Massive pleural and pericardial effusion due to hypothyroidism in a patient with a surgically treated thyroid-stimulating hormone-producing pituitary adenoma

OBJECTIVEThyroid-stimulating hormone (TSH)–secreting pituitary adenoma (TSHoma) is a rare type of pituitary adenoma; thus, little is known about TSHomas. The purpose of this study was to analyze clinical characteristics and therapeutic outcomes of TSHomas based on a single-center experience. The authors also searched for reliable preoperative and early postoperative factors that could predict long-term endocrinological remission.METHODSThe clinical, radiological, and pathological characteristics and surgical and endocrinological outcomes of 31 consecutive cases of TSHomas that were surgically treated between 2005 and 2017 were reviewed retrospectively. Preoperative factors were evaluated for their ability to predict long-term remission by comparing remission and nonremission groups. TSH and free thyroxine levels were measured at 2, 6, 12, 18, and 24 hours after surgery to determine whether they could predict long-term remission.RESULTSGross-total removal of tumor was achieved in 28 patients (90.3%), and 26 patients (83.9%) achieved endocrinological remission by surgery alone based on long-term endocrinological follow-up (median 50 months, range 32–81 months). The majority of the tumors were solid (21/31, 67.7%), and en bloc resection was possible in 16 patients (51.6%). Larger tumor size and tumor invasion into cavernous sinus and sphenoid sinus were strong predictors of lower rates of endocrinological remission. Immediate postoperative TSH level at 12 hours after surgery was the strongest predictor, with a 0.62 μIU/mL cutoff. Postoperative complications included CSF rhinorrhea in one patient and epistaxis in another patient, who underwent additional surgical treatment for the complications.CONCLUSIONSTumor size and extent are major prognostic factors for both extent of resection and endocrinological remission. The consistency of TSHomas was more likely to be solid, which makes extracapsular dissection more feasible. Long-term remission of TSHomas could be predicted even during the early postoperative period.

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TSH, GH, and Prolactin Producing Pituitary Adenoma: An Unusual Case Presentation

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.1256 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A616-A616

Author(s):

Helard Andres Manrique ◽

Miguel Eduardo Pinto

Keyword(s):

Pituitary Adenoma ◽

Brain Mri ◽

Cell Lineage ◽

Pituitary Tumors ◽

Thyroid Stimulating Hormone ◽

Fertility Treatment ◽

Free T4 ◽

Somatomedin C ◽

Operative Findings ◽

Stimulating Hormone

Abstract Background: Pituitary adenomas are benign and frequent tumors, some of them with tendency to be recurrent or invasive e. several pituitary tumors are positive for secretion of one or more hormones of the same adenohypophysial cell lineage. However, some cases have a subclinical course and are underestimated because they have plurihormonal secretion of different adenohypophyseal cells lineage. Clinical Case: A 38 years old women with chronic headaches, who is in fertility treatment for 12 month ago presents to the clinic with unremarkable physical examination. Her laboratory studies include: Normal campimetry. T3 (triiodothyronine) 2.15 ng/m L (NR:0.8 - 2.0), TSH (thyroid stimulating hormone) 4.4 uU/mL (NR:0.27 - 4.2), T4 (tetraiodothyronine) 13.54 ug/dl, (NR:5.1 - 14.1), Free T4 2.44 ng/d (NR:0.93 - 1.7), Estradiol 60.2 pg/ml, FSH (Follicle stimulating hormone) 4.3 mUI/ml (NR:1,7-12), Cortisol (?8 am) 9.29 ug/dl (NR:4.2 - 38.4), ACTH (Corticotrophin-releasing hormone) 13.1 pg/ml (NR: 0.0 - 46.0), Somatomedin C (IGF-1) 231 .0 ng/ml (NR for age?: 57.0-241.0). Brain MRI with pituitary protocol showed in T1 an isointense lesion and slightly heterogeneous in T2 in the anterior and left aspect of the turkish saddle, of 1 x 1.1 x 1.1 cm of anteroposterior, transverse and cephalocaudal diameter, suggestive of a macroadenoma. The tumor pathology showed, possitive for a pituitary adenoma. Immunohistochemistry results were negative for: ACTH:, positive for GH, TSH: (+++) and for Prolactin:. Her post-operative findings showed a residual pituitary gland without significant findings. Her post operative pituitary axis include: Sodium 139.2 mmol/l (NR”135.0 - 145.0), Chloride 100.8 mmol/l (NR95.0 - 115.0), Potassium 3.71 mmol/l (NR3.5 - 5.1), ACTH 4.1 pg/ml(NR0.0 - 46.0), Cortisol (am) 11.11 ug/dl (NR4.2 - 38.4), Estradiol 106.5 pg/ml, FSH 5.1 mUI/ml, LH (Luteinizing Hormone) 13.53 mIU/ml, Somatomedin C (IGF-1) 134 .0 ng/m, Free T32.4 pg/ml, TSH 0.9 uU/mL Free T4 0.99 ng/dl, and Prolactin 23.4ng/ml. Patient had a satisfactory clinical course after surgery, she maintained normal pituitary function without requirement of hormonal replacement therapy. Conclusion: We present a a prolactin, TSH and GH secreting pituitary adenoma case, which is very unusual. It i is important to make a proper pituitary evaluation, and offer effective treatment to prevent complications

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Case Report: A Case of Pituitary Adenoma Producing Growth Hormone and Thyroid-Stimulating Hormone Simultaneously

Frontiers in Endocrinology ◽

10.3389/fendo.2021.659076 ◽

2021 ◽

Vol 12 ◽

Author(s):

Junpei Sanada ◽

Fuminori Tatsumi ◽

Shinji Kamei ◽

Yoshiro Fushimi ◽

Masashi Shimoda ◽

...

Keyword(s):

Growth Hormone ◽

Pituitary Adenoma ◽

Thyroid Function ◽

Tumor Resection ◽

Brain Magnetic Resonance Imaging ◽

Thyroid Stimulating Hormone ◽

Clinical Findings ◽

Additional Treatment ◽

Pituitary Fossa ◽

Stimulating Hormone

BackgroundPituitary adenoma producing growth hormone (GH) or thyroid-stimulating hormone (TSH) is characterized by various specific symptoms and/or findings. However, the frequency of pituitary adenoma producing both hormones is relatively low. In this report, we show a case of pituitary adenoma producing both GH and TSH simultaneously.Case presentationA 27-year-old woman was diagnosed as acromegaly based on various symptoms and clinical findings. For further examination and treatment, she was hospitalized in our institution. It was likely that this subject had pituitary adenoma producing both GH and TSH. In brain magnetic resonance imaging, there was a giant tumor around pituitary fossa. After the diagnosis of GH- and TSH-producing pituitary adenoma, pituitary tumor resection and cyber knife therapy were performed. In addition, we started additional treatment with somatostatin analog and GH receptor antagonist. After then, GH and insulin-like growth factor (IGF-1) levels were suppressed. After the operation, since thyroid function was not sufficiently suppressed, we started anti-thyroid drug thiamazole. After then, thyroid function was normalized and we stopped thiamazole. In GH and TSH staining, many GH-positive and TSH-positive cells were observed. These findings further confirmed our diagnosis that the pituitary adenoma in this subject produced both GH and TSH simultaneously.ConclusionsWe should bear in mind the possibility of pituitary adenoma producing both GH and TSH at the same time.

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