A thyrotropin-secreting macroadenoma with positive growth hormone and prolactin immunostaining: A case report and literature review

Thyrotropin (thyroid stimulating hormone [TSH]) secreting pituitary adenomas (TSHoma) are rare adenomas presenting with hyperthyroidism due to impaired negative feedback of thyroid hormone on the pituitary and inappropriate TSH secretion. This article presents a case of TSH-secreting macroadenoma without any clinical hyperthyroidism symptoms accompanying immunoreaction with growth hormone (GH) and prolactin. A 36-year-old female patient was admitted with complaints of irregular menses and blurred vision. On physical exam, she had bitemporal hemianopsia defect. Magnetic resonance imaging (MRI) evaluation showed suprasellar macroadenoma measuring 33 mm × 26 mm × 28 mm was detected on pituitary MRI. She had no hyperthyroidism symptoms clinically. Although free T4 and free T3 levels were elevated, TSH level was inappropriately within the upper limit of normal. Response to T3 suppression and thyrotropin releasing hormone-stimulation test was inadequate. Other pituitary hormones were normal. Transsphenoidal adenomectomy was performed due to parasellar compression findings. Immunohistochemically widespread reaction was observed with TSH, GH and prolactin in the adenoma. The patient underwent a second surgical procedure 2 months later due to macroscopic residual tumor, bitemporal hemianopsia and a suprasellar homogenous uptake with regular borders on indium-111 octreotide scintigraphy. After second surgery; due to ongoing symptoms and residual tumor, she was managed with octreotide and cabergoline treatment. On her follow-up with medical treatment, TSH and free T4 values were within normal limits. Although silent TSHomas are rare, they may arise with compression symptoms as in our case. The differential diagnosis of secondary hyperthyroidism should include TSHomas and thyroid hormone receptor resistance syndrome.

Yazar Kuzu F.
Bayraktaro?lu T.
Zor F.
Gün B.
Saliho?lu Y.
Kalaycí M.
Yayın Türü Review
Tek Biçim Adres https://hdl.handle.net/20.500.12628/4089
Tek Biçim Adres 10.4103/1119-3077.158983
Koleksiyonlar Araştırma Çıktıları | WoS | Scopus | TR-Dizin | PubMed | SOBİAD
Scopus İndeksli Yayınlar Koleksiyonu
WoS İndeksli Yayınlar Koleksiyonu
Sayfalar 693 - 697
Yayın Yılı 2015
Eser Adı
[dc.title]
A thyrotropin-secreting macroadenoma with positive growth hormone and prolactin immunostaining: A case report and literature review
Yayın Yılı
[dc.date.issued]
2015
Yayıncı
[dc.publisher]
Medknow Publications
Yayın Türü
[dc.type]
review
Özet
[dc.description.abstract]
Thyrotropin (thyroid stimulating hormone [TSH]) secreting pituitary adenomas (TSHoma) are rare adenomas presenting with hyperthyroidism due to impaired negative feedback of thyroid hormone on the pituitary and inappropriate TSH secretion. This article presents a case of TSH-secreting macroadenoma without any clinical hyperthyroidism symptoms accompanying immunoreaction with growth hormone (GH) and prolactin. A 36-year-old female patient was admitted with complaints of irregular menses and blurred vision. On physical exam, she had bitemporal hemianopsia defect. Magnetic resonance imaging (MRI) evaluation showed suprasellar macroadenoma measuring 33 mm × 26 mm × 28 mm was detected on pituitary MRI. She had no hyperthyroidism symptoms clinically. Although free T4 and free T3 levels were elevated, TSH level was inappropriately within the upper limit of normal. Response to T3 suppression and thyrotropin releasing hormone-stimulation test was inadequate. Other pituitary hormones were normal. Transsphenoidal adenomectomy was performed due to parasellar compression findings. Immunohistochemically widespread reaction was observed with TSH, GH and prolactin in the adenoma. The patient underwent a second surgical procedure 2 months later due to macroscopic residual tumor, bitemporal hemianopsia and a suprasellar homogenous uptake with regular borders on indium-111 octreotide scintigraphy. After second surgery; due to ongoing symptoms and residual tumor, she was managed with octreotide and cabergoline treatment. On her follow-up with medical treatment, TSH and free T4 values were within normal limits. Although silent TSHomas are rare, they may arise with compression symptoms as in our case. The differential diagnosis of secondary hyperthyroidism should include TSHomas and thyroid hormone receptor resistance syndrome.
Tek Biçim Adres
[dc.identifier.uri]
https://dx.doi.org/10.4103/1119-3077.158983
Tek Biçim Adres
[dc.identifier.uri]
https://hdl.handle.net/20.500.12628/4089
Yayın Dili
[dc.language.iso]
eng
Yazar
[dc.contributor.author]
Kuzu F.
Yazar
[dc.contributor.author]
Bayraktaro?lu T.
Yazar
[dc.contributor.author]
Zor F.
Yazar
[dc.contributor.author]
Gün B.
Yazar
[dc.contributor.author]
Saliho?lu Y.
Yazar
[dc.contributor.author]
Kalaycí M.
Haklar
[dc.rights]
info:eu-repo/semantics/closedAccess
İlk Sayfa Sayısı
[dc.identifier.startpage]
693
Son Sayfa Sayısı
[dc.identifier.endpage]
697
Açık Erişim Tarihi
[dc.date.available]
2019-12-23
Görüntülenme Sayısı ( Şehir )
Görüntülenme Sayısı ( Ülke )
Görüntülenme Sayısı ( Zaman Dağılımı )
Görüntülenme
13
09.12.2022 tarihinden bu yana
İndirme
1
09.12.2022 tarihinden bu yana
Son Erişim Tarihi
21 Şubat 2024 15:46
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Tıklayınız
symptoms hormone hyperthyroidism pituitary normal prolactin patient Although treatment residual second octreotide suprasellar bitemporal hemianopsia thyroid adenomas compression within macroadenoma TSHomas adenoma procedure hormones Transsphenoidal adenomectomy performed observed widespread surgical parasellar months reaction underwent findings
6698 sayılı Kişisel Verilerin Korunması Kanunu kapsamında yükümlülüklerimiz ve çerez politikamız hakkında bilgi sahibi olmak için alttaki bağlantıyı kullanabilirsiniz.

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