Endocrinol Metab.  2011 Jun;26(2):160-165. 10.3803/EnM.2011.26.2.160.

A Case of Pituitary Adenoma with Simultaneous Secretion of TSH and GH

• Lee EY
• Ku CR
• Kim HM
• Lee WK
• Lim JS
• Hwang S
• Kim DH
• Shin DY
• Lee EJ

• KMID: 1497724
• DOI: http://doi.org/10.3803/EnM.2011.26.2.160

Abstract

Thyrotropin (TSH)-secreting pituitary adenoma is a very rare disease. In one-quarter of patients suffering from this disease, the pituitary tumor secretes other anterior pituitary hormones. Herein, we report a case of pituitary adenoma with simultaneous secretion of TSH and growth hormone (GH). A 34-year-old female visitied local hospital complaining of sweating, intermittent palpitation, and weight loss of 8 kg within 1 year. The patient had undergone trans-sphenoidal surgery 3 years prior for resolution of a TSH and GH co-secreting pituitary adenoma. She had been administered somatostatin analogue prior to visiting our hospital. The patient's GH levels were suppressed to below 1 ng/mL on the 75 g oral glucose tolerance test, and her basal insulin-like growth factor-I (IGF-I) level was within normal range. Thyroid function tests demonstrated increased levels of both free thyroxine and TSH. Sella-MRI revealed pituitary adenoma at the floor of the pituitary fossa, approximately 2 cm in height. Therefore, she was diagnosed with residual TSH-secreting pituitary adenoma. The patient again underwent trans-sphenoidal surgery and entered complete remission, based on hormone levels and MRI findings.

Keyword

Thyrotropin; Growth hormone; Pituitary adenoma

MeSH Terms

Adult
Female
Floors and Floorcoverings
Glucose Tolerance Test
Growth Hormone
Humans
Pituitary Hormones, Anterior
Pituitary Neoplasms
Rare Diseases
Reference Values
Somatostatin
Stress, Psychological
Sweat
Sweating
Thyroid Function Tests
Thyrotropin
Thyroxine
Weight Loss
Growth Hormone
Pituitary Hormones, Anterior
Somatostatin
Thyrotropin
Thyroxine

Figure

• 

  Fig. 1. A coronal view of TSH-secreting macroadenoma by MRI, which was taken before and after the surgery. A. About 30 mm sized macroadenoma displacing the enhanced pituitary gland cranially (arrows) before the first TSA (upper panel) and residual tumor (arrow heads) after the first TSA (lower panel). B. About 20 mm sized macroadenoma (arrows) at the floor of pituitary fossa before the second TSA (upper panel) and completely resected tumor after the second the TSA (lower panel). TSA, trans-sphenoidal surgery; TSH, thyroid stimulating hormone.

• 

  Fig. 2. A high-power view of the pituitary adenoma. A. Tumor tissues show regular thin fibrous septa surrounding tumor cells and chromophobe adenoma (H&E stain, × 200). B-D. Immunohistochemical staining of the tumor cells was positive to TSH (B). and GH (C). and negative to PRL (D). (× 100). GH, growth hormone; RPL, prolactin; TSH, thyroid stimulating hormone.

• 

  Fig. 3. Clinical course of the patient (changes in free T4 and TSH levels). MMI, methima-zole; POD, postoperative days; T4, thyroxine; TSA, trans-sphenoidal surgery; TSH, thyroid stimulating hormone

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