. This imaging characteristic can be a clue to look for underlying hormone deficiency, especially in primary hypothyroidism. Therefore, a thorough endocrine evaluation especially looking for primary hypothyroidism in such dome-shaped pituitary lesions are mandatory to prevent unwarranted neuro-surgical intervention as treatment of primary hypothyroidism may result in resolution of the abnormal enlargement.
我们描述了三例原发性甲状腺功能减退症患者，这些患者最初因垂体增生而就诊于神经外科。我们在这些患者的磁共振成像（MRI）中发现了一种新的垂体“圆顶状”增大模式。在这3例患者中，有2例在咨询内分泌科医生后推迟了计划中的手术，垂体增生通过左甲状腺素治疗完全消退。在第三例中，在咨询内分泌科之前已经进行了垂体手术，组织病理学显示促甲状腺激素细胞增生。所描述的增生性病变通常具有均匀对称的“圆顶”状结构，这与无功能垂体腺瘤（NFPA）不同，后者通常形状各异且均匀性不同。对文献中发表的类似病例报告的垂体图像分析也显示了这种典型的“圆顶”状垂体增大。这种影像学特征可能是寻找潜在激素缺乏的线索，尤其是在原发性甲状腺功能减退症中。因此，对于这种圆顶状垂体病变，必须进行全面的内分泌评估，尤其是寻找原发性甲状腺功能减退症，以防止不必要的神经外科干预，因为原发性甲状腺功能减退症的治疗可能会使异常增大消退。
