Clinical challenges of a co-secreting TSH/GH pituitary adenoma

Ng, Hui Yi; Namboodiri, Divya; Learoyd, Diana; Davidson, Andrew; Champion, Bernard; Preda, Veronica

doi:10.1530/edm-19-0068

Cited by 11 publications

(18 citation statements)

References 9 publications

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“…It is known that both GH-producing somatotroph and TSH-producing thyrotroph are derived from Pit-1-producing cells in the process of differentiation into mature pituitary cells ( 11 ). Therefore, from the point of cell lineage, GH-producing and TSH-producing cells are relatively close.…”

Section: Discussionmentioning

confidence: 99%

Case Report: A Case of Pituitary Adenoma Producing Growth Hormone and Thyroid-Stimulating Hormone Simultaneously

et al. 2021

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BackgroundPituitary adenoma producing growth hormone (GH) or thyroid-stimulating hormone (TSH) is characterized by various specific symptoms and/or findings. However, the frequency of pituitary adenoma producing both hormones is relatively low. In this report, we show a case of pituitary adenoma producing both GH and TSH simultaneously.Case presentationA 27-year-old woman was diagnosed as acromegaly based on various symptoms and clinical findings. For further examination and treatment, she was hospitalized in our institution. It was likely that this subject had pituitary adenoma producing both GH and TSH. In brain magnetic resonance imaging, there was a giant tumor around pituitary fossa. After the diagnosis of GH- and TSH-producing pituitary adenoma, pituitary tumor resection and cyber knife therapy were performed. In addition, we started additional treatment with somatostatin analog and GH receptor antagonist. After then, GH and insulin-like growth factor (IGF-1) levels were suppressed. After the operation, since thyroid function was not sufficiently suppressed, we started anti-thyroid drug thiamazole. After then, thyroid function was normalized and we stopped thiamazole. In GH and TSH staining, many GH-positive and TSH-positive cells were observed. These findings further confirmed our diagnosis that the pituitary adenoma in this subject produced both GH and TSH simultaneously.ConclusionsWe should bear in mind the possibility of pituitary adenoma producing both GH and TSH at the same time.

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Section: Discussionmentioning

confidence: 99%

Case Report: A Case of Pituitary Adenoma Producing Growth Hormone and Thyroid-Stimulating Hormone Simultaneously

et al. 2021

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“…Thus, TSHoma coexisting with thyroid cancer has a non-negligible incidence and is a complex disease that is challenging to treat. Furthermore, when a TSHoma co-secretes other pituitary hormones, its management becomes even more difficult because of the interactions among hormones [ 15 ]. Approximately one-quarter of TSHomas are mixed pituitary adenomas with concomitant hormonal hypersecretion; TSH/GH co-secretion is the most frequent [ 5 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…Scarcely reported Pit-1 lineage plurihormonal pituitary adenomas are frequently large and invasive. Pit-1 overexpression was associated with cell proliferation in GH, prolactin, and TSH secreting pituitary adenomas, even though the pathomechanism was still unclear [ 15 , 33 ].…”

Section: Discussionmentioning

confidence: 99%

A challenging TSH/GH co-secreting pituitary adenoma with concomitant thyroid cancer; a case report and literature review

et al. 2021

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Background Thyroid stimulating hormone (TSH) secreting pituitary adenoma (TSHoma) with coexisting thyroid cancer is extremely rare, and proper treatment of both diseases may pose a unique clinical challenge. When TSHoma has plurihormonality, particularly involving the co-secretion of growth hormone (GH), management can be more complicated. Herein, we present a difficult-to-manage case of papillary thyroid cancer with an incurable TSH/GH-secreting pituitary adenoma. Case presentation A 59-year-old man was referred to our hospital due to memory impairment and inappropriate TSH level. Sella magnetic resonance imaging revealed a huge pituitary mass extending to the suprasellar area. Clinical diagnosis of TSH/GH co-secreting pituitary adenoma was made based on elevated free T4, total T3, serum α-subunit, insulin-like growth factor-1 levels and non-suppressible GH levels after oral glucose loading. Rectal cancer and multifocal papillary thyroid microcarcinoma (PTMC) were diagnosed during initial screening for internal malignancy; lower anterior resection was performed and close observation was planned for PTMC. Long-acting octreotide therapy was commenced, which resulted in a dramatic reduction in TSHoma size and facilitated control of hormonal excess. Total thyroidectomy and radioactive iodine (RAI) therapy were needed during follow up due to the growth of PTMC. After the surgery, the pituitary adenoma represented resistance to somatostatin analogue therapy and the tumor size gradually increased despite the addition of dopamine agonist therapy. Furthermore, TSH suppressive therapy with levothyroxine was impossible and an adequate TSH level for RAI therapy was unmountable. Late debulking pituitary surgery was ineffective, and the patient gradually deteriorated and lost to follow up. Conclusion We report the first aggravated case of TSH/GH co-secreting pituitary tumor after total thyroidectomy for concomitant multifocal PTMC. Deferring of thyroid surgery until the TSHoma is well controlled may be the optimal therapeutic strategy in patients with TSHoma and coexistent thyroid cancer; ablative thyroid surgery may result in catastrophic pituitary tumor growth.

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“…The clinical symptoms were variable. Some only presented with hyperthyroidism (12,9,14). Simultaneously, some patients showed acromegaly with hyperprolactinemia (11) or hyperthyroidism (16,17).…”

Section: Discussionmentioning

confidence: 99%

Plurimorphous plurihormonal Pit-1 positive macroadenoma with central hyperthyroidism: a rare case report and literature review

Peng

Guo

et al. 2022

Preprint

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Background Thyrotropin (TSH)-secreting pituitary neuroendocrine tumors (PitNETs) are pretty rare pituitary adenomas, occasionally accompanied by hypersecretion of other anterior pituitary hormones: growth hormone (GH) and prolactin (PRL). The clinical, biochemical, and pathological characteristics may represent diverse circumstances. Case presentation: In this report, a 33-year-old woman diagnosed with TSH PitNET co-secreting GH presented no obvious clinical symptoms. The main characteristics were elevated TSH, fT3, and fT4 levels accompanied by slightly elevated GH and IGF-1levels. The magnetic resonance imaging (MRI) detected a pituitary macroadenoma (18×16×16mm) with cavernous sinus and suprasellar invasion. The immunohistochemistry revealed diffuse positivity for TSH, strong immunoreactivity for GH, and sporadic positivity for PRL. The electron microscope and double immunofluorescence staining confirmed that a plurimorphous plurihormonal adenoma produced TSH, GH, and PRL. After preoperative somatostatin receptor ligands (SRLs) treatment and transsphenoidal surgery, the patient achieved clinical and biochemical remission during follow-up. Conclusion In the TSH PitNET, the positive immunohistochemistry for TSH, GH, and PRL translated into hormonal overproduction with TSH and GH.

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Clinical challenges of a co-secreting TSH/GH pituitary adenoma

Cited by 11 publications

References 9 publications

Case Report: A Case of Pituitary Adenoma Producing Growth Hormone and Thyroid-Stimulating Hormone Simultaneously

Case Report: A Case of Pituitary Adenoma Producing Growth Hormone and Thyroid-Stimulating Hormone Simultaneously

A challenging TSH/GH co-secreting pituitary adenoma with concomitant thyroid cancer; a case report and literature review

Plurimorphous plurihormonal Pit-1 positive macroadenoma with central hyperthyroidism: a rare case report and literature review

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