Endocrinol Metab.  2010 Dec;25(4):378-381. 10.3803/EnM.2010.25.4.378.

The Effect of Octreotide LAR on GH and TSH Co-Secreting Pituitary Adenoma

• Kim NK
• Hah YJ
• Lee HY
• Kim SJ
• Kim MK
• Park KG
• Kim E
• Chang H
• Kim HS

• KMID: 1497767
• DOI: http://doi.org/10.3803/EnM.2010.25.4.378

Abstract

Growth hormone (GH) and thyroid stimulating hormone (TSH)-secreting pituitary adenomas are very rare and they account for only 0.5% for all pituitary adenomas. These adenomas are usually treated with surgery, but this surgery is not easy because the tumor is usually huge and invasive. We reported here on a case of a GH-TSH-secreting adenoma in a 23-year-old male patient who was initially treated with octreotide LAR. He presented with symptoms of headache, palpitation and a visual defect that he had for the 3 months. He had hypertrophy of the frontal bone and enlargement of both the hands and feet. The visual field test showed bitemporal hemianopsia. The laboratory examinations showed high serum levels of free T4, TSH and free alpha-subunit. Additionally, the serum levels of GH and insulin-like growth factor-I (IGF-I) were increased. GH was not suppressed below 1microg/L by an oral 75g glucose loading test, and TSH was not stimulated by thyrotropin-releasing hormone (TRH). Because sellar MRI showed invasive macroadenoma encasing the vessels, we initially tried octreotide LAR for treatment. A year later, the IGF-I and thyroid function tests were normalized and the size of the tumor was reduced with cystic change. The symptoms of palpitation and headache were improved without a change of the visual field defect.

Keyword

Acromegaly; Octreotide LAR; Pituitary adenoma; TSH-secreting tumor

MeSH Terms

Acromegaly
Adenoma
Foot
Frontal Bone
Glucose
Growth Hormone
Hand
Headache
Hemianopsia
Humans
Hypertrophy
Insulin-Like Growth Factor I
Male
Octreotide
Pituitary Neoplasms
Thyroid Function Tests
Thyrotropin
Thyrotropin-Releasing Hormone
Visual Field Tests
Visual Fields
Young Adult
Glucose
Growth Hormone
Insulin-Like Growth Factor I
Octreotide
Thyrotropin
Thyrotropin-Releasing Hormone

Figure

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  Fig. 1 Radiologic findings. (A) T2 weighted image (T2W1) sagittal scan of sellar shows a large lobulated mass lesion on the pituitary gland. (B) T2 weighted image (T2W1) sagittal scan of sella after 1 year using octreotide LAR shows reduction of previous mass with cystic change.

Reference

1. Larsen PR, Kronenberg HM, Melmed S, Polonsky KS. Williams textbook of endocrinology. 2002. 10th ed. Saunders;185.

2. Beck-Peccoz P, Brucker-Davis F, Persani L, Smallridge RC, Weintraub BD. Thyrotropin-secreting pituitary tumors. Endocr Rev. 1996. 17:610–638.

3. Saeger W, Lüdecke DK, Buchfelder M, Fahlbusch R, Quabbe HJ, Petersenn S. Pathohistological classification of pituitary tumors: 10 years of experience with the German Pituitary Tumor Registry. Eur J Endocrinol. 2007. 156:203–216.

4. Smallridge RC. Thyrotropin-secreting pituitary tumors. Endocrinol Metab Clin North Am. 1987. 16:765–792.

5. Weintraub BD, Gershengorn MC, Kourides IA, Fein H. Inappropriate secretion of thyroid-stimulating hormone. Ann Intern Med. 1981. 95:339–351.

6. Caron P, Arlot S, Bauters C, Chanson P, Kuhn JM, Pugeat M, Marechaud R, Teutsch C, Vidal E, Sassano P. Efficacy of the long-acting octreotide formulation (octreotide-LAR) in patients with thyrotropin-secreting pituitary adenomas. J Clin Endocrinol Metab. 2001. 86:2849–2853.

7. Chanson P, Weintraub BD, Harris AG. Octreotide therapy for thyroidstimulating hormone-secreting pituitary adenomas. A follow-up of 52 patients. Ann Intern Med. 1993. 119:236–240.

8. Shivaswamy V, Larsen JL. Octreotide normalizes thyroid function tests in a pregnant woman with a thyrotropin-secreting adenoma. Endocrinologist. 2007. 17:184–187.

9. Hah YJ, Kim MK, Kim HS, Kim E, Yim MB, Choe M, Park KG. A case of TSH-secreting pituitary adenoma with acromegaly. Korean J Med. 2009. 77:S97–S102.

10. Waldhäusl W, Bratusch-Marrain P, Nowotny P, Büchler M, Forssmann WG, Lujf A, Schuster H. Secondary hyperthyroidism due to thyrotropin hypersecretion: study of pituitary tumor morphology and thyrotropin chemistry and release. J Clin Endocrinol Metab. 1979. 49:879–887.

11. Refetoff S, Weiss RE, Usala SJ. The syndromes of resistance to thyroid hormone. Endocr Rev. 1993. 14:348–399.

12. Kourides IA, Ridgway EC, Weintraub BD, Bigos ST, Gershengorn MC, Maloof F. Thyrotropin-induced hyperthyroidism: use of alpha and beta subunit levels to identify patients with pituitary tumors. J Clin Endocrinol Metab. 1977. 45:534–543.

13. Weeke J, Hansen AP, Lundaek K. Inhibition by somatostatin of basal levels of serum thyrotropin (TSH) in normal men. J Clin Endocrinol Metab. 1975. 41:168–171.

14. Siler TM, Yen SC, Vale W, Guillemin R. Inhibition by somatostatin on the release of TSH induced in man by thyrotropin-releasing factor. J Clin Endocrinol Metab. 1974. 38:742–745.

15. Reschini E, Giustina G, Cantalamessa Lperacchi M. Hyperthyroidism with elevated plasma TSH levels and pituitary tumor: study with somatostatin. J Clin Endocrinol Metab. 1976. 43:924–927.

16. Kim JY, Jee JH, Yoon CH, Chung YJ, Lee BW, Cho GY, Kim SY, Chung JH, Min YK, Lee MS, Lee MK, Kim KW. Efficacy of octreotide LAR in acromegalic patients. J Korean Soc Endocrinol. 2005. 20:344–352.

17. Amato G, Mazziotti G, Rotondi M, Iorio S, Doga M, Sorvillo F, Manganella G, Di Salle F, Giustina A, Carella C. Long-term effects of lanreotide SR and octreotide LAR on tumour shrinkage and GH hypersecretion in patients with previously untreated acromegaly. Clin Endocrinol (Oxf). 2002. 56:65–71.

18. Bevan JS, Atkin SL, Atkinson AB, Bouloux PM, Hanna F, Harris PE, James RA, McConnell M, Roberts GA, Scanlon MF, Stewart PM, Teasdale E, Turner HE, Wass JA, Wardlaw JM. Primary medical therapy for acromegaly: an open, prospective, multicenter study of the effects of subcutaneous and intramuscular slow-release octreotide on growth hormone, insulin-like growth factor-I, and tumor size. J Clin Endocrinol Metab. 2002. 87:4554–4563.

19. Colao A, Ferone D, Marzullo P, Cappabianca P, Cirillo S, Boerlin V, Lancranjan I, Lombardi G. Long-term effects of depot long-acting somatostatin analog octreotide on hormone levels and tumor mass in acromegaly. J Clin Endocrinol Metab. 2001. 86:2779–2786.

20. Lancranjan I, Bruns C, Grass P, Jaquet P, Jervell J, Kendall-Taylor P, Lamberts SW, Marbach P, Orskov H, Pagani G, Sheppard M, Simionescu L. Sandostatin LAR: a promising therapeutic tool in the management of acromegalic patients. Metabolism. 1996. 45:67–71.