Article Sidebar
Main Article Content
Abstract
Background: Non-functioning pituitary adenomas (NFPAs) present variable clinical manifestations depending on tumor size and location. Concurrent primary autoimmune thyroid disease in NFPA patients is exceptionally rare and requires careful diagnostic distinction from secondary hypothyroidism.
Case presentation: A 40-year-old female presented with progressive bilateral peripheral vision narrowing over 3 months, chronic bifrontal headaches, secondary amenorrhea, and nocturia-predominant polyuria. Neuro-ophthalmologic examination revealed bitemporal hemianopsia with visual acuity 20/200 left eye and 20/25 right eye. Endocrine evaluation demonstrated: primary hyperthyroidism (TSH 0.02 µIU/mL, FT4 28.32 pmol/L, positive thyroid receptor antibodies), secondary adrenal insufficiency (cortisol 1 µg/dL, ACTH <5 pg/mL), and hypogonadotropic hypogonadism (LH 1.62 IU/L). Neuroimaging revealed a 2.13 × 2.28 × 3.05 cm sellar/suprasellar lesion with optic chiasm compression (Knosp Grade II). Endoscopic transsphenoidal surgery achieved complete gross total resection. Histopathology confirmed null-cell adenoma with low Ki-67 proliferation index (2%).
Conclusion: Postoperative course was uncomplicated with rapid visual field improvement, complete resolution of bitemporal hemianopsia by 2 weeks, and normalization of all endocrine axes by 12 weeks, including menstrual recovery and gonadal axis restoration. This case illustrates the diagnostic challenge of distinguishing secondary hyperprolactinemia from primary prolactinoma in NFPA, the rarity of concurrent Graves' disease with pituitary macroadenoma, and favorable outcomes with complete surgical decompression achieving multisystem endocrine recovery.
Keywords
Article Details
As our aim is to disseminate original research article, hence the publishing right is a necessary one. The publishing right is needed in order to reach the agreement between the author and publisher. As the journal is fully open access, the authors will sign an exclusive license agreement.
The authors have the right to:
- Share their article in the same ways permitted to third parties under the relevant user license.
- Retain copyright, patent, trademark and other intellectual property rights including research data.
- Proper attribution and credit for the published work.
For the open access article, the publisher is granted to the following right.
- The non-exclusive right to publish the article and grant right to others.
- For the published article, the publisher applied for the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
