Abstract
Pituitary thyrotroph hyperplasia, a rare cause of pituitary enlargement, is usually associated with protracted primary hypothyroidism. We present here a case of pituitary thyrotroph hyperplasia in a 51 year old woman who was thought to have a pituitary macroadenoma with suprasellar extension. The cytologic investigation of the intraoperative touch preparation identified hyperplastic thyrotrophs, provided the correct diagnosis and helped to limit further aggressive surgical removal of the lesion, which is known to regress after adequate thyroid hormone replacement therapy. This is the first study to describe the cytologic features of pituitary thyrotroph hyperplasia confirmed subsequently by histology, immunocytochemistry and transmission electron microscopy.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Ahmed M, Banna M, Sakati N, Woodhouse N. Pituitary gland enlargement in primary hypothyroidism: a report of 5 cases with follow-up data Hormone Res 1989;32:188–192.
Atchison JA, Lee PA, Albright AL. Reversible pituitary mass secondary to hypothyroidism. J Amer Med Ass 1989; 262:3175–3177.
Beck-Peccoz P, Brucker-Davis F, Persani L, Smallridge RC, Werntraub BD. Thyrotropin-secreting pituitary tumors. Endocr Rev 1996;17:610–638.
Bilaniuk LT, Moshang T, Cara J, Weingarten MZ, Sutton LN, Samuel LR, Zimmerman RA. Pituitary enlargement mimicking pituitary tumor. J Neurosurg 1985;63:39–42.
Boyce R, Beadles CF. Enlargement of the hypophysis cerebri in myxoedema; with remarks upon hypertrophy of the hypophysis associated with changes in the thyroid body. J Path Bact 1893;1:223–239.
Chan AW, MacFarlane IA, Foy PM, Miles JB. Pituitary enlargement and hyperprolactinemia due to primary hypothyroidism: errors and delays in diagnosis. Br J Neurosurg 1990;4:107–112.
Floyd JL, Dorwart RH, Nelson MJ, Mueller GL, DeVroede M. Pituitary hyperplasia secondary to thyroid failure: CT appearance. AJNR 1984;5:469–471.
Groff TR, Shulkin BL, Utiger RD, Talbert LM. Amenorrhea-galactorrhea, hyperprolactinemia and suprasellar pituitary enlargement as presenting features of primary hypothyroidism. Obstet Gynecol 1984;63:86S–89S.
Heyburn PJ, Gibby OM, Hourihan M, Hall R, Scanlon MF. Primary hypothyroidism presenting as amenorrhoea and galactorrhoea with hyperprolactinaemia and pituitary enlargement. Br Med J 1986;292:1660–1661.
Horvath E, Kovacs K. Fine structural cytology of the adenohypophysis in rat and man. J Electr Micr Techn 1988;8: 401–432.
Horvath E, Kovacs K. The adenohypophysis. In: Kovacs K, Asa SL, eds. Functional Endocrine Pathology. Boston: Blackwell, 1991;245–281.
Horvath E, Lloyd RV, Kovacs K. Propylthiouracyl-induced hypothyroidism results in reversible transdifferentiation of somatotrophs into thyroidectomy cells. Amorphologic study of the rat pituitary including immunoelectron microscopy. Lab Invest 1990;63:511–520.
Horvath E, Scheithauer BW, Kovacs K, Lloyd RV, Regional neuropathology: Hypothalamus and pituitary. In: Graham DI, Lantos PL, eds. Greenfield' Neuropathology. London: Arnold, 6th Edition, 1997;1007–1094.
Hutchins WW, Crues IIIJV, Miya P, Pojunas KW. MR demonstration of pituitary hyperplasia and regression after therapy for hypothyroidism. Am J Neuroradiol 1990;11:410.
Jawadi MH, Ballonoff LB, Stears JC, Katz FH. Primary hypothyroidism and pituitary enlargement. Radiological evidence of pituitary regression. Arch Intern Med 1978;138: 1555–1557.
Khalil A, Kovacs K, Sima AAF, Burrow GN, Horvath E. Pituitary thyrotroph hyperplasia mimicking prolactin-secreting adenoma. J Endocrinol Invest 1984;7:399–404.
Kovacs K, Horvath E. Tumors of the Pituitary gland. Washington DC: Armed Forces Institute of Pathology, 1986.
Langlois MP, Lamenche JB, Bellabarba D. Long-standing goiter and hypothyroidism: An unusual presentation of a TSH-secreting adenoma. Thyroid 1996;6:329–335.
Leiba S, Landau B, Ber A. Target gland insufficiency and pituitary tumours. Acta Endocrinol (Copenh) 1960;60:112–120.
Okuno T, Sudo M, Momoi T, Takao T, Ito M, Konishi Y, Yoshioka M, Susuki J, Nakano Y. Pituitary hyperplasia due to hypothyroidism. J Comp Assist Tomogr 1980;4:600–602.
Pioro EP, Scheithauer BW, Laws JrER, Randall RV, Kovacs KT, Horvath E. Combined thyrotroph and lactotroph cell hyperplasia simulating prolactin-secreting pituitary adenoma in long-standing primary hypothyroidism. Surg Neurol 1988; 29:218–226.
Poretski L, Garber J, Kleefield J. Primary amenorrhea and pseudoprolactinoma in a patient with primary hypothyroidism. Am J Med 1986;81:180–183.
Samaan NA, Osborne BM, MacKay B, Leavens ME, Duello TM, Halmi NS. Endocrine and morphologic studies of pituitary adenomas secondary to primary hypothyroidism. J Clin Endocrinol Metab 1977;45:903–911.
Scheithauer BW, Kovacs K, Randall RV, Ryan N. Pituitary gland in hypothyroidism. Histologic and immunocytologic study. Arch Pathol Lab Med 1985;109:499–504.
Silver BJ, Kyner JL, Dick AR, Chang CHJ. Primary hypothyroidism. Suprasellar pituitary enlargement and regression on computed tomographic scanning. J Amer Med Ass 1981;246:364–365.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Alkhani, A.M., Cusimano, M., Kovacs, K. et al. Cytology of Pituitary Thyrotroph Hyperplasia in Protracted Primary Hypothyroidism. Pituitary 1, 291–295 (1999). https://doi.org/10.1023/A:1009966812195
Issue Date:
DOI: https://doi.org/10.1023/A:1009966812195