Thyrotropin-producing pituitary adenoma associated with Graves' disease

Koriyama, Nobuyuki; Nakazaki, Mitsuhiro; Hashiguchi, Hiroshi; Aso, Katsumi; Ikeda, Yoichi; Kimura, Takashi; Eto, Hideyuki; Hirano, Hirofumi; Nakano, Shizuo

doi:10.1530/eje.0.1510587

Cited by 24 publications

(33 citation statements)

References 36 publications

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“…In some previously reported patients, Graves' disease and thyrotropinoma occurred consecutively, not concomitantly, because there was insufficient evidence of thyrotropinoma at the time that Graves' disease was detected (8)(9)(10). Two previous patients, however, seemed to have concomitant Graves' disease and thyrotropinoma (11,12), which was similar to our findings in patient 3.…”

Section: Discussionsupporting

confidence: 88%

Thyrotropinomas: Presentation of Three Cases and Review of Literature

Diri¹,

Şimşek²,

Karaca³

et al. 2016

Erciyes Med J

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Thyrotropinomas are rare pituitary tumors that are difficult to diagnose due to their variety of clinical presentations. We describe three patients with thyrotropinoma and review the management of this disease based on current literature. Patient 1 had a typical acromegalic phenotype with a pituitary adenoma that secreted both growth hormone (GH) and thyroid-stimulating hormone (TSH). Patient 2 underwent pituitary surgery without antithyroid treatment; this tumor was also positive for both TSH and GH on pathological examination, and the patient experienced transient central hypothyroidism postoperatively. Patient 3, who had both a thyrotropinoma and autoimmune thyroiditis, underwent surgery after one year of treatment with lanreotide; the removed pituitary adenoma was positive only for TSH. To our knowledge, concomitant Graves' disease and thyrotropinoma is very rare, with only two patients previously reported. In conclusion, thyrotropinomas are increasingly being encountered when they are smaller, which has improved patient prognosis. Nevertheless, the diagnosis and perioperative management of thyrotropinomas remain challenging, which suggests that patients with such tumors should be managed by endocrinologists.

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Section: Discussionsupporting

confidence: 88%

Thyrotropinomas: Presentation of Three Cases and Review of Literature

Diri¹,

Şimşek²,

Karaca³

et al. 2016

Erciyes Med J

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“…Previously, only six cases of such association and with histological confirmation have been reported [4,5,6,7,8,9] (table 1). Five cases were reported in female patients.…”

Section: Discussionmentioning

confidence: 99%

“…The coexistence of autoimmune thyroid disease and TSHoma is rarely reported. Very few cases of coexistence of TSHoma with hyperthyroidism due to Graves' disease have been reported [4,5,6,7,8,9]. Here, we describe a female patient displaying TSHoma with Graves' disease who presented initially with inappropriate TSH values.…”

Section: Introductionmentioning

confidence: 87%

Coexistence of Thyroid-Stimulating Hormone-Secreting Pituitary Adenoma and Graves' Hyperthyroidism

et al. 2013

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Background: Coexistence of thyroid-stimulating hormone (TSH)-secreting pituitary adenoma (TSHoma) with Graves' disease has been rarely reported. We describe a female patient displaying TSHoma with Graves' disease and who presented initially with inappropriate TSH values. Case Report: A 36-year-old woman presented with signs of thyrotoxicosis, small and vascular goiter and mild bilateral exophthalmos. Thyroid function tests showed hyperthyroxinemia and normal TSH values despite the use of different assays. Heterophile antibody testing result was negative. The patient underwent total right lobectomy with partial left lobectomy after 18 months of carbimazole treatment. Histology confirmed Graves' disease. Symptoms of thyrotoxicosis recurred 2 months later. Thyroid function tests showed hyperthyroxinemia and elevated TSH values. Investigations were consistent with a 10-mm TSHoma. The patient underwent a trans-sphenoidal tumor resection following preoperative lanreotide preparation. Histological examination and immunocytochemistry concluded to a pure TSH-producing tumor. There was no evidence of tumor recurrence after 18 years of follow-up. Conclusion: Association of TSHoma with Graves' disease should be carefully taken into account, especially when TSH values are not compatible with either the clinical history or other thyroid functions tests.

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“…While serum TSH concentration was decreased to a normal range in response to treatment with the somatostatin analog, octreotide, the concentrations of free T3 and free T4 were not normalized and tachycardia continued. Some cases of TSHoma complicated by Graves' disease have been reported [10][11][12]. TSH is known to repress the expression of interferon-γ-induced Fas antigen [13], intercellular adhesion molecule (ICAM)-1 [14] and class II trans-activator, which is a non-DNAbinding regulator of major histocompatibility complex (MHC) transcription on the thyroid cell surface [11].…”

Section: A B Cmentioning

confidence: 99%

“…Some cases of TSHoma complicated by Graves' disease have been reported [10][11][12]. TSH is known to repress the expression of interferon-γ-induced Fas antigen [13], intercellular adhesion molecule (ICAM)-1 [14] and class II trans-activator, which is a non-DNAbinding regulator of major histocompatibility complex (MHC) transcription on the thyroid cell surface [11]. Rapid reductions in TSH levels after the treatment of TSHoma may induce Fas-mediated apoptosis, as a result of cell surface Fas expression and expression of both ICAM-1 and MHC class II molecules on the cell surface of thyroid cells.…”

Section: A B Cmentioning

confidence: 99%

A case of TSH-producing adenoma treated with octreotide in combination with thiamazole for the control of TSH and thyroid hormones after trans-sphenoidal neurosurgery

et al. 2011

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Thyroid-sTimulaTing hormone (TSH) -producing pituitary adenomas (TSHoma) are rare, accounting for 0.5-1.1% of all pituitary adenomas [1,2]. The diagnosis of these adenomas can be delayed and most TSH-producing adenomas are macroadenomas [1]. Herein, we report a patient with chronic heart and renal failure who was diagnosed with TSH-producing adenoma and underwent treatment with octreotide and thiamazole to control the level of TSH and thyroid hormone secretion after pituitary trans-sphenoidal surgery.A case of TSH-producing adenoma treated with octreotide in combination with thiamazole for the control of TSH and thyroid hormones after trans-sphenoidal neurosurgery Sayaka Fukushima 1) , Masaki Takahashi 2) , Chihiro Yoneda 1) , Hiroyuki Matsuura 1) , Takenori Haruki 1) , Jun Ogino 1) , Minako Koike 2) , Osami Kubo 4) , Takakazu Kawamata 3) and Naotake Hashimoto 1) abstract. While TSH-producing adenoma (TSHoma) is rare, the diagnosis is often delayed because the clinical features are heterogeneous. The patient was a 69-year-old woman who had been referred to the Yachiyo Medical Center in August 2008, because of dyspnea, loss of appetite, weight loss of 10 kg, and diarrhea that lasted 4 years. We diagnosed this patient with pituitary TSH-producing macroadenoma. Thyroid hormone concentration was increasing although the serum TSH level was within a normal range after trans-sphenoidal surgery. We considered that because of enlargement of the thyroid gland due to long-term stimulation by TSH, a low concentration of TSH could stimulate the thyroid gland to produce excess T3 or T4. The somatostatin analogue, octreotide was used to control the TSHoma and serum TSH concentration but not thyroid hormone. The octreotide in combination with thiamazole treatment for 14 months controlled thyroid hormone concentration and decreased the thyroid mass, and ultimately, the thiamazole could be stopped. To date, the use of combination therapy of octreotide with thiamazole in patients with remaining TSH-producing adenoma without Basedow's disease is rare, and we suggest that this treatment is one of the therapeutic means to treat recurrence of TSH-producing adenoma after surgery with progressive complications or large thyroid gland.

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Thyrotropin-producing pituitary adenoma associated with Graves' disease

Cited by 24 publications

References 36 publications

Thyrotropinomas: Presentation of Three Cases and Review of Literature

Thyrotropinomas: Presentation of Three Cases and Review of Literature

Coexistence of Thyroid-Stimulating Hormone-Secreting Pituitary Adenoma and Graves' Hyperthyroidism

A case of TSH-producing adenoma treated with octreotide in combination with thiamazole for the control of TSH and thyroid hormones after trans-sphenoidal neurosurgery

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