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2015 ; 2015
(ä): 150017
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Pituitary hyperplasia: case series and literature review of an under-recognised
and heterogeneous condition
#MMPMID26124954
De Sousa SM
; Earls P
; McCormack AI
Endocrinol Diabetes Metab Case Rep
2015[]; 2015
(ä): 150017
PMID26124954
show ga
Pituitary hyperplasia (PH) occurs in heterogeneous settings and remains
under-recognised. Increased awareness of this condition and its natural history
should circumvent unnecessary trans-sphenoidal surgery. We performed an
observational case series of patients referred to a single endocrinologist over a
3-year period. Four young women were identified with PH manifesting as diffuse,
symmetrical pituitary enlargement near or touching the optic apparatus on MRI.
The first woman presented with primary hypothyroidism and likely had thyrotroph
hyperplasia given prompt resolution with thyroxine. The second and third women
were diagnosed with pathological gonadotroph hyperplasia due to primary gonadal
insufficiency, with histopathological confirmation including gonadal-deficiency
cells in the third case where surgery could have been avoided. The fourth woman
likely had idiopathic PH, though she had concomitant polycystic ovary syndrome
which is a debated cause of PH. Patients suspected of PH should undergo
comprehensive hormonal, radiological and sometimes ophthalmological evaluation.
This is best conducted by a specialised multidisciplinary team with preference
for treatment of underlying conditions and close monitoring over surgical
intervention. LEARNING POINTS: Normal pituitary dimensions are influenced by age
and gender with the greatest pituitary heights seen in young adults and
perimenopausal women.Pituitary enlargement may be seen in the settings of
pregnancy, end-organ insufficiency with loss of negative feedback, and excess
trophic hormone from the hypothalamus or neuroendocrine tumours.PH may be caused
or exacerbated by medications including oestrogen, GNRH analogues and
antipsychotics.Management involves identification of cases of idiopathic PH
suitable for simple surveillance and reversal of pathological or iatrogenic
causes where they exist.Surgery should be avoided in PH as it rarely progresses.