scholarly journals Adenoma hipofisário secretor de TSH: uma revisão sistemática / TSH-secreting pituitary adenoma: a systematic review

2020 ◽  
Vol 65 (1) ◽  
pp. 1
Author(s):  
Paulyanara Monique Alves de Souza ◽  
Jefferson Ricardo Rodrigues Morais ◽  
Karla Vanessa Rodrigues Morais ◽  
Josué Da Silva Brito ◽  
Talitha Araújo Faria
Keyword(s):  
Thyroid Hormones ◽  
Pituitary Adenomas ◽  
Case Reports ◽  
Somatostatin Analogs ◽  
Mass Effect ◽  
Pituitary Neoplasms ◽  
Central Hypothyroidism ◽  
First Choice ◽  
Tsh Secretion ◽  
Inappropriate Tsh Secretion

Introdução: Os adenomas hipofisários são tumores caracterizados pela proliferação de células adeno-hipofisárias produtoras de hormônios tróficos. Dentre eles, os adenomas hipofisários produtores de TSH (TSHomas), neoplasias benignas pouco frequentes, que correspondem a menos do que 3% dos adenomas hipofisários. Método: Pesquisamos os termos TSHomas, tireotropinomas e adenomas pituitários secretores de TSH nas bases Pubmed, Lilacs e Scielo. Incluímos artigos publicados entre 2010 e 2020, sendo excluídos relatos de casos, artigos indisponíveis e que não tratavam sobre o tema. Resultados e discussão: Os TSHomas são tumores fibrosos, monoclonais, com incidência entre 0,015 a 0,03 casos/100.000 habitantes, que se manifestam por hipertireoidismo e sintomas causados por efeito de massa. São diagnosticados diante da elevação de TSH juntamente a hormônios tireoidianos, na presença de alterações neurorradiológicas. O tratamento de primeira escolha consiste na neurocirurgia transesfenoidal, sendo os análogos de somatostatina e a radioterapia alternativas para o manejo de pacientes em que a intervenção cirúrgica é desaconselhada. Conclusão: Os TSHomas são raros, contudo, precisam ser investigados diante da secreção inadequada de TSH.Palavras chave: Adenoma, Hormônios tireoidianos, Neoplasias hipofisárias, Síndrome da secreção inadequada de TSH, Hipertireoidismo centralABSTRACTIntroduction: Pituitary adenomas are tumors characterized by the proliferation of adenohypophysis cells that produce trophic hormones. Among them, TSH-producing pituitary adenomas (TSHomas), uncommon benign neoplasms, whichcorrespond to less than 3% of pituitary adenomas. Method: We searched for the terms TSHomas, thyrotropinomas and pituitary adenomas secreting TSH in the Pubmed, Lilacs and Scielo databases. We included articles published between 2010 and 2020, excluding case reports, articles that were unavailable and did not deal with the topic. Results and discussion: TSHomas are fibrous, monoclonal tumors, with an incidence of 0.015 to 0.03 cases / 100,000 inhabitants, which are manifested by hyperthyroidism and symptoms caused by a mass effect. They are diagnosed with elevated TSH along with thyroid hormones, in the presence of neuroradiological changes. The first-choice treatment consists of transsphenoidal neurosurgery, with somatostatin analogs and radiotherapy being alternatives for the management of patients in whom surgical intervention is not recommended. Conclusion: TSHomas are rare, however, they need to be investigated due to inadequate TSH secretion.Keywords: Adenoma, Thyroid hormones, Pituitary neoplasms, Inappropriate TSH secretion syndrome, Central hypothyroidism

scholarly journals SAT-276 Co-Secreting TSH and Growth Hormone Pituitary Adenoma

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Hatem Eid
Keyword(s):  
Growth Hormone ◽  
Pituitary Adenoma ◽  
Pituitary Adenomas ◽  
Case Reports ◽  
Somatostatin Analogs ◽  
Signs And Symptoms ◽  
Pituitary Hormones ◽  
Oral Glucose ◽  
Pituitary Macroadenoma ◽  
Α Subunit

Abstract Introduction: Secreting pituitary adenoma is exceedingly rare. Less than 15 cases having been reported. Its clinical presentation and diagnosis is challenging. We report a case of pituitary macroadenoma, with features of acromegaly and hyperthyroidism. Case report: A 75 years’ old man presented with new onset atrial fibrillation. He had high FT4 with normal TSH. His ultrasound scan of the neck showed a solitary nodule. He had ablation twice and was started on bisoprolol and anticoagulant. He had MRI scan for headaches and this showed a pituitary macroadenoma. He had high IGF-1. His oral glucose tolerance showed failure of GH suppression. His FT4 was persistently high with normal TSH and he had high a subunits. This suggested the diagnosis of TSH and GH secreting pituitary adenoma. Discussion: TSH-secreting pituitary adenomas are rare and not uncommonly, they co-secrete other pituitary hormones including growth hormones. Somatotrophs and lactotrops share common transcription factors with thyrotrophs. TSH-secreting adenomas are benign but 60% of them are locally invasive. TSH-secreting pituitary adenomas typically present with either symptoms of tumor growth like headache or visual field disturbance or symptoms of hyperthyroidism. Thyroid nodules are common in patients with TSHomas. In patients with TSH-secreting pituitary adenomas, majority will need only surgery and radiation. The medical treatment used to normalize TSH and FT4 levels is somatostatin analogs. This is effective in about 90% of patients with TSH secreting pituitary adenomas TSHoma should be differentiated from resistance to thyroid (RTH). The main difference between TSHoma and RTH is the presence of signs and symptoms of hyperthyroidism in patients with TSHoma, absence of a family history, normal thyroid hormone levels in family members, and the presence of an elevated glycoprotein α-subunit in patients with pituitary tumor. Reference: H Adams and D Adams. A case of a co-secreting TSH and growth hormone pituitary adenoma presenting with a thyroid nodule. EDM case reports 2018 [email protected]

Thyreotroop adenoom van de hypofyse: een zeldzame oorzaak van hyperthyreoïdie

2021 ◽  
Author(s):  
T. DEVELTERE ◽  
F. DUYCK ◽  
D. VANHAUWAERT ◽  
F. DEDEURWAERDERE ◽  
K. SPINCEMAILLE
Keyword(s):  
Differential Diagnosis ◽  
Pituitary Adenoma ◽  
Thyroid Hormones ◽  
Somatostatin Analogs ◽  
Thyroid Stimulating Hormone ◽  
Panic Attacks ◽  
Analytical Interference ◽  
Diagnostic Certainty ◽  
Tsh Secretion ◽  
Central Hyperthyroidism

TSH-secreting pituitary adenoma: a rare cause of hyperthyroidism Central hyperthyroidism is noted in a 35-year-old man with recurrent panic attacks. Thyroid-stimulating hormone-secreting pituitary adenoma (TSH-secreting adenoma) is found to be the underlying etiology. A pituitary adenomectomy is carried out, with regression of the symptoms and hyperthyroidism. TSH-secreting adenomas are rare and cause hyperthyroidism due to autonomous TSH secretion. In addition to hyperthyroidism, dysfunction of other pituitary axes and neurological problems due to local compression may also be present. Biochemically, TSH adenoma is characterized by elevated levels of thyroid hormones without suppression of the TSH concentration. After analytical interference has been ruled out, additional biochemical and radiological investigations are necessary in the differential diagnosis and to establish diagnostic certainty. Neurosurgical resection is the cornerstone of the treatment, although radiotherapy and somatostatin analogs may also be considered.

scholarly journals Thyrotropin-Producing Pituitary Adenomas

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A615-A615
Author(s):  
Mingxue Arguello ◽  
Shiri Levy
Keyword(s):  
Pituitary Adenomas ◽  
Transsphenoidal Surgery ◽  
Remission Rate ◽  
Case Reports ◽  
External Beam Radiotherapy ◽  
Somatostatin Analogs ◽  
Thyroid Storm ◽  
Pituitary Hormone ◽  
The Past ◽  
Primary Hyperthyroidism

Abstract Thyrotropin-producing pituitary adenomas are rare cause of hyperthyroidism and it compose about 0.5-3% of all functioning pituitary tumors. Diagnosis of thyrotropin-producing pituitary adenomas can be challenging because TSH concentrations can be normal with only elevated T4. As a result, patient would be simply treated as primary hyperthyroidism. The latency between onset of hyperthyroidism and diagnosis of pituitary adenoma was reported to be 4-6 years. Many patients had radioactive iodine treatment or thyroidectomy treatment for primary hyperthyroidism at the time of diagnosis. A 35-year-old male with history of intermittent FT4 elevation for the past 3 years presented at endocrine clinic for evaluation. Patient also had recent headache and dizziness. TSH was only marginally elevated once in the past 3 years. Alpha-subunit was found to be 2.6 ng/mL with negative heterophile antibody. MRI showed a 13.7 mm x 20.4mm x16.1mm sellar and suprasellar mass without cavernous sinus invasion but with chiasmal compression. Other pituitary hormone co-secretion was not found in this patient. Patient was treated with octreotide 20mg monthly for 3 month with normalization of T4 and size of the tumor also decreased on the medication. Patients was prepared for transsphenoidal surgery. Treatment for thyrotropin-producing pituitary adenomas is mainly surgery. However, medical therapy with somatostatin analogs does play an important part in terms of inducing euthyroid prior to surgery. There are also articles describing shrinkage of the tumor prior to surgery while on somatostatin analogs. There were also rare case reports of thyroid storm from thyrotropin-producing pituitary adenomas when patients were not treated with somatostatin analogs prior to surgery. The surgical outcome was determined by the size of the tumor. Transient hypothyroidism or hypopituitarism can happen after the surgery. However, it is more common in external beam radiotherapy or radiosurgery treatment. For thyrotropin-producing pituitary microadenomas, transsphenoidal surgery is the treatment of choice with high remission rate. In some difficult cases where octreotide was not controlling the hyperthyroidism, methimazole use in combination with octreotide after surgery was also documented in the literature. The idea of using somatostatin analogs as primary treatment of thyrotropin-producing pituitary adenomas due to the risk of hypopituitarism with transsphenoidal surgery was explored in some literature. But, no strong evidence of better outcome with medication treatment alone was found.

scholarly journals Successful Multimodal Treatment of a TSH-Secreting Pituitary Adenoma (TSH-oma)

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A611-A612
Author(s):  
Donna Lee ◽  
Lakshmi Mahali ◽  
Vafa Tabatabaie
Keyword(s):  
Adrenal Insufficiency ◽  
Pituitary Adenomas ◽  
Somatostatin Analogs ◽  
Surgical Techniques ◽  
Mass Effect ◽  
Symptomatic Improvement ◽  
Therapeutic Management ◽  
Secondary Adrenal Insufficiency ◽  
Α Subunit ◽  
Laboratory Results

Abstract Background: TSH-omas are rare tumors accounting for 0.5-2% of all pituitary adenomas. Due to their indolent nature, most TSH-omas are diagnosed at the stage of invasive macroadenomas. Over the past several decades, the management of TSH-omas has evolved substantially. While surgery remains first-line therapy, somatostatin analogs have emerged as important therapeutic agents as a result of their effectiveness in normalizing thyroid hormone levels in ~95% of patients with severe hyperthyroidism and reducing TSH-oma size in ~50% of patients. Clinical Case: A 52-year-old woman with a history of multinodular goiter was incidentally found to have a 2.2 x 1.8 x 2.1 cm pituitary macroadenoma with suprasellar extension, mass effect on the optic chiasm, and left cavernous sinus involvement when she presented with chest pain, palpitations, headache, and left-sided numbness and weakness. Laboratory results showed high FT4/T4/T3 with inappropriately high TSH, elevated α-subunit, and low cortisol with low-normal ACTH highly suggestive of TSH-oma with concurrent secondary adrenal insufficiency. An ophthalmology exam revealed a left superior temporal defect. The patient was treated with atenolol, prednisone, and octreotide two weeks before surgery with symptomatic improvement and near-normalization of FT4. Following an uncomplicated transsphenoidal resection, FT4 normalized within one week. At her one-month follow-up, both TSH and FT4 were normal, and her secondary adrenal insufficiency had resolved. Her visual field defect also recovered. Laboratory Results: TSH 5.35 (normal range 0.40-4.60 μU/mL), FT4 3.0 (0.8-1.7 ng/dL), T4 18.1 (5.0-12.0 μg/dL), T3 235 (80-200 ng/dL), ACTH 10 (6-50 pg/mL), cortisol 4.5 (5.0-25.0 μg/dL), α-subunit 8.0 (0.1-1.5 ng/mL); after 2 weeks on SQ octreotide 50mg q12h: TSH 1.93 (0.30-4.20 μU/mL), FT4 1.7 (0.6-1.5 ng/dL); 1 month post-op: TSH 1.53 (0.30-4.20 μU/mL), FT4 0.8 (0.6-1.5 ng/dL), ACTH 12 (7.2-63 pg/mL), cortisol 6.9 (4.0-20.0 μg/dL) Conclusion: Since the first reported case of TSH-oma in 1960, the diagnostic and therapeutic management of these rare pituitary adenomas have evolved due to the emergence of ultrasensitive TSH assays, advanced imaging and surgical techniques, and somatostatin analogs. However, to this day, most TSH-omas are still diagnosed at the stage of invasive macroadenomas, when successful surgical resection becomes more difficult. Hence, up to two-thirds of patients may require adjuvant therapy with medication or radiation. As evidenced in our patient, who achieved a near-euthyroid state within just two weeks of starting low dose octreotide, somatostatin analogs are highly effective in controlling hyperthyroidism and have solidified their place in the therapeutic management of TSH-omas. This case highlights the success of a multimodal approach to the treatment of TSH-omas.

Mild hyperthyroidism with inappropriate secretion of TSH in postmenopausal women

1986 ◽  
Vol 111 (2) ◽  
pp. 204-208 ◽  
Author(s):  
N. Custro ◽  
V. Scafidi
Keyword(s):  
Thyroid Hormones ◽  
Postmenopausal Women ◽  
Present Report ◽  
Serum Levels ◽  
Suppressive Effect ◽  
Pituitary Thyroid Axis ◽  
Tsh Secretion ◽  
Thyroid Axis ◽  
Suppression Test ◽  
Inappropriate Tsh Secretion

Abstract. In a previous study on the function of the hypothalamus - pituitary - thyroid axis, about 10% of postmenopausal women with the climacteric syndrome were found to have borderline high values of T3 and T4 and signs of pituitary decreased sensitivity to the suppressive effect of increased thyroid hormones. The present report concerns 5 women in the first phase of their menopause who showed a mild hyperthyroidism under basal conditions and after suppression test with liothyronine. Each patient had borderline increased levels of serum total and free T4 and T3 and a marked TSH responsiveness to exogenous TRH. After liothyronine, the serum levels of T4, FT4, TSH and the responsiveness to TRH-test clearly decreased. These data suggest an inappropriate TSH secretion with a decreased pituitary sentitivity to thyroid hormones. These cases could represent a modification of the hypothalamus-pituitary-thyroid axis associated with that of the gonadal axis, secondary to the absence of rapid adaptation of neurotransmitters.

scholarly journals Immediate Post-Extraction Short Implant Placement with Immediate Loading and without Extraction of an Impacted Maxillary Canine: Two Case Reports

Materials ◽  
2021 ◽  
Vol 14 (11) ◽  
pp. 2757
Author(s):  
José Antonio Moreno-Rodríguez ◽  
Julia Guerrero-Gironés ◽  
Francisco Javier Rodríguez-Lozano ◽  
Miguel Ramón Pecci-Lloret
Keyword(s):  
Dental Implant ◽  
Alveolar Bone ◽  
Case Reports ◽  
Young Patients ◽  
Aesthetic Result ◽  
First Choice ◽  
Surgical Extraction ◽  
Impacted Canine ◽  
Short Implant

For the treatment of impacted maxillary canines, traction associated with a complete orthodontic treatment is the first choice in young patients. However, in adults, this treatment has a worse prognosis. The surgical extraction of the impacted tooth can result in a series of complications and a compromised alveolar bone integrity, which may lead to the requirement of a bone regeneration/grafting procedure to replace the canine with a dental implant. These case reports aimed to describe an alternative treatment procedure to the surgical extraction of impacted maxillary canines in adults. Following clinical and computerized tomography-scan (CT-Scan) examination, the possibility of maintaining the impacted canine in its position and replacing the temporary canine present in its place with a dental implant was planned. A short dental implant with an immediate provisional crown was placed, without contacting the impacted canine. At 3 months follow-up, a definitive metal-ceramic restoration was placed. Follow-up visits were performed periodically. The implant site showed a physiological soft tissue color and firmness, no marginal bone loss, no infection or inflammation, and an adequate aesthetic result in all follow-up visits. These results suggest that the treatment carried out is a valid option to rehabilitate with an osseointegrated short implant area where a canine is included, as long as there is a sufficient amount of the remaining bone.

scholarly journals Fetus in fetu: two case reports from North African country

2021 ◽  
Vol 69 (1) ◽  
Author(s):  
Moutaz Ragab ◽  
Omar Nagy Abdelhakeem ◽  
Omar Mansour ◽  
Mai Gad ◽  
Hesham Anwar Hussein
Keyword(s):  
Histopathological Examination ◽  
Case Reports ◽  
Abdominal Mass ◽  
Mature Teratoma ◽  
Surgical Techniques ◽  
Rare Condition ◽  
Mass Effect ◽  
Fetus In Fetu ◽  
Vascular Connection ◽  
First Case

Abstract Background Fetus in fetu is a rare congenital anomaly. The exact etiology is unclear; one of the mostly accepted theories is the occurrence of an embryological insult occurring in a diamniotic monochorionic twin leading to asymmetrical division of the blastocyst mass. Commonly, they present in the infancy with clinical picture related to their mass effect. About 80% of cases are in the abdomen retroperitoneally. Case presentation We present two cases of this rare condition. The first case was for a 10-year-old girl that presented with anemia and abdominal mass, while the second case was for a 4-month-old boy that was diagnosed antenatally by ultrasound. Both cases had vertebrae, recognizable fetal organs, and skin coverage. Both had a distinct sac. The second case had a vascular connection with the host arising from the superior mesenteric artery. Both cases were intra-abdominal and showed normal levels of alpha-fetoprotein. Histopathological examination revealed elements from the three germ layers without any evidence of immature cells ruling out teratoma as a differential diagnosis. Conclusions Owing to its rarity, fetus in fetu requires a high degree of suspicion and meticulous surgical techniques to avoid either injury of the adjacent vital structures or bleeding from the main blood supply connection to the host. It should be differentiated from mature teratoma.

scholarly journals Delayed Extradural Hematoma after Evacuation of Contralateral Acute Extradural Hematoma

2020 ◽  
Author(s):  
Majid Anwer ◽  
Atique Ur Rehman ◽  
Farheen Ahmed ◽  
Satyendra Kumar ◽  
Md Masleh Uddin
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Postoperative Period ◽  
Road Traffic ◽  
Case Reports ◽  
Mass Effect ◽  
Extradural Hematoma ◽  
Traumatic Head Injury ◽  
Neurologic Deterioration ◽  
The Right

Abstract Introduction Traumatic head injury with extradural hematoma (EDH) is seen in 2% of patients. Development of EDH on the contralateral side is an uncommon complication that has been reported in various case reports. Case Report We report here a case of an 18-year-old male who had a road traffic injury. He was diagnosed as a case of left-sided large frontotemporoparietal acute extradural bleed with a mass effect toward the right side. He was managed with urgent craniotomy and evacuation of hematoma. A noncontrast computed tomography (NCCT) scan performed 8 hours after postoperative period showed a large frontotemporoparietal bleed on the right side with a mass effect toward the left side. He was again taken to the operating room and right-sided craniotomy and evacuation of hematoma were performed. A postoperative NCCT scan revealed a resolved hematoma. The patient made a complete recovery in the postoperative period and is doing well. Conclusion Delayed onset epidural hematoma is diagnosed when the initial computed tomography (CT) scan is negative or is performed early and when late CT scan performed to assess clinical or ICP deterioration shows an EDH. The diagnosis of such a condition requires a high index of suspicion based on the mechanism of injury along with fracture patterns. Additionally, change in pupillary size, raised intracranial pressure, and bulging of the brain intraoperatively are additional clues for contralateral bleeding. Neurologic deterioration may or may not be associated with delayed EDH presentation. An early postoperative NCCT scan within 24 hours is recommended to detect this complication with or without any neurologic deterioration.

Lack of effects of circulating thyroid hormone levels on serum leptin concentrations

1997 ◽  
pp. 659-663 ◽  
Author(s):  
S Corbetta ◽  
P Englaro ◽  
S Giambona ◽  
L Persani ◽  
WF Blum ◽  
...  
Keyword(s):  
Thyroid Hormones ◽  
Standard Deviation Score ◽  
Protein Product ◽  
Primary Hypothyroidism ◽  
Central Hypothyroidism ◽  
Serum Leptin ◽  
Thyroxine Therapy ◽  
Significant Difference ◽  
Before And After ◽  
Thyroxine Replacement Therapy

Leptin is the protein product of the ob gene, secreted by adipocytes. It has been suggested that it may play an important role in regulating appetite and energy expenditure. The aim of this study was to evaluate a possible interaction of thyroid hormones with the leptin system. We studied 114 adult patients (65 females and 49 males): 36 were affected with primary hypothyroidism (PH), 38 with central hypothyroidism (CH) and 40 with thyrotoxicosis (TT). Patients with CH were studied both before and after 6 months of L-thyroxine replacement therapy. Body mass index (BMI; kg/m2), thyroid function and fasting serum leptin were assessed in all patients. Since BMI has been proved to be the major influencing variable of circulating leptin levels, data were expressed as standard deviation score (SDS) calculated from 393 male and 561 female controls matched for age and BMI. No difference in SDS was recorded between males and females whatever the levels of circulating thyroid hormones. In males, no significant difference was recorded among the SDSs of PH (-0.36 +/- 1.2), TT (-0.35 +/- 1.2) and CH (0.01 +/- 1.4) patients. Females with PH had an SDSs significantly lower than TT females (-0.77 +/- 1.0 vs -0.06 +/- 1.2; P < 0.02), while no significant differences between CH (-0.34 +/- 0.7) and TT females or between CH and PH females were observed. SDS in CH patients after 6 months of L-thyroxine therapy significantly varied only in females (0.25 +/- 1.4). In conclusion, circulating thyroid hormones do not appear to play any relevant role in leptin synthesis and secretion. However, as females with either overt hypo- or hyper-thyroidism or central hypothyroidism after L-thyroxine therapy show differences in their SDSs, a subtle interaction between sex steroids and thyroid status in modulating leptin secretion, at least in women, may occur.

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