Thyroid Research and Practice

CASE REPORT
Year
: 2017  |  Volume : 14  |  Issue : 2  |  Page : 81--85

Primary hypothyroidism presenting as a pituitary macroadenoma and precocious puberty


Balram Sharma, Hema Singh, Sanjay Saran, Sandeep Kumar Mathur 
 Department of Endocrinology, SMS Medical College and Hospitals, Jaipur, Rajasthan, India

Correspondence Address:
Balram Sharma
Department of Endocrinology, SMS Medical College and Hospitals, Jaipur, Rajasthan
India

The association in young females of long-standing primary hypothyroidism, isosexual precocious pseudopuberty, and multicystic enlarged ovaries was first described in 1960 by Van Wyk and Grumbach. In this case study, we report a girl with precocious puberty, poor linear growth, decreased vision, and a large pituitary pseudotumor due to long-standing hypothyroidism with regression of all components following thyroxine (T4) supplementation. This girl aged 12 years and 3 months presented in Endocrinology Department with complaints of early menarche starting at the age of 8 years with normal cycles along with early progressive breast development starting almost simultaneously. On examination, she had a reduced growth for age (<5th centile) with adequate breast development (Tanner Stage 3) but no pubic or axillary hair development. Physical and biochemical examination for blood indices revealed a microcytic hypochromic anemia. Most importantly, she had an elevated thyroid stimulating hormone >150 μIU/ml (0.35–5.5) and a free T4 (FT4) and free triiodothyronine below normal limits suggestive of primary hypothyroidism. Furthermore, serum prolactin levels were elevated along with an elevated serum follicle-stimulating hormone, luteinizing hormone, and estradiol. Multicystic ovaries and a bulky uterus on ultrasound were suggestive of precocious puberty. Magnetic resonance imaging scan of the sella turcica was suggestive of a pituitary macroadenoma. Posttreatment with gluten-free diet, iron supplements, and T4 replacement, her thyroid function, hemoglobin, and prolactin normalized along with a regression in the size of the ovary. Therefore, in patients of this age presenting with a pituitary macroadenoma, anemia, precocious puberty, and primary hypothyroidism, medical management was preferred over neurosurgical intervention so as to avoid permanent hypopituitarism and lifelong hormone replacement therapy.


How to cite this article:
Sharma B, Singh H, Saran S, Mathur SK. Primary hypothyroidism presenting as a pituitary macroadenoma and precocious puberty.Thyroid Res Pract 2017;14:81-85


How to cite this URL:
Sharma B, Singh H, Saran S, Mathur SK. Primary hypothyroidism presenting as a pituitary macroadenoma and precocious puberty. Thyroid Res Pract [serial online] 2017 [cited 2020 Dec 2 ];14:81-85
Available from: https://www.thetrp.net/article.asp?issn=0973-0354;year=2017;volume=14;issue=2;spage=81;epage=85;aulast=Sharma;type=0