Dome-shaped pituitary enlargement in primary hypothyroidism / Journal of the ASEAN Federation of Endocrine Societies

@#We describe three cases of primary hypothyroidism which presented initially to neurosurgery department with pituitary hyperplasia. We have found a novel pattern of ‘dome-shaped’ enlargement of pituitary in MRI of these patients. Out of these 3 patients, in two of them, the planned surgery was deferred when endocrinologists were consulted and the pituitary hyperplasia completely resolved with levothyroxine treatment. In the third case, pituitary surgery was already performed before endocrinology consultation and histopathology revealed thyrotroph hyperplasia. The hyperplastic lesions described typically have a homogenous symmetrical ‘dome’ shaped architecture unlike the non-functioning pituitary adenoma (NFPA), which usually might often be of varying shapes and homogeneity. Analysis of pituitary images from similar case reports published in literature, also showed this typical ‘dome’ shaped pituitary enlargement. This imaging characteristic can be a clue to look for underlying hormone deficiency, especially in primary hypothyroidism. Therefore, a thorough endocrine evaluation especially looking for primary hypothyroidism in such dome-shaped pituitary lesions are mandatory to prevent unwarranted neuro-surgical intervention as treatment of primary hypothyroidism may result in resolution of the abnormal enlargement.

Identification of Ganglion cyst causing suprascapular nerve neuropathy by high resolution neurosonography

Suprascapular neuropathy is a rare cause of non-specific shoulder pain affecting all age groups. Magnetic resonance imaging is the most common modality utilized to investigate the cause of suprascapular neuropathy. We report here a case of 22 year old man who presented with diffuse right shoulder region pain and severe wasting of the right infraspinatus muscle of 2 months duration. He was engaged in regular overhead activities at a gymnasium for about 2 years. A possible diagnosis of suprascapular nerve entrapment was considered. The patient was investigated with high resolution neurosonography, which showed a ganglion (paralabral) cyst at the spinoglenoid notch compressing the suprascapular nerve. We propose the use of neurosonography as an economical and effective tool for initial screening of non-specific shoulder pain with or without wasting/weakness of scapular muscles. An early identification of the cause of the neuropathy prior to the onset of muscle weakness/ wasting, and therapeutic intervention is able to avoid permanent disability