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Key Clinical Message: Prompt and precise diagnosis of pituitary hyperplasia secondary to primary hypothyroidism (PHPH) is crucial to avoid unwarranted pituitary surgery and potential permanent impairment. Although PHPH may present similarly to pituitary adenoma, it is responsive to thyroxine therapy, underscoring the critical role of differential diagnosis in the treatment of adolescent patients. [ABSTRACT FROM AUTHOR]

Pituitary hyperplasia due to hypothyroidism can be treated medically. This condition should not be mistaken for adenoma and surgery should be avoided. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 15.3-year-old female with late-onset Van Wyk Grumbach syndrome, characterized by severe hypothyroidism, hyperprolactinemia, and multicystic ovaries. Topics discussed include the complex hormonal interaction in VWG syndrome pathogenesis and the importance of re-evaluation after levothyroxine treatment to avoid unnecessary tests and surgical interventions.

Aim To investigate the different characteristics of girls with pituitary hyperplasia secondary to primary hypothyroidism ( PPH), with and without sexual precocity. Methods Pituitary hyperplasia secondary to primary hypothyroidism girls were divided into two groups: group A, with sexual precocity (n = 8), and group B, without sexual precocity (n = 14). The following values were measured before and after 3 months levothyroxine therapy: free triiodothyronine ( FT3), free thyroxine ( FT4), thyrotropin ( TSH), follicle-stimulating hormone ( FSH), luteinising hormone ( LH), prolactin ( PRL), estradiol (E2), testosterone (T), pituitary height, uterine volume ( UV), ovarian volume ( OV) and follicular diameter ( FD). Results Thyrotropin, FSH, PRL, E2, T, pituitary height, UV, OV and FD were higher in group A than group B (all p < 0.05); FT3, FT4 and LH levels were not different (all p > 0.05). In all of the PPH girls, pituitary height was correlated with FT3, FT4 and PRL (r = −0.545, p = 0.009, r = −0.567, p = 0.006 and r = 0.666, p = 0.001, respectively). PRL was positively correlated with UV, FD and FSH (r = 0.581, p = 0.005, r = 0.482, p = 0.031 and r = 0.667, p = 0.001, respectively), and FSH was positively correlated with OV (r = 0.522, p = 0.013). These abnormalities regressed after therapy. Conclusion Pituitary hyperplasia secondary to primary hypothyroidism girls with sexual precocity have increased plasma TSH, FSH, PRL, E2 and T levels, pituitary height and uterine, ovarian and follicular size. [ABSTRACT FROM AUTHOR]

Severe primary hypothyroidism should be considered in the differential diagnosis of pituitary enlargement. Thyroid hormone replacement therapy should lead to regression of pituitary hyperplasia. [ABSTRACT FROM AUTHOR]

Pituitary hyperplasia consequent to untreated primary hypothyroidism undergoes impressive regression following thyroxine therapy. We describe a young man with primary hypothyroidism and pituitary hyperplasia, who showed significant but incomplete regression of pituitary enlargement despite 18 months of L-thyroxine therapy (1 year in replacement dose (150 μg/day) and an additional 6 months in suppressive dose (300 μg/day)). [ABSTRACT FROM AUTHOR]