Haider Shanzay, Templeton Kelsey, Omay S Bulent, Inzucchi Silvio E
1Department of Internal Medicine, Division of Endocrinology and Metabolism, Yale School of Medicine, New Haven, Connecticut; and.
2Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut.
J Neurosurg Case Lessons. 2023 Feb 13;5(7). doi: 10.3171/CASE22496.
Pituitary adenomas are the most common cause of pituitary enlargement and can potentially warrant surgical intervention. However, there are physiological causes of pituitary enlargement that can be reversed with hormone replacement alone.
A 29-year-old female presented with acute onset paranoia to the psychiatry department. A computed tomography scan of the head revealed a 2.3 cm sellar mass with confirmation on magnetic resonance imaging. Testing showed a markedly elevated thyroid-stimulating hormone 1,600 µIU/mL (0.470-4.200 µIU/mL), suggesting pituitary hyperplasia. Treatment with levothyroxine replacement resulted in marked improvement in symptoms and resolution of pituitary hyperplasia on four month follow up.
This rare presentation of severe primary hypothyroidism highlights the importance of evaluating for physiological causes of pituitary enlargement.
垂体腺瘤是垂体增大最常见的原因，可能需要手术干预。然而，垂体增大也有一些生理原因，仅通过激素替代治疗即可逆转。
一名29岁女性因急性发作的妄想症就诊于精神科。头部计算机断层扫描显示鞍区有一个2.3厘米的肿块，磁共振成像证实了这一结果。检测显示促甲状腺激素显著升高，达1600微国际单位/毫升（0.470 - 4.200微国际单位/毫升），提示垂体增生。左甲状腺素替代治疗后，症状明显改善，四个月随访时垂体增生消退。
这种罕见的严重原发性甲状腺功能减退表现突出了评估垂体增大生理原因的重要性。
