Гиперплазия гипофиза у девочки с первичным гипотиреозом, обусловленным аутоиммунным тиреоидитом. Клиническое наблюдение: ЗАМЕТКИ ИЗ ПРАКТИКИ

Алексей Сергеевич  Оленев; Людмила Викторовна  Тыртова; Наталия Васильевна  Паршина; Дарья Александровна  Тыртова; Мария Михайловна  Смирнова; Тимофей Александрович  Александров; Виктория Ильинична  Шалыт; Кристина Владимировна  Скобелева

doi:10.56871/

Pituitary hyperplasia in a girl with primary hypothyroidism caused by autoimmune thyroiditis. A clinical observation

PRACTICAL NOTES

Aleksey S. Olenev Saint Petersburg State Pediatric Medical University https://orcid.org/0000-0003-3289-4400
Ludmila V. Tyrtova Saint Petersburg State Pediatric Medical University https://orcid.org/0000-0003-4417-1373
Natalia V. Parshina Saint Petersburg State Pediatric Medical University https://orcid.org/0009-0007-4212-1571
Daria A. Tyrtova Saint Petersburg State Pediatric Medical University https://orcid.org/0009-0002-8947-5012
Maria M. Smirnova Saint Petersburg State Pediatric Medical University https://orcid.org/0009-0003-9729-3275
Timofey A. Alexandrov Saint Petersburg State Pediatric Medical University https://orcid.org/0009-0000-4517-0204
Victoria I. Shalyt Saint Petersburg State Pediatric Medical University https://orcid.org/0009-0009-9026-3640
Kristina V. Skobeleva Saint Petersburg State Pediatric Medical University https://orcid.org/0000-0001-9790-3633

Keywords:

primary hypothyroidism autoimmune thyroiditis pituitary hyperplasia polyendocrine syndrome первичный гипотиреоз аутоиммунный тиреоидит гиперплазия гипофиза полиэндокринный синдром

Abstract

Introduction.Autoimmune thyroiditis is one of the main causes of acquired primary hypothyroidism in children. Long-term undiagnosed and untreated primary hypothyroidism can lead to pituitary hyperplasia and be accompanied by hyperprolactinemia and/or precocious puberty in children. Difficulties in the differential diagnosis of pituitary pathological lesions may arise when using modern neuroimaging techniques.The aimof this study is to present a clinical case of compensatory pituitary hyperplasia in primary untreated hypothyroidism associated with autoimmune thyroiditis and autoimmune diabetes mellitus and to substantiate the possibility of developing a polyendocrine autoimmune syndrome.Key points.Thisarticle describes a clinical case of autoimmune thyroiditis with hypothyroidism and the development of compensatory pituitary hyperplasia. Neuroimaging results required differential diagnosis between compensatory pituitary hyperplasia, autoimmune hypophysitis, and other pituitary pathologies. Laboratory findings of stage 2 autoimmune diabetes mellitus suggested the development of autoimmune polyendocrine syndrome type 3A in the girl; however, no additional autoimmune diseases corresponding to this type of autoimmune polyendocrine syndrome were identified dynamically. Normalization of pituitary gland size according to magnetic resonance imaging data during hormone replacement therapy with levothyroxine confirmed the compensatory nature of the hyperplasia, which allowed for the definitive exclusion of other pituitary pathologies. Medication-based compensation for hypothyroidism will subsequently ensure the maintenance of normal pituitary gland size. However, with further progression of suspected autoimmune polyendocrine syndrome type 3A, the possibility of autoimmune hypophysitis with corresponding consequences cannot be ruled out.Conclusion.Timely diagnosis of an autoimmune disease dictates the need for an examination to identify other autoimmune pathological processes that may be in the preclinical stage. Early diagnosis and treatment should help prevent complications. When hypothalamic-pituitary tumors are detected, endocrinological analysis and the results of a comprehensive dynamic examination can help establish cause-and-effect relationships, clarify the nature of structural changes in the pituitary gland, select the optimal treatment strategy, and, in some cases, avoid unnecessary neurosurgical interventions.

Author Biographies

Aleksey S. Olenev, Saint Petersburg State Pediatric Medical University

Cand. Sci. (Med.), Associate Professor, Department of Faculty Pediatrics

Ludmila V. Tyrtova, Saint Petersburg State Pediatric Medical University

Dr. Sci. (Med.), Professor of the Department of Faculty Pediatrics

Natalia V. Parshina, Saint Petersburg State Pediatric Medical University

Cand. Sci. (Med.), Associate Professor of the Department of Faculty Pediatrics

Daria A. Tyrtova, Saint Petersburg State Pediatric Medical University

Pediatric Endocrinologist, Department of Faculty Pediatrics

Maria M. Smirnova, Saint Petersburg State Pediatric Medical University

Cand. Sci. (Med.), Assistant, Department of Faculty Pediatrics

Timofey A. Alexandrov, Saint Petersburg State Pediatric Medical University

Physician,Department of Functional and Radiation Diagnostics

Victoria I. Shalyt, Saint Petersburg State Pediatric Medical University

Physician, Division of Pediatric Endocrinology

Kristina V. Skobeleva, Saint Petersburg State Pediatric Medical University

Cand. Sci. (Med.), Assistant, Department of Propaedeutics of Children’s Diseases; Deputy Chief Physician for Medical Work at the Saint Petersburg State Pediatric Medical University Clinic

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Pituitary hyperplasia in a girl with primary hypothyroidism caused by autoimmune thyroiditis. A clinical observation: PRACTICAL NOTES. (2026). Children’s Medicine of the North-West, 14(2), 242-251. https://doi.org/10.56871/

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Pituitary hyperplasia in a girl with primary hypothyroidism caused by autoimmune thyroiditis. A clinical observation: PRACTICAL NOTES. (2026). Children’s Medicine of the North-West, 14(2), 242-251. https://doi.org/10.56871/

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