Refractory Transposing Hyperthyroid Disorder Inducing Tsh-secreting Pituitary Adenoma: A Case Report and Literature Review
Abstract
Introduction: TSH-secreting pituitary adenomas (TSH-sPAs) or thyrotropinomas are very rare forms of pituitary adenomas (PAs). Although several authors have presented single cases or case series on this occurrence, only few authors have indicated that hyperthyroidism heralded the pathogenesis of TSH-sPA. We also present a case of refractory transposing hyperthyroid disorder inducing TSH-sPA. Case Presentation: We present a 47-year-old woman with 20 years’ history hyperthyroidism and a visible anterior neck swelling with normal TSH. She was put on anti-thyroid medications that transposed her hyperthyroid state to hypothyroid state with elevated TSH and a pituitary adenoma (PA). The PA was surgically excised via transsphenoidal approach. Conclusion: Hyperthyroidism or anti-thyroid medications could be responsible for the trigger of a feedback mechanism that led to over-secretion of TSH and subsequently the development of PA.
Keywords
Full Text:
PDFReferences
Brucker-Davis Fo, Oldfield EH, Skarulis MC, Doppman JL and Weintraub BD: Thyrotropin-secreting pituitary tumors: diagnostic criteria, thyroid hormone sensitivity, and treatment outcome in 25 patients followed at the National Institutes of Health. The Journal of Clinical Endocrinology & Metabolism 84: 476-486, 1999.
Nazato D and Abucham J: Diagnosis and treatment of TSH-secreting adenomas: review of a longtime experience in a reference center. Journal of Endocrinological Investigation 1-8, 2017.
Önnestam L, Berinder K, Burman P, et al: National incidence and prevalence of TSH-secreting pituitary adenomas in Sweden. The Journal of Clinical Endocrinology & Metabolism 98: 626-635, 2013.
Varsseveld NC, Bisschop PH, Biermasz NR, Pereira AM, Fliers E and Drent ML: A long‐term follow‐up study of eighteen patients with thyrotrophin‐secreting pituitary adenomas. Clinical endocrinology 80: 395-402, 2014.
Grisoli F, Leclercq T, Winteler J-P, et al: Thyroid-stimulating hormone pituitary adenomas and hyperthyroidism. Surgical neurology 25: 361-368, 1986.
Ogawa Y and Tominaga T: Thyroid-stimulating hormone-secreting pituitary adenoma presenting with recurrent hyperthyroidism in post-treated Graves’ disease: a case report. Journal of medical case reports 7: 27, 2013.
Kamoun M, d'Herbomez M, Lemaire C, et al: Coexistence of thyroid-stimulating hormone-secreting pituitary adenoma and graves' hyperthyroidism. European thyroid journal 3: 60-64, 2014.
Vanderpump MP, Michael W and Tunbridge G: The epidemiology of autoimmune thyroid disease. In: Autoimmune endocrinopathies. Springer, pp141-162, 1999.
Lloyd R: Pituitary tumors; Introduction. WHO Classification of Tumors Pathology and Genetics Tumors of Endocrine Organs 10-13, 2004.
Kamoi K, Mitsuma T, Sato H, et al: Hyperthyroidism caused by a pituitary thyrotrophin-secreting tumour with excessive secretion of thyrotrophin-releasing hormone and subsequently followed by Graves' disease in a middle-aged woman. Acta endocrinologica 110: 373-382, 1985.
O'Donnell J, Hadden D, Weaver J and Montgomery D: Thyrotoxicosis recurring after surgical removal of a thyrotrophin-secreting pituitary tumour. Journal 1973.
Ness-Abramof R, Ishay A, Harel G, et al: TSH-secreting pituitary adenomas: follow-up of 11 cases and review of the literature. Pituitary 10: 307-310, 2007.
Losa M, Giovanelli M, Persani L, Mortini P, Faglia G and Beck-Peccoz P: Criteria of cure and follow-up of central hyperthyroidism due to thyrotropin-secreting pituitary adenomas. The Journal of Clinical Endocrinology & Metabolism 81: 3084-3090, 1996.
Ogawa Y and Tominaga T: A case of atypical thyrotroph cell adenoma, which re-grew within 3 months after surgery and required multimodal treatment. Journal of neuro-oncology 87: 91-95, 2008.
Fiore E and Vitti P: Serum TSH and risk of papillary thyroid cancer in nodular thyroid disease. The Journal of Clinical Endocrinology & Metabolism 97: 1134-1145, 2012.
Losa M, Fortunato M, Molteni L, Peretti E and Mortini P: Thyrotropin-secreting pituitary adenomas: biological and molecular features, diagnosis and therapy. Minerva endocrinologica 33: 329-340, 2008.
Beck-Peccoz P, Persani L, Mannavola D and Campi I: TSH-secreting adenomas. Best Practice & Research Clinical Endocrinology & Metabolism 23: 597-606, 2009.
Riis ALD, Hansen TK, Møller N, Weeke J and Jørgensen JOL: Hyperthyroidism is associated with suppressed circulating ghrelin levels. The Journal of Clinical Endocrinology & Metabolism 88: 853-857, 2003.
Pijl H, De Meijer P, Langius J, et al: Food choice in hyperthyroidism: potential influence of the autonomic nervous system and brain serotonin precursor availability. The Journal of Clinical Endocrinology & Metabolism 86: 5848-5853, 2001.
Boellis A, di Napoli A, Romano A and Bozzao A: Pituitary apoplexy: an update on clinical and imaging features. Insights into imaging 5: 753-762, 2014.
Bonneville F, Cattin F, Marsot-Dupuch K, Dormont D, Bonneville J-F and Chiras J: T1 signal hyperintensity in the sellar region: spectrum of findings. Radiographics 26: 93-113, 2006.
Piotin M, Tampieri D, Rüfenacht D, et al: The various MRI patterns of pituitary apoplexy. European radiology 9: 918-923, 1999.
Dubuisson AS, Beckers A and Stevenaert A: Classical pituitary tumour apoplexy: clinical features, management and outcomes in a series of 24 patients. Clin Neurol Neurosur 109: 63-70, 2007.
Semple PL, Jane Jr JA, Lopes MBS and Laws ER: Pituitary apoplexy: correlation between magnetic resonance imaging and histopathological results. 2008.
Arita K, Kurisu K, Tominaga A, et al: Thickening of sphenoid sinus mucosa during the acute stage of pituitary apoplexy: case report. Journal of neurosurgery 95: 897-901, 2001.
Ogawa Y, Tominaga T and Ikeda H: Intrasellar small TSH secreting pituitary adenomas, 2 case reports. No shinkei geka Neurological surgery 35: 679-684, 2007.
Patrick A, Atkin S, MacKenzie J, Foy P, White M and MacFarlane I: Hyperthyroidism secondary to a pituitary adenoma secreting TSH, FSH, alpha‐subunit and GH. Clinical endocrinology 40: 275-278, 1994.
Sanno N, Teramoto A and Osamura RY: Long-term surgical outcome in 16 patients with thyrotropin pituitary adenoma. Journal of neurosurgery 93: 194-200, 2000.
Beck-Peccoz P and Persani L: Medical management of thyrotropin-secreting pituitary adenomas. Pituitary 5: 83-88, 2002.
Caron P, Arlot S, Bauters C, et al: Efficacy of the long-acting octreotide formulation (octreotide-LAR) in patients with thyrotropin-secreting pituitary adenomas. The Journal of Clinical Endocrinology & Metabolism 86: 2849-2853, 2001.
Dhillon KS, Cohan P, Kelly DF, Darwin CH, Iyer KV and Chopra IJ: Treatment of hyperthyroidism associated with thyrotropin-secreting pituitary adenomas with iopanoic acid. The Journal of Clinical Endocrinology & Metabolism 89: 708-711, 2004.
Socin HV, Chanson P, Delemer B, et al: The changing spectrum of TSH-secreting pituitary adenomas: diagnosis and management in 43 patients. European journal of endocrinology 148: 433-442, 2003.
DOI: https://doi.org/10.7575/aiac.abcmed.v.7n.2p.64
Refbacks
- There are currently no refbacks.
This work is licensed under a Creative Commons Attribution 4.0 International License.
2013-2023 (CC-BY) Australian International Academic Centre PTY.LTD.
Advances in Bioscience and Clinical Medicine