Abstract:
BACKGROUND:Primary hypothyroidism can cause both hyperprolactinemia and pituitary hyperplasia. The degree of hyperprolactinemia is generally modest, and rarely do prolactin concentrations exceed 100 ng/mL (4.34 nmol/L). This combination of hyperprolactinemia and pituitary gland enlargement might raise suspicion for a prolactinoma or a nonfunctioning adenoma limiting the ability of hypothalamic dopamine to inhibit prolactin production, the so-called "stalk effect." CASE DESCRIPTION:We describe a 30-year-old female with headaches, galactorrhea, and hyperprolactinemia with a presumptive diagnosis of a prolactinoma. She had hypothyroidism after treatment of Graves disease at age 17 years but was noncompliant with levothyroxine replacement. Thyroid-stimulating hormone (TSH) was 263 mIU/L, FT4 was 3.01 pmol/L, and prolactin was 323 ng/mL (14.06 nmol/L). Magnetic resonance imaging (MRI) demonstrated increased volume of the pituitary gland with homogeneous enhancement with gadolinium. Levothyroxine treatment for 2 weeks decreased her TSH to130 mIU/L, but her total prolactin remained elevated at 386 ng/mL (16.78 nmol/L). Further testing identified that 76% of the total prolactin was macroprolactin. CONCLUSIONS:Primary hypothyroidism can cause hyperprolactinemia, and prolonged disease may lead to pituitary hyperplasia. However, a marked elevation of prolactin should raise suspicion to investigate additional etiologies for hyperprolactinemia. Our case exemplifies a dual etiology for hyperprolactinemia and pituitary hyperplasia caused by both hypothyroidism and macroprolactin. This knowledge is invaluable for clinicians to avoid unnecessary management with dopamine agonists and/or surgery. This patient's prolactin was 323 ng/mL (14.06 nmol/L). Before our case, the highest prolactin in a hypothyroid patient reported in the literature was 253 ng/mL (11.0 nmol/L).
journal_name
World Neurosurgjournal_title
World neurosurgeryauthors
Khorassanizadeh R,Sundaresh V,Levine SNdoi
10.1016/j.wneu.2016.04.103subject
Has Abstractpub_date
2016-07-01 00:00:00pages
675.e11-4eissn
1878-8750issn
1878-8769pii
S1878-8750(16)30232-7journal_volume
91pub_type
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journal_title:World neurosurgery
pub_type: 杂志文章,评审
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abstract:OBJECTIVE:Postoperative infection is a potentially dramatic consequence in endoscopic endonasal surgery. The aim of this study was to assess the efficacy of our intraoperative antibiotic prophylaxis by analyzing the risk factors of postoperative meningitis in our series. METHODS:Each endoscopic endonasal procedure per...
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pub_type: 杂志文章,多中心研究
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abstract::Basilar bifurcation is a challenging site for aneurysm clipping. Anatomical factors such as size and projection of the aneurysm, distance between the aneurysm neck and the dorsum sellae, and location of the basilar bifurcation contribute to surgical complexity. Endovascular treatment has been used more frequently than...
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doi:10.1016/j.wneu.2018.12.093
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abstract:BACKGROUND:Gliomatosis cerebri (GC) is a fatal diffusely infiltrating glioma. Because of its rarity, only scarce evidence is available regarding outcome predictors and the proper management of GC. METHODS:Reported studies of patients with histologically confirmed GC were systematically reviewed and individual patient-...
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pub_type: 杂志文章,meta分析
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abstract:BACKGROUND:Most sellar gangliocytomas are discovered with a concurrent pituitary adenoma, also known as a mixed gangliocytoma-adenoma (MGA). MGAs are rare, with fewer than 100 cases reported in the literature to date and only 1 previously documented surgical series. Because MGAs are radiologically indistinguishable fro...
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pub_type: 杂志文章
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abstract:BACKGROUND:The rationale of only fixation without any kind of bone, ligament, disc, or osteophyte decompression as a treatment for single- or multiple-level cervical spinal degeneration was analyzed. The concept was based on the understanding that muscle weakness-related spinal instability is the cause of spinal degene...
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abstract:BACKGROUND:Microscopic training is essential for development of neurosurgical skills. A range of models is reported in the literature for this purpose, including live animals, exvivo, and synthetic material. Among the factors involved in selection and development of a training station, cost is a decisive one. METHODS:...
journal_title:World neurosurgery
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更新日期:2010-12-01 00:00:00
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更新日期:2019-05-01 00:00:00
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doi:10.1016/j.wneu.2018.02.179
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pub_type: 杂志文章,meta分析
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更新日期:2019-07-01 00:00:00
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pub_type: 杂志文章
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更新日期:2012-02-01 00:00:00
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