Article Text

CLINICAL CASE OF SECONDARY HYPOTHYROIDISM AND HYPOOVARISM
  1. D Despotova1,
  2. M I Lilova1,
  3. G C Popova1,
  4. V Kenderova1,
  5. D N Hristova1,
  6. E A Lazarova1,
  7. K Grozdeva1,
  8. P Petrova1
  1. 1Pediatric Department, Tokuda Hospital, Sofia, Bulgaria

Abstract

The autoimmune condition hypophysitis is a rare disease, affecting 0.0002% to 0.005% of the population. It is often diagnosed through exclusion of other diseases and should be considered in the differential diagnoses of every non-secreting pituitary formation.

We present the case of a 17-year-old girl with 6-months duration of amenorrhea and thyromegaly. Positive antithyroid antibodies were established. The thyroid hormone status and the TRH test have proven secondary hypothyroidism. The investigation of sex hormones established secondary hypoovarism. TSH 0.381 (0.35–5.5) IU/ml, FT4 11.15 (11.5–23.5) pmol/l, LH 0.25 (1–20) mU/ml, FSH 1.58 (2–22) mU/ml, E2 36 (39–241) pmol/l. TRH test with 200 mcg i.v. gave the following results: TSH at 0 min, 0.699; 30 min, 5.079; 60 min, 3.68 (normal 0.35–4.5) mU/l.

MRI of the hypothalamic-hypophyseal tract visualized a pico adenoma, 3 mm in size, in the region of adenohypophysis. Because of the small size of the pituitary formation, we consider that it is unlikely to be the cause of the pituitary dysfunction. This increases the possibility for autoimmune hypophysitis.

There are no literature data for investigation of large patient groups, as well as knowledge on diagnostic procedures, therapy and management. The present experience is based on reports on separate cases and we consider that our case can contribute to it.

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