Abstract
The association between precocious puberty (PP) and primary hypothyroidism (PH) is known, but although an enlarged sella may be seen, a pituitary tumour has not been reported in this syndrome. A 5 year old girl presented with vaginal bleeding, and multicystic ovaries were detected by sonography. PH was found with markedly elevated TSH (1500 IU/l), decreased T4, (22 nmol/l) and T3 (0.85 nmol/l), in spite of few clinical signs of hypothyroidism. Serum FSH (5.5 IE/l), LH(0.4 IE/l), and prolactin (PRL) (150 μg/l) were compatible with central PP. The response to LHRH (50 μg/m2 i.v.) showed no significant increases. A cerebral CT scan revealed a large intra- and suprasellar tumour without signs of raised intracranial pressure. Two months of thyroxine therapy was followed by normalization of thyroid hormones, TSH, PRL, FSH and the ovarian sex steroids, and the pituitary tumour was markedly regressed. A repeated LHRH test showed now a significant increase in FSH and LH.
Increased endogenous TRH or the hyperprolactinemia itself may have caused PP in this patient whereas LHRH does not seem to be involved. The tumour may be an adenoma consisting of TSH, PRL and FSH secreting cells. A remarkable feature was the advanced stage of estrogenization at debut without overt clinical hypothyroidism.
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Krabbe, S. PRECOCIOUS PUBERTY AND PITUITARY TUMOUR IN PRIMARY HYPOTHYROIDISM. EFFECT OF THYROXINE AND IMPLICATIONS FOR THE PATHOGENESIS. Pediatr Res 20, 1198 (1986). https://doi.org/10.1203/00006450-198611000-00150
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DOI: https://doi.org/10.1203/00006450-198611000-00150