ESPE Abstracts

Introduction: Prolonged evolution of an untreated hypothyroidism can lead to thyrotropic cell hyperplasia, which could be indistinguishable from a pituitary macroadnoma on resonance. Differential diagnosis is very important since it allows to avoid aggressive therapeutic behaviors.

Case report: We show a 3-year-old girl who, in the context of a study due to psychomotor retardation, borderline head circumference and coarse features, presented in magnetic resonance an enlarged adenohypophysis (10.8 mm) and bent, which compressed neurohypophysis, and TSH of 2021.9 mU/l. She had insomnia, but no fatigue, visual disturbances, or headache. Parents had not noticed growth disturbance. She received laxatives for constipation. Her mother had two abortions and his uncle had type 1 diabetes. She showed microcephaly from 20 weeks of pregnancy with karyotype and aneuploidies in amniotic fluid normal, and magnetic resonance imaging and brain ultrasound at birth normal. No heel test was performed. Anthropometry at birth was normal. On examination she had a short stature (-2.75 SD), wide forehead and nose, and hypertelorism. Thyroid scintigraphy was performed, which is normal, and thyroid ultrasound showed pseudonodules and heterogeneous echogenicity. She showed Thyroxine 0.23 ng/dl, thyroglobulin 0.5 ng/ml, Ac Anti Thyroglobulin 1668.50 U/ml and Ac Anti TPO (microsomal) 2028.00 U/ml. Rest of pituitary hormonal axes, celiac disease and arrays were normal. She started treatment with levothyroxine 50 mg/day, with normalization of TSH and T4 in 2 months. Parents referred that she slept well, she did not need laxatives, and psychomotor development had greatly improved since she started levothyroxine treatment. As for the stature, she showed -1.82 SD and growth velocity with P> 99 (6.03 SD) at one year of treatment.

Conclusion: In conclusion, this case recalls the importance of a baseline study of all hormonal axes in any tumor of selar origin that excludes non-surgical causes.