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Ectopic Thyroid-Stimulating Hormone-Secreting Pituitary Adenoma of the Nasopharynx Diagnosed by Gallium 68 DOTATATE Positron Emission Tomography/Computed Tomography.
World Neurosurg. 2019 05; 125:400-404.WN

Abstract

BACKGROUND

Ectopic thyroid-secreting hormone (TSH)-secreting pituitary adenomas are rare, with only 9 cases reported in the literature.

CASE DESCRIPTION

We describe a case of an ectopic TSH-secreting pituitary adenoma located in the nasopharynx in a patient initially presenting with signs and symptoms of hyperthyroidism that persisted despite treatment with antithyroid medications. Magnetic resonance imaging of the pituitary gland was normal, although subsequent review by a neuroradiologist revealed a nodule attached to the posterior septum in the nasopharynx that was, in retrospect, seen on several other magnetic resonance imaging scans. Gallium 68 (68Ga) DOTATATE positron emission tomography/computed tomography showed increased uptake in the nasopharyngeal nodule. The patient underwent resection of the nasopharyngeal mass with remission of hyperthyroidism. On pathology, the resected mass stained positive for TSH and prolactin.

CONCLUSIONS

This is the first report of use of 68Ga-DOTATATE positron emission tomography/computed tomography to aid in localizing an ectopic TSH-secreting tumor. Prior studies have shown that 68Ga-DOTATATE positron emission tomography/computed tomography improves detection of small lesions with shorter imaging times and lower radiation doses compared with other modalities. Our case emphasizes the importance of using 68Ga-DOTATATE PET/CT in the diagnosis of ectopic pituitary adenomas, as these tumors can be challenging to diagnose radiographically.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Kim S
Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, University of California, San Francisco, San Francisco, California, USA. Electronic address: stephanie.kim@ucsf.edu.
Dillon WP
Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA.
Hope TA
Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA.
El-Sayed IH
Division of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, USA.
van Zante A
Department of Pathology, University of California, San Francisco, San Francisco, California, USA.
Wu K
Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, University of California, San Francisco, San Francisco, California, USA.
Masharani U
Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, University of California, San Francisco, San Francisco, California, USA.

MeSH

AdenomaEndoscopyFemaleHumansMiddle AgedNasopharyngeal NeoplasmsOrganometallic CompoundsPituitary NeoplasmsPositron Emission Tomography Computed TomographyThyrotropinTreatment Outcome

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

30797906

Citation

Kim, Stephanie, et al. "Ectopic Thyroid-Stimulating Hormone-Secreting Pituitary Adenoma of the Nasopharynx Diagnosed By Gallium 68 DOTATATE Positron Emission Tomography/Computed Tomography." World Neurosurgery, vol. 125, 2019, pp. 400-404.
Kim S, Dillon WP, Hope TA, et al. Ectopic Thyroid-Stimulating Hormone-Secreting Pituitary Adenoma of the Nasopharynx Diagnosed by Gallium 68 DOTATATE Positron Emission Tomography/Computed Tomography. World Neurosurg. 2019;125:400-404.
Kim, S., Dillon, W. P., Hope, T. A., El-Sayed, I. H., van Zante, A., Wu, K., & Masharani, U. (2019). Ectopic Thyroid-Stimulating Hormone-Secreting Pituitary Adenoma of the Nasopharynx Diagnosed by Gallium 68 DOTATATE Positron Emission Tomography/Computed Tomography. World Neurosurgery, 125, 400-404. https://doi.org/10.1016/j.wneu.2019.02.022
Kim S, et al. Ectopic Thyroid-Stimulating Hormone-Secreting Pituitary Adenoma of the Nasopharynx Diagnosed By Gallium 68 DOTATATE Positron Emission Tomography/Computed Tomography. World Neurosurg. 2019;125:400-404. PubMed PMID: 30797906.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Ectopic Thyroid-Stimulating Hormone-Secreting Pituitary Adenoma of the Nasopharynx Diagnosed by Gallium 68 DOTATATE Positron Emission Tomography/Computed Tomography. AU - Kim,Stephanie, AU - Dillon,William P, AU - Hope,Thomas A, AU - El-Sayed,Ivan H, AU - van Zante,Annemieke, AU - Wu,Karin, AU - Masharani,Umesh, Y1 - 2019/02/22/ PY - 2018/12/05/received PY - 2019/02/10/accepted PY - 2019/2/25/pubmed PY - 2019/11/19/medline PY - 2019/2/25/entrez KW - (68)Ga-Dotatate KW - Ectopic pituitary adenoma KW - Hyperthyroidism KW - PET/CT KW - TSH SP - 400 EP - 404 JF - World neurosurgery JO - World Neurosurg VL - 125 N2 - BACKGROUND: Ectopic thyroid-secreting hormone (TSH)-secreting pituitary adenomas are rare, with only 9 cases reported in the literature. CASE DESCRIPTION: We describe a case of an ectopic TSH-secreting pituitary adenoma located in the nasopharynx in a patient initially presenting with signs and symptoms of hyperthyroidism that persisted despite treatment with antithyroid medications. Magnetic resonance imaging of the pituitary gland was normal, although subsequent review by a neuroradiologist revealed a nodule attached to the posterior septum in the nasopharynx that was, in retrospect, seen on several other magnetic resonance imaging scans. Gallium 68 (68Ga) DOTATATE positron emission tomography/computed tomography showed increased uptake in the nasopharyngeal nodule. The patient underwent resection of the nasopharyngeal mass with remission of hyperthyroidism. On pathology, the resected mass stained positive for TSH and prolactin. CONCLUSIONS: This is the first report of use of 68Ga-DOTATATE positron emission tomography/computed tomography to aid in localizing an ectopic TSH-secreting tumor. Prior studies have shown that 68Ga-DOTATATE positron emission tomography/computed tomography improves detection of small lesions with shorter imaging times and lower radiation doses compared with other modalities. Our case emphasizes the importance of using 68Ga-DOTATATE PET/CT in the diagnosis of ectopic pituitary adenomas, as these tumors can be challenging to diagnose radiographically. SN - 1878-8769 UR - https://www.unboundmedicine.com/medline/citation/30797906/Ectopic_Thyroid_Stimulating_Hormone_Secreting_Pituitary_Adenoma_of_the_Nasopharynx_Diagnosed_by_Gallium_68_DOTATATE_Positron_Emission_Tomography/Computed_Tomography_ DB - PRIME DP - Unbound Medicine ER -