Intermittent fasting has become an increasingly popular strategy in losing weight and associated reduction in obesity-related medical complications. Overwhelming studies support metabolic improvements from intermittent fasting in blood glucose levels, cardiac and brain function, and other health benefits, in addition to weight loss. However, concerns have also been raised on side effects including muscle loss, ketosis, and electrolyte imbalance. Of particular concern, the effect of intermittent fasting on hormonal circadian rhythms has received little attention. Given the known importance of circadian hormonal changes to normal physiology, potential detrimental effects by dysregulation of hormonal changes deserve careful discussions. In this review, we describe the changes in circadian rhythms of hormones caused by intermittent fasting. We covered major hormones commonly pathophysiologically involved in clinical endocrinology, including insulin, thyroid hormones, and glucocorticoids. Given that intermittent fasting could alter both the level and frequency of hormone secretion, decisions on practicing intermittent fasting should take more considerations on potential detrimental consequences versus beneficial effects pertaining to individual health conditions.
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Pituitary hyperplasia associated with untreated primary hypothyroidism in children is a rare condition. There are only a few reports on this condition in children, and especially when pituitary hyperplasia is accompanied with Hashimoto thyroiditis and growth arrest. Here, we describe an unusual association of pituitary hyperplasia with hypothyroidism and growth retardation, and this was all caused by Hashimoto thyroiditis. Hormonal testing showed a low thyroxine level and a high thyroid stimulating hormone level, elevated anti-thyroglobulin, low growth hormone levels and prepubertal levels of gonadotropins. A large intrasellar mass expanding beyond the sella turcica was detected on magnetic resonance imaging (MRI). Homogeneous contrast enhancement of mass highly suggested that it was a pituitary hyperplasia rather than a pituitary tumor. Therapy with L-thyroxine resulted in rapid improvement of the clinical signs, including renewed growth, normalization of the hormone levels and resolution of the pituitary hyperplasia on MRI within 90 days. In children, prolonged unrecognized primary hypothyroidism might be accompanied by growth deficiency and pubertal disharmony. Physicians must be aware of pituitary hyperplasia in these cases.
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