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Hyperthyroidism caused by an ectopic thyrotropin-secreting tumor of the nasopharynx: a case report and review of the literature.
Thyroid. 2013 Sep; 23(9):1172-7.T

Abstract

BACKGROUND

Ectopic thyrotropin (TSH)-secreting tumors are extremely rare. To our knowledge, only three cases have previously been reported so far, but the tumors were not studied ultrastructurally and in vitro. We present a case that was extensively examined to gain deeper insights in terms of the histopathological features and hormonal secretion profile of the tumor.

PATIENT FINDINGS

A 49-year-old female complained of nasal obstruction for 15 years and thyrotoxicosis for one and a half years. Except for a high basal TSH with concomitantly elevated free tri-iodothyronine (FT3) and free thyroxine (FT4) levels, her pituitary hormone profile yielded normal results. Magnetic resonance imaging revealed a 2 cm × 2 cm mass in the nasopharynx, which showed an increased tracer uptake on octreotide scintigraphy. Preoperative treatment with octreotide effectively reduced serum TSH, FT3, and FT4 to normal levels. The mass was endoscopically removed via an endonasal approach. Immunophenotyping and hormone determination of cultured cells confirmed that the mass was a plurihormonal TSH-/growth hormone (GH)-/prolactin (PRL)-producing adenoma. Co-expression of TSH and GH was found in most cells. Electron microscopy showed that the adenoma was formed by a single cell type, with secretory granules of small size. In vitro studies demonstrated that octreotide reduced both TSH and GH secretion.

SUMMARY

We report an ectopic TSH-secreting tumor, which had plurihormonal secretion in vitro, including TSH, GH, and PRL. Histologically, it mimicked a TSH-secreting pituitary adenoma. Octreotide was useful in the diagnosis and treatment of this ectopic TSH-secreting tumor.

CONCLUSIONS

Ectopic TSH-secreting tumors are extremely rare. In terms of hormone secretion profile, histological characteristics, and response to octreotide, they are similar to pituitary TSH-secreting adenomas, suggesting that they are of identical cell origin.

Authors+Show Affiliations

1 Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital , Beijing, P.R. China .No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article
Review

Language

eng

PubMed ID

23402621

Citation

Tong, Anli, et al. "Hyperthyroidism Caused By an Ectopic Thyrotropin-secreting Tumor of the Nasopharynx: a Case Report and Review of the Literature." Thyroid : Official Journal of the American Thyroid Association, vol. 23, no. 9, 2013, pp. 1172-7.
Tong A, Xia W, Qi F, et al. Hyperthyroidism caused by an ectopic thyrotropin-secreting tumor of the nasopharynx: a case report and review of the literature. Thyroid. 2013;23(9):1172-7.
Tong, A., Xia, W., Qi, F., Jin, Z., Yang, D., Zhang, Z., Li, F., Xing, X., & Lian, X. (2013). Hyperthyroidism caused by an ectopic thyrotropin-secreting tumor of the nasopharynx: a case report and review of the literature. Thyroid : Official Journal of the American Thyroid Association, 23(9), 1172-7. https://doi.org/10.1089/thy.2012.0574
Tong A, et al. Hyperthyroidism Caused By an Ectopic Thyrotropin-secreting Tumor of the Nasopharynx: a Case Report and Review of the Literature. Thyroid. 2013;23(9):1172-7. PubMed PMID: 23402621.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hyperthyroidism caused by an ectopic thyrotropin-secreting tumor of the nasopharynx: a case report and review of the literature. AU - Tong,Anli, AU - Xia,Weibo, AU - Qi,Fang, AU - Jin,Zimeng, AU - Yang,Di, AU - Zhang,Zhuhua, AU - Li,Fang, AU - Xing,Xiaoping, AU - Lian,Xiaolan, Y1 - 2013/08/27/ PY - 2013/2/14/entrez PY - 2013/2/14/pubmed PY - 2015/5/20/medline SP - 1172 EP - 7 JF - Thyroid : official journal of the American Thyroid Association JO - Thyroid VL - 23 IS - 9 N2 - BACKGROUND: Ectopic thyrotropin (TSH)-secreting tumors are extremely rare. To our knowledge, only three cases have previously been reported so far, but the tumors were not studied ultrastructurally and in vitro. We present a case that was extensively examined to gain deeper insights in terms of the histopathological features and hormonal secretion profile of the tumor. PATIENT FINDINGS: A 49-year-old female complained of nasal obstruction for 15 years and thyrotoxicosis for one and a half years. Except for a high basal TSH with concomitantly elevated free tri-iodothyronine (FT3) and free thyroxine (FT4) levels, her pituitary hormone profile yielded normal results. Magnetic resonance imaging revealed a 2 cm × 2 cm mass in the nasopharynx, which showed an increased tracer uptake on octreotide scintigraphy. Preoperative treatment with octreotide effectively reduced serum TSH, FT3, and FT4 to normal levels. The mass was endoscopically removed via an endonasal approach. Immunophenotyping and hormone determination of cultured cells confirmed that the mass was a plurihormonal TSH-/growth hormone (GH)-/prolactin (PRL)-producing adenoma. Co-expression of TSH and GH was found in most cells. Electron microscopy showed that the adenoma was formed by a single cell type, with secretory granules of small size. In vitro studies demonstrated that octreotide reduced both TSH and GH secretion. SUMMARY: We report an ectopic TSH-secreting tumor, which had plurihormonal secretion in vitro, including TSH, GH, and PRL. Histologically, it mimicked a TSH-secreting pituitary adenoma. Octreotide was useful in the diagnosis and treatment of this ectopic TSH-secreting tumor. CONCLUSIONS: Ectopic TSH-secreting tumors are extremely rare. In terms of hormone secretion profile, histological characteristics, and response to octreotide, they are similar to pituitary TSH-secreting adenomas, suggesting that they are of identical cell origin. SN - 1557-9077 UR - https://www.unboundmedicine.com/medline/citation/23402621/Hyperthyroidism_caused_by_an_ectopic_thyrotropin_secreting_tumor_of_the_nasopharynx:_a_case_report_and_review_of_the_literature_ L2 - https://www.liebertpub.com/doi/10.1089/thy.2012.0574?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -