Hyperthyroidism Due to Thyroid-Stimulating Hormone Secretion After Surgery for Cushing's Syndrome: A Novel Cause of the Syndrome of Inappropriate Secretion of Thyroid-Stimulating Hormone

Tamada, Daisuke; Onodera, Toshiharu; Kitamura, Tatsuya; Yamamoto, Yorimasa; Hayashi, Yoshitaka; Murata, Yoshiharu; Otsuki, Michio; Shimomura, Iichiro

doi:10.1210/jc.2013-2135

Cited by 12 publications

(25 citation statements)

References 19 publications

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“…From the next day, while observing symptoms, the HC dose should be gradually tapered to 100 mg, 75 mg and 50 mg per day. A hyperthyroid state due to the syndrome of inappropriate TSH secretion [37] is sometimes observed owing to the rapid tapering of HC, in which case we suggest gradual decreases in the dose of HC.…”

Section: I-44 Cushing's Syndrome After Surgerymentioning

confidence: 77%

“…The longer the duration of Cushing's syndrome, the longer the replacement of HC after adrenalectomy is [63]. In the process of tapering HC, steroid withdrawal syndrome can be observed even with 20 mg HC [64], and the syndrome of inappropriate TSH secretion may take place, which may lead to symptoms of steroid withdrawal syndrome [37]. In such cases, gradual tapering of HC is necessary.…”

Section: [Cushing's Syndrome]mentioning

confidence: 99%

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Diagnosis and treatment of adrenal insufficiency including adrenal crisis: a Japan Endocrine Society clinical practice guideline [Opinion]

et al. 2016

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Abstract. This clinical practice guideline of the diagnosis and treatment of adrenal insufficiency (AI) including adrenal crisis was produced on behalf of the Japan Endocrine Society. This evidence-based guideline was developed by a committee including all authors, and was reviewed by a subcommittee of the Japan Endocrine Society. The Japanese version has already been published, and the essential points have been summarized in this English language version. We recommend diagnostic tests, including measurement of basal cortisol and ACTH levels in combination with a rapid ACTH (250 µg corticotropin) test, the CRH test, and for particular situations the insulin tolerance test. Cut-off values in basal and peak cortisol levels after the rapid ACTH or CRH tests are proposed based on the assumption that a peak cortisol level ≥18 µg/ dL in the insulin tolerance test indicates normal adrenal function. In adult AI patients, 15-25 mg hydrocortisone (HC) in 2-3 daily doses, depending on adrenal reserve and body weight, is a basic replacement regime for AI. In special situations such as sickness, operations, pregnancy and drug interactions, cautious HC dosing or the correct choice of glucocorticoids is necessary. From long-term treatment, optimal diurnal rhythm and concentration of serum cortisol are important for the prevention of cardiovascular disease and osteoporosis. In maintenance therapy during the growth period of patients with 21-hydroxylase deficiency, proper doses of HC should be used, and long-acting glucocorticoids should not be used. Education and carrying an emergency card are essential for the prevention and rapid treatment of adrenal crisis.Key words: Adrenal insufficiency, Adrenal crisis, Cortisol, Hydrocortisone, Congenital adrenal hyperplasia Summary of Recommendations I. Chronic adrenal insufficiency (AI) I-1.0 SymptomsWe recommend suspecting AI in patients who have the following symptoms.

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Section: I-44 Cushing's Syndrome After Surgerymentioning

confidence: 77%

Section: [Cushing's Syndrome]mentioning

confidence: 99%

Diagnosis and treatment of adrenal insufficiency including adrenal crisis: a Japan Endocrine Society clinical practice guideline [Opinion]

et al. 2016

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“…Also, rarely, thyroxin binding globulin (TBG) deficiency can result in decreased levels of total thyroid hormone and thereby increased free T4 (85), from lower binding capacity, even if TBG deficiency is most commonly presented as central hypothyroidism. Another rare cause of SITSH is inadequate hydrocortisone replacement after surgery in Cushing's syndrome (86).…”

Section: Differential Diagnosesmentioning

confidence: 99%

DIAGNOSIS OF ENDOCRINE DISEASE: Diagnostic approach to TSH-producing pituitary adenoma

Tjörnstrand

Nyström

2017

European Journal of Endocrinology

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Thyrotropin (TSH)-secreting adenomas (TSHomas) are the rarest form of pituitary adenomas, and most endocrinologists will see few cases in a lifetime, if any. In most cases, the diagnostic approach is complicated and cases may be referred after being presented as a syndrome of inappropriate TSH secretion or as a pituitary mass. This review aims to cover the past, present and possible future diagnostic approaches to TSHomas, including different clinical presentations, laboratory assessment and imaging advances. The differential diagnoses will be discussed, as well as possible coexisting disorders. By evaluating the existing reports and reviews describing this rare condition, this review aims to present a clinically practical suggestion on the diagnosic workup for TSHomas, Major advances and scientific breakthroughs in the imaging area in recent years, facilitating diagnosis of TSHomas, support the belief that future progress within the imaging field will play an important role in providing methods for a more efficient diagnosis of this rare condition.

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“…High TSH levels continued after thyroid hormones came back to the normal level with the recovery of adrenal insufficiency from surgery for CS. We have recently reported the patient with hyperthyroidism due to SITSH after CS surgery [12]. Both FT3 and FT4 were high in the patient.…”

Section: Discussionmentioning

confidence: 78%

“…replacement of HC and that SITSH is the main reason for the symptoms of SWS [12]. However, it remains unknown how long fluctuations of thyroid hormones continues after surgery for CS.…”

Section: Resultsmentioning

confidence: 99%

Clinical significance of fluctuations in thyroid hormones after surgery for Cushing’s syndrome

et al. 2015

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Hyperthyroidism Due to Thyroid-Stimulating Hormone Secretion After Surgery for Cushing's Syndrome: A Novel Cause of the Syndrome of Inappropriate Secretion of Thyroid-Stimulating Hormone

Cited by 12 publications

References 19 publications

Diagnosis and treatment of adrenal insufficiency including adrenal crisis: a Japan Endocrine Society clinical practice guideline [Opinion]

Diagnosis and treatment of adrenal insufficiency including adrenal crisis: a Japan Endocrine Society clinical practice guideline [Opinion]

DIAGNOSIS OF ENDOCRINE DISEASE: Diagnostic approach to TSH-producing pituitary adenoma

Clinical significance of fluctuations in thyroid hormones after surgery for Cushing’s syndrome

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Hyperthyroidism Due to Thyroid-Stimulating Hormone Secretion After Surgery for Cushing's Syndrome: A Novel Cause of the Syndrome of Inappropriate Secretion of Thyroid-Stimulating Hormone

Cited by 12 publications

References 19 publications

Diagnosis and treatment of adrenal insufficiency including adrenal crisis: a Japan Endocrine Society clinical practice guideline [Opinion]

Diagnosis and treatment of adrenal insufficiency including adrenal crisis: a Japan Endocrine Society clinical practice guideline [Opinion]

DIAGNOSIS OF ENDOCRINE DISEASE: Diagnostic approach to TSH-producing pituitary adenoma

Clinical significance of fluctuations in thyroid hormones after surgery for Cushing&rsquo;s syndrome

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Clinical significance of fluctuations in thyroid hormones after surgery for Cushing’s syndrome