title: Pituitary Hyperplasia in a Female Patient with a Severe Childhood Abuse History.
abstract: A 24-year-old Caucasian female patient was referred to our endocrinology service to investigate a structural magnetic resonance imaging (sMRI) finding of "pituitary mass". The first two sMRI were identified as pituitary adenoma but the following two examinations suggested the possibility of pituitary hyperplasia (PH). The patient was referred to our service for diagnostic clarification and therapy due to the divergence in sMRI reports and the surgical procedure indicated by the neurosurgical team of the other institution. The patient had no complaints, laboratory tests were all normal, and the sMRI clearly showed a PH. However, what caught our attention was her behavior. During the interview she was intermittently talking and acting like a child even though her age was 24. She reported being a foster child and was severely mistreated during childhood. Parallel psychiatric evaluation was requested and an association between the PH and the childhood abuse was identified. Early life stress may be associated with accelerated pituitary gland volume development, but there is still a paucity of data in literature about this issue. We should be aware of other cases like this one, and a correct differential diagnosis may contribute to contraindicate transsphenoidal surgery. When a childhood abuse history is present, we recommend admission to a psychiatric facility for adequate treatment.
authors.affiliation: a Endocrinology Section, Medical School and Hospital Universitário Clementino Fraga Filho , Federal University of Rio de Janeiro , Ilha do Fundão, Rio de Janeiro , Brazil.
authors.forename: Andrea Fragoso
authors.initials: AF
authors.lastname: Perozo
authors.affiliation: b Institute of Psychiatry (IPUB) , Federal University of Rio de Janeiro , Rio de Janeiro , Brazil.
authors.forename: Tiago
authors.initials: T
authors.lastname: Figueiredo
authors.affiliation: c Institute of Biomedical Sciences , Federal University of Rio de Janeiro , Ilha do Fundão, Rio de Janeiro , Brazil.
authors.forename: Michelle Botelho
authors.initials: MB
authors.lastname: Caarls
authors.affiliation: b Institute of Psychiatry (IPUB) , Federal University of Rio de Janeiro , Rio de Janeiro , Brazil.
authors.forename: Daniel
authors.identifier: http://orcid.org/0000-0001-8903-5004
authors.initials: D
authors.lastname: Segenreich
authors.affiliation: d Hospital Federal da Lagoa; Endocrinology Section, Medical School and Hospital Universitário Clementino Fraga Filho , Federal University of Rio de Janeiro, Ilha do Fundão , Rio de Janeiro , Brazil.
authors.forename: Leonardo Vieira
authors.initials: LV
authors.lastname: Neto
mesh_terms: D054523:Adult Survivors of Child Abuse; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006965:Hyperplasia; D008279:Magnetic Resonance Imaging; D010902:Pituitary Gland / Q000000981:diagnostic imaging* / Q000473:pathology*; D055815:Young Adult
keywords: Childhood abuse; early trauma; neuroendocrinology; psychiatry; structural magnetic resonance imaging (sMRI)