Tags

Type your tag names separated by a space and hit enter

A thyrotropin-secreting macroadenoma with positive growth hormone and prolactin immunostaining: A case report and literature review.
Niger J Clin Pract. 2015 Sep-Oct; 18(5):693-7.NJ

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.

Authors+Show Affiliations

Department of Endocrinology and Metabolism, Faculty of Medicine, Bülent Ecevit University, Zonguldak, Turkey.No 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

26096253

Citation

Kuzu, F, et al. "A Thyrotropin-secreting Macroadenoma With Positive Growth Hormone and Prolactin Immunostaining: a Case Report and Literature Review." Nigerian Journal of Clinical Practice, vol. 18, no. 5, 2015, pp. 693-7.
Kuzu F, Bayraktaroğlu T, Zor F, et al. A thyrotropin-secreting macroadenoma with positive growth hormone and prolactin immunostaining: A case report and literature review. Niger J Clin Pract. 2015;18(5):693-7.
Kuzu, F., Bayraktaroğlu, T., Zor, F., G N, B. D., Salihoğlu, Y. S., & Kalaycı, M. (2015). A thyrotropin-secreting macroadenoma with positive growth hormone and prolactin immunostaining: A case report and literature review. Nigerian Journal of Clinical Practice, 18(5), 693-7. https://doi.org/10.4103/1119-3077.158983
Kuzu F, et al. A Thyrotropin-secreting Macroadenoma With Positive Growth Hormone and Prolactin Immunostaining: a Case Report and Literature Review. Niger J Clin Pract. 2015 Sep-Oct;18(5):693-7. PubMed PMID: 26096253.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A thyrotropin-secreting macroadenoma with positive growth hormone and prolactin immunostaining: A case report and literature review. AU - Kuzu,F, AU - Bayraktaroğlu,T, AU - Zor,F, AU - G N,B D, AU - Salihoğlu,Y S, AU - Kalaycı,M, PY - 2015/6/23/entrez PY - 2015/6/23/pubmed PY - 2015/6/23/medline SP - 693 EP - 7 JF - Nigerian journal of clinical practice JO - Niger J Clin Pract VL - 18 IS - 5 N2 - 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. SN - 1119-3077 UR - https://www.unboundmedicine.com/medline/citation/26096253/A_thyrotropin_secreting_macroadenoma_with_positive_growth_hormone_and_prolactin_immunostaining:_A_case_report_and_literature_review_ L2 - http://www.njcponline.com/article.asp?issn=1119-3077;year=2015;volume=18;issue=5;spage=693;epage=697;aulast=Kuzu DB - PRIME DP - Unbound Medicine ER -