TARGET GLAND INSUFFICIENCY AND PITUITARY TUMOURS

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Abstract
Three patients with pituitary tumours are described. The first is a patient with myxoedema who 28 years ago was treated for thyrotoxicosis with irradiation of the thyroid gland. It is the author's opinion that the long-standing hypothyroidism may have induced a hypersecretion of TSH and secondary hyperplasia of the pituitary gland which resulted in an enlargement of the sella. The second patient presented signs of a pituitary tumour with a compression of the chiasma and hypofunction of the thyroid and gonads. One year previously she had a febrile disease diagnosed as morbili. After she was treated with substitution therapy with thyroid hormones there was an improvement in her condition, with disappearance of the ocular signs of the glandular insufficiency. It is assumed that this patient developed a primary hypothyroidism due to thyroiditis which probably induced a mucopolysaccharide infiltration around the pituitary gland. This infiltration in turn resulted in the rapid enlargement of the sella and signs of compression of the optic chiasma. Thyroid therapy probably caused disappearance of the mucopolysaccharides infiltration with a consequent return of the ocular signs to normal. The sella remained enlarged. The third patient also presented an enlarged sella. The pituitary gland produced high levels of gonadotrophins, but the levels of GH, ACTH and TSH were normal. The patient had premature ovarian failure. In this case the tumour was discovered when the patient was still menstruating. This tumour seems to be of a dependent type since oestrogen therapy induced inhibition of the high levels of gonadotrophins. It is suggested that the prolonged subnormal levels of oestrogens stimulated the development of the pituitary tumour. The relation between the target gland insufficiency and the development of the pituitary tumours is discussed.

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