THU226 Pituitary Hyperplasia With Optic Chiasm Compression Secondary To Levothyroxine Non-adherence In An Adolescent Patient
Bibliographic record
Abstract
Abstract Disclosure: C. Hawco: None. L. Bursztyn: None. P. Gallego: None. S. Van Uum: None. Background: Pituitary hyperplasia is a rare complication of primary hypothyroidism in pediatric patients. There have been multiple reports of unnecessary surgical procedures for this medically treatable condition. Clinical Case: A 16-year-old female was referred for pituitary enlargement. She had presented to a community hospital following an unwitnessed syncopal event, complicated by retrograde amnesia and headache. At the age of 2 she was diagnosed with primary hypothyroidism during work up for similar syncopal episodes. Past medical and developmental history was otherwise non-contributory. She had a long-standing history of medication non-compliance, and had not taken Levothyroxine during the previous 11 months. On her presentation to hospital, a CT scan revealed pituitary enlargement with a hypodensity suspicious for hemorrhage. Pituitary panel was significant for TSH greater than 1000 (0.51-4.30) mIU/L, free T4 of 4 (13-21) pmol/L and Prolactin 98 ng/mL (<25) ng/mL. She was subsequently transferred to our tertiary care pediatric hospital for admission and ongoing care. An MRI of the sella identified a 1.0 x 2.3 x 1.7 cm pituitary mass with suprasellar extension and mass effect on the optic chiasm and nerves. There was no associated hemorrhage. The thyroid gland was diffusely enlarged. Visual acuity was 20/60 in both eyes at the time of hospital admission, compared to 20/20 the previous week at her optometrist. Formal visual field testing was abnormal, but unreliable with no clear defects. She was initiated on Levothyroxine 100 mcg daily and closely monitored for adherence and symptom resolution. After two months on this dose, repeat MRI sella showed a decrease of the pituitary mass to 0.8 x 2.1 x 1.0 cm in size, consistent with a diagnosis of pituitary hyperplasia secondary to untreated primary hypothyroidism. After treatment for 3 months, her visual acuity returned to 20/20 in both eyes with normal visual fields. With ongoing adherence to medical therapy, she remained clinically euthyroid with further decrease in her pituitary size, and normalization of both thyroid indices and prolactin[SV1]. Conclusion: This case is a rare presentation of pituitary hyperplasia in the setting of treatment nonadherence in primary hypothyroidism. It emphasizes the importance of monitoring for signs and symptoms of pituitary enlargement when low or non-adherence for levothyroxine treatment is suspected. The resolution of pituitary enlargement with Levothyroxine treatment also reinforces that this condition is best managed medically, avoiding unnecessary surgical procedures. Reference: (1) Sapkota, S., Karn, M., Sapkota, S. Pituitary hyperplasia in childhood primary hypothyroidism: a review. Childs Nerv Syst. 2021;37;749-762. [SV1] Presentation: Thursday, June 15, 2023
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".