Nikith Siddu, Krishnappa Brijesh, Lakkundi Shilpa, Thakar Sumit, Lila Anurag, Goyal Aditi, Annavarapu Umalakshmi, Sagar Reddy S L, Shanthaiah Dhananjaya Melkunte, Bandgar Tushar, Aryan Saritha, Sarathi Vijaya
Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, India.
Department of Endocrinology, Seth G S Medical College & KEM Hospital, Mumbai, India.
Endocrine. 2024 Oct;86(1):358-368. doi: 10.1007/s12020-024-03983-1. Epub 2024 Aug 8.
In a patient with elevated thyroid stimulating hormone (TSH, >50 µIU/ml) with sellar mass, it is crucial to differentiate isolated pituitary hyperplasia (IPH) from primary hypothyroidism coexisting with nonfunctioning pituitary adenoma (PHCNFPA) pre-operatively to avoid unwarranted surgery in the former condition. Here, we describe patients having pituitary mass/enlargement with markedly elevated TSH (>50 µIU/ml) and attempt to find the differentiating features between IPH and PHCNFPA.
This is a retrospective study conducted at a tertiary care center. Case records of patients presenting between January 2020 and December 2022 with elevated TSH (>50 µIU/ml) for whom magnetic resonance imaging (MRI) of the sella was available were reviewed. Demographic details, symptomatology, clinical examination findings, thyroid function tests, data on pituitary hormonal excess and deficiencies, MRI findings, and details regarding levothyroxine supplementation were noted. Based on the final diagnosis, the patients were categorized into two groups: PHCNFPA and IPH.
Five and 11 patients were diagnosed with PHCNFPA and IPH, respectively. The median (IQR) age at presentation of patients with PHCNFPA was significantly higher than that of IPH patients [37 (28-60.5) vs. 21 (10-21.5) years, p: 0.002]. A longer duration of hypothyroid symptoms was noted in the IPH group whereas visual field defects and corticotropin deficiency were more frequent and the pituitary lesion size was greater in PHCNFPA. Thyroid function tests were not different between the two groups. The pituitary enlargement in IPH was initially an increase in pituitary height that progressed to symmetrical nipple-, dome- or tent-shaped enlargement. Besides this characteristic enlargement pattern, isointense appearance on T1-weighted and T2-weighted images, homogeneous contrast enhancement, and prompt regression of pituitary lesion with levothyroxine replacement were characteristic of IPH whereas heterogeneous enhancement, cystic/hemorrhagic change, and ≥Knosp III invasion were characteristic of PHCNFPA. Peripheral rim enhancement and Knosp I-II parasellar extension were not uncommon in patients with IPH and did not distinguish it from PHCNFPA.
The present study reports the radiological evolution of IPH and a unique series of PHCNFPA along with the distinguishing characteristics between them.
对于促甲状腺激素（TSH）升高（>50 μIU/ml）且伴有鞍区肿块的患者，术前区分孤立性垂体增生（IPH）与原发性甲状腺功能减退合并无功能垂体腺瘤（PHCNFPA）至关重要，以避免对前者进行不必要的手术。在此，我们描述了患有垂体肿块/增大且TSH显著升高（>50 μIU/ml）的患者，并试图找出IPH和PHCNFPA之间的鉴别特征。
这是一项在三级医疗中心进行的回顾性研究。回顾了2020年1月至2022年12月期间TSH升高（>50 μIU/ml）且有蝶鞍磁共振成像（MRI）资料的患者的病例记录。记录了人口统计学细节、症状、临床检查结果、甲状腺功能测试、垂体激素过多和缺乏的数据、MRI结果以及左甲状腺素补充的详细情况。根据最终诊断，将患者分为两组：PHCNFPA和IPH。
分别有5例和11例患者被诊断为PHCNFPA和IPH。PHCNFPA患者就诊时的中位（IQR）年龄显著高于IPH患者[37（28 - 60.5）岁 vs. 21（10 - 21.5）岁，p：0.002]。IPH组甲状腺功能减退症状持续时间更长，而视野缺损和促肾上腺皮质激素缺乏在PHCNFPA中更常见，且垂体病变大小更大。两组之间的甲状腺功能测试无差异。IPH中的垂体增大最初是垂体高度增加，随后发展为对称的乳头状、穹顶状或帐篷状增大。除了这种特征性的增大模式外，T1加权和T2加权图像上的等信号外观、均匀的对比增强以及左甲状腺素替代治疗后垂体病变迅速消退是IPH的特征，而异质性增强、囊性/出血性改变以及≥Knosp III级侵袭是PHCNFPA的特征。IPH患者中周边边缘增强和Knosp I-II级鞍旁延伸并不少见，且无法将其与PHCNFPA区分开来。
本研究报告了IPH的影像学演变以及一系列独特的PHCNFPA病例，并阐述了它们之间的鉴别特征。
