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A Rare Case of Thyrotropin-Secreting Pituitary Adenoma Coexisting with Papillary Thyroid Carcinoma Presenting with Visual Disturbance without Hyperthyroidism.
World Neurosurg. 2018 Nov; 119:394-399.WN

Abstract

BACKGROUND

Thyroid-stimulating hormone-secreting pituitary adenomas (TSHomas) are uncommon, and majority of the patients present with symptoms of hyperthyroidism. Herein, we report the first case of TSHoma with differentiated thyroid carcinoma (DTC) that presented with visual disturbance without any clinical feature of hyperthyroidism.

CASE DESCRIPTION

A 57-year-old man presented with left temporal hemianopsia of his left eye without any sign of hyperthyroidism. A mass lesion in the sellar and suprasellar region compressing the optic nerves was identified via magnetic resonance imaging. Free thyroxine and free triiodothyronine levels were slightly elevated, whereas the serum level of thyroid-stimulating hormone remained within normal range. Further endocrinologic examination led to the preoperative diagnosis of TSHoma. Ultrasonography and 111In-octreotide scan showed a mass lesion in left lobe of the thyroid gland, and subsequent thyroid aspiration biopsy confirmed the diagnosis of papillary thyroid carcinoma. After administration of short-acting octreotide to prevent thyrotoxic crisis in the perioperative period, the tumor was removed via endoscopic transnasal-transsphenoidal surgery, and the pathologic diagnosis of TSHoma was made. His visual acuity improved, and free triiodothyronine and free thyroxine levels normalized. He underwent thyroidectomy 3 months later after endoscopic transnasal-transsphenoidal surgery.

CONCLUSIONS

Herein, we report the first case of TSHoma with DTC that presented with visual disturbance without any clinical feature of hyperthyroidism and reviewed the 13 reported cases of TSHoma coexisting with DTC. The optimal treatment strategy in patients with TSHoma and coexistent DTC has not been established, and individualized therapeutic strategies are needed.

Authors+Show Affiliations

Department of Neurosurgery, Kumamoto University Hospital, Kumamoto, Japan.Department of Neurosurgery, Kumamoto University Hospital, Kumamoto, Japan. Electronic address: nshinojima-kuh@umin.ac.jp.Department of Neurosurgery, Kumamoto University Hospital, Kumamoto, Japan.Department of Neurosurgery, Kumamoto University Hospital, Kumamoto, Japan.Department of Neurosurgery, Hitoyoshi Medical Center, Kumamoto, Japan.Department of Metabolic Medicine, Kumamoto University Hospital, Kumamoto, Japan.Department of Metabolic Medicine, Kumamoto University Hospital, Kumamoto, Japan.Department of Metabolic Medicine, Kumamoto University Hospital, Kumamoto, Japan.Department of Metabolic Medicine, Kumamoto University Hospital, Kumamoto, Japan.Department of Breast and Endocrine Surgery, Kumamoto University Hospital, Kumamoto, Japan.Department of Diagnostic Pathology, Kumamoto University Hospital, Kumamoto, Japan.Department of Neurosurgery, Kumamoto University Hospital, Kumamoto, Japan.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

30096503

Citation

Inoue, Hirotaka, et al. "A Rare Case of Thyrotropin-Secreting Pituitary Adenoma Coexisting With Papillary Thyroid Carcinoma Presenting With Visual Disturbance Without Hyperthyroidism." World Neurosurgery, vol. 119, 2018, pp. 394-399.
Inoue H, Shinojima N, Ueda R, et al. A Rare Case of Thyrotropin-Secreting Pituitary Adenoma Coexisting with Papillary Thyroid Carcinoma Presenting with Visual Disturbance without Hyperthyroidism. World Neurosurg. 2018;119:394-399.
Inoue, H., Shinojima, N., Ueda, R., Yamamoto, K., Ishii, N., Igata, M., Kawashima, J., Araki, E., Iwase, H., Mikami, Y., Yano, S., & Mukasa, A. (2018). A Rare Case of Thyrotropin-Secreting Pituitary Adenoma Coexisting with Papillary Thyroid Carcinoma Presenting with Visual Disturbance without Hyperthyroidism. World Neurosurgery, 119, 394-399. https://doi.org/10.1016/j.wneu.2018.07.274
Inoue H, et al. A Rare Case of Thyrotropin-Secreting Pituitary Adenoma Coexisting With Papillary Thyroid Carcinoma Presenting With Visual Disturbance Without Hyperthyroidism. World Neurosurg. 2018;119:394-399. PubMed PMID: 30096503.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A Rare Case of Thyrotropin-Secreting Pituitary Adenoma Coexisting with Papillary Thyroid Carcinoma Presenting with Visual Disturbance without Hyperthyroidism. AU - Inoue,Hirotaka, AU - Shinojima,Naoki, AU - Ueda,Ryuta, AU - Yamamoto,Keizo, AU - Ishii,Norio, AU - Igata,Motoyuki, AU - Kawashima,Junji, AU - Araki,Eiichi, AU - Iwase,Hirotaka, AU - Mikami,Yoshiki, AU - Yano,Shigetoshi, AU - Mukasa,Akitake, Y1 - 2018/08/07/ PY - 2018/05/14/received PY - 2018/07/29/revised PY - 2018/07/30/accepted PY - 2018/8/11/pubmed PY - 2018/12/12/medline PY - 2018/8/11/entrez KW - Differentiated thyroid carcinoma KW - Hemianopsia KW - Pituitary adenomas KW - Thyroid-stimulating hormone SP - 394 EP - 399 JF - World neurosurgery JO - World Neurosurg VL - 119 N2 - BACKGROUND: Thyroid-stimulating hormone-secreting pituitary adenomas (TSHomas) are uncommon, and majority of the patients present with symptoms of hyperthyroidism. Herein, we report the first case of TSHoma with differentiated thyroid carcinoma (DTC) that presented with visual disturbance without any clinical feature of hyperthyroidism. CASE DESCRIPTION: A 57-year-old man presented with left temporal hemianopsia of his left eye without any sign of hyperthyroidism. A mass lesion in the sellar and suprasellar region compressing the optic nerves was identified via magnetic resonance imaging. Free thyroxine and free triiodothyronine levels were slightly elevated, whereas the serum level of thyroid-stimulating hormone remained within normal range. Further endocrinologic examination led to the preoperative diagnosis of TSHoma. Ultrasonography and 111In-octreotide scan showed a mass lesion in left lobe of the thyroid gland, and subsequent thyroid aspiration biopsy confirmed the diagnosis of papillary thyroid carcinoma. After administration of short-acting octreotide to prevent thyrotoxic crisis in the perioperative period, the tumor was removed via endoscopic transnasal-transsphenoidal surgery, and the pathologic diagnosis of TSHoma was made. His visual acuity improved, and free triiodothyronine and free thyroxine levels normalized. He underwent thyroidectomy 3 months later after endoscopic transnasal-transsphenoidal surgery. CONCLUSIONS: Herein, we report the first case of TSHoma with DTC that presented with visual disturbance without any clinical feature of hyperthyroidism and reviewed the 13 reported cases of TSHoma coexisting with DTC. The optimal treatment strategy in patients with TSHoma and coexistent DTC has not been established, and individualized therapeutic strategies are needed. SN - 1878-8769 UR - https://www.unboundmedicine.com/medline/citation/30096503/A_Rare_Case_of_Thyrotropin_Secreting_Pituitary_Adenoma_Coexisting_with_Papillary_Thyroid_Carcinoma_Presenting_with_Visual_Disturbance_without_Hyperthyroidism_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1878-8750(18)31754-6 DB - PRIME DP - Unbound Medicine ER -