ESPE Abstracts (2021) 94 P2-389

ESPE2021 ePoster Category 2 Pituitary, neuroendocrinology and puberty (48 abstracts)

Atypical Presentation of Pituitary Macroadenoma in an adolescent girl: Central Hypothyroidism and Attenuated Pubertal Growth Spurt.

Nada Alaaraj , Ashraf Soliman , Noor Hamed & Shayma Ahmed

Hamad General Hospital, Doha, Qatar

Introduction: Hyperprolactinemia (HPrl) secondary to macroadenoma is a rare endocrinopathy in childhood but represents one of the most frequent forms of pituitary adenoma.

Case report: A 12yr old girl was referred for assessment of progressive weight gain in the last 1.5 years. Despite trials of weight control by changing the dietary habit and daily exercise weight her BMI SDS increased from 1.2 to 2.2. This was associated with progressive fatigability and a decrease of her HtSDS from 0 to -1.2). There was no history of headache, visual deficit, nausea or vomiting, change in school performance or sleeping pattern, heat/cold intolerance, galactorrhea, polyurea, or polydipsia. She was born at term with a normal birth weight (3kg). Physical examination revealed normal vital signs and BP for age. She had HtSDS = - 1.2, BMI SDS = 2.2, Mid-parental Height SDS = - 0.17 and annual growth velocity = 3cm/year (-2SD). Her breast and pubic hair were at Tanner stage 3. She had normal neurological exams and normal eye movements with a normal visual field. Lab tests showed Low FT4 and relatively low TSH twice (12.6 and 9.2 pmol/l, TSH = 1.1 and 1.2 mIU/L respectively). Her peak growth hormone after clonidine provocation was 4.43mcg/l. The bone age was 13 years. Pituitary MRI showed: a well-defined intra and suprasellar mass lesion measuring about 2.2 x 1.7 cm seen at the left lateral and paramedian aspect of the pituitary gland, extending to the left cavernous sinus and encasing the cavernous ICA completely. The pituitary infundibulum deviated to the right side. The mass lesion was effacing the suprasellar cisterna and indenting the inferior aspect of the optic chiasm. The girl was started on levothyroxine and Cabergoline therapy. A trial of Growth hormone therapy was started then on hold after raised in IGF-1 to +2SD.

TSH (N:0.5- 4.3mIU/L)*0.78
FT4 (N:12.9-20.6pmol/l)12.6 (L)12.1 (L)159.2 (L)
Cortisol (Am)233
ACTH (Am)35
Prolactin (mIU/l)56,487 (= 2655 ng/l)
Serum osmolality288
Urine osmolality795
*On Levothyroxine 50mcg and therapy hold for 1 week, ** on GH 0.05mg/kg/day

Conclusion: Attenuation of a pubertal growth spurt and pubertal progression and central hypothyroidism could be the presenting manifestations of pituitary macroadenoma in adolescents even without neuro-ophthalmic signs or galactorrhea.

Volume 94

59th Annual ESPE (ESPE 2021 Online)

22 Sep 2021 - 26 Sep 2021

European Society for Paediatric Endocrinology 

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