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Hyperthyroidism, inappropriate plasma TSH and pituitary adenoma in three patients, two receiving long-term phenothiazine therapy.
Q J Med. 1990 Apr; 75(276):345-54.QJ

Abstract

Hypersecretion of TSH by a pituitary adenoma is thought to be a rare form of hyperthyroidism. We describe three such patients, each of whom presented with clinical hyperthyroidism and a diffuse goitre, without eye signs or dermatopathy. Two were receiving long-term phenothiazine, one of these was also acromegalic. Plasma thyroxine, free T4 and tri-iodothyronine were repeatedly raised in each; plasma TSH was grossly elevated in one and inappropriately normal in the other two. Plasma TSH did not rise in response to thyrotrophin-releasing hormone or metoclopramide and was not suppressed by L-dopa in any patient. Anti-thyrotrophin receptor antibodies were undetectable. Skull radiographs showed erosion and expansion of the pituitary fossa and CT scans confirmed a pituitary mass in each patient. A pituitary adenoma was removed by transphenoidal surgery in two patients and a TSH-secreting adenoma was confirmed by immunocytochemical staining and electron microscopy. Both patients were clinically euthyroid post-operatively but still had evidence of TSH excess. Pituitary surgery was technically unsuccessful in the third patient. Although two patients had hyperthyroidism of long duration, all three were diagnosed within one year of the introduction of a sensitive TSH assay to our laboratory. A TSH-secreting pituitary adenoma may be a more common cause of hyperthyroidism than has been believed.

Authors+Show Affiliations

Department of Medicine, Regional Hospital, Cork, Ireland.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

2117296

Citation

Dunne, F P., et al. "Hyperthyroidism, Inappropriate Plasma TSH and Pituitary Adenoma in Three Patients, Two Receiving Long-term Phenothiazine Therapy." The Quarterly Journal of Medicine, vol. 75, no. 276, 1990, pp. 345-54.
Dunne FP, Feely MP, Ferriss JB, et al. Hyperthyroidism, inappropriate plasma TSH and pituitary adenoma in three patients, two receiving long-term phenothiazine therapy. Q J Med. 1990;75(276):345-54.
Dunne, F. P., Feely, M. P., Ferriss, J. B., Keohane, C., Murphy, D., & Perry, I. (1990). Hyperthyroidism, inappropriate plasma TSH and pituitary adenoma in three patients, two receiving long-term phenothiazine therapy. The Quarterly Journal of Medicine, 75(276), 345-54.
Dunne FP, et al. Hyperthyroidism, Inappropriate Plasma TSH and Pituitary Adenoma in Three Patients, Two Receiving Long-term Phenothiazine Therapy. Q J Med. 1990;75(276):345-54. PubMed PMID: 2117296.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hyperthyroidism, inappropriate plasma TSH and pituitary adenoma in three patients, two receiving long-term phenothiazine therapy. AU - Dunne,F P, AU - Feely,M P, AU - Ferriss,J B, AU - Keohane,C, AU - Murphy,D, AU - Perry,I, PY - 1990/4/1/pubmed PY - 1990/4/1/medline PY - 1990/4/1/entrez SP - 345 EP - 54 JF - The Quarterly journal of medicine JO - Q J Med VL - 75 IS - 276 N2 - Hypersecretion of TSH by a pituitary adenoma is thought to be a rare form of hyperthyroidism. We describe three such patients, each of whom presented with clinical hyperthyroidism and a diffuse goitre, without eye signs or dermatopathy. Two were receiving long-term phenothiazine, one of these was also acromegalic. Plasma thyroxine, free T4 and tri-iodothyronine were repeatedly raised in each; plasma TSH was grossly elevated in one and inappropriately normal in the other two. Plasma TSH did not rise in response to thyrotrophin-releasing hormone or metoclopramide and was not suppressed by L-dopa in any patient. Anti-thyrotrophin receptor antibodies were undetectable. Skull radiographs showed erosion and expansion of the pituitary fossa and CT scans confirmed a pituitary mass in each patient. A pituitary adenoma was removed by transphenoidal surgery in two patients and a TSH-secreting adenoma was confirmed by immunocytochemical staining and electron microscopy. Both patients were clinically euthyroid post-operatively but still had evidence of TSH excess. Pituitary surgery was technically unsuccessful in the third patient. Although two patients had hyperthyroidism of long duration, all three were diagnosed within one year of the introduction of a sensitive TSH assay to our laboratory. A TSH-secreting pituitary adenoma may be a more common cause of hyperthyroidism than has been believed. SN - 0033-5622 UR - https://www.unboundmedicine.com/medline/citation/2117296/Hyperthyroidism_inappropriate_plasma_TSH_and_pituitary_adenoma_in_three_patients_two_receiving_long_term_phenothiazine_therapy_ L2 - https://medlineplus.gov/hyperthyroidism.html DB - PRIME DP - Unbound Medicine ER -