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Severe hyperthyroidism due to neoplastic TSH hypersecretion in an old man
D Rubello1, B Busnardo, M E Girelli
1Istituto di Semeiotica Medica, Università di Padova, Italy.
Journal of Endocrinological Investigation
|September 1, 1989
Summary
This case study details neoplastic TSH hypersecretion in a man with severe hyperthyroidism and cardiovascular disease. Treatment with methimazole and radiotherapy showed limited success, with hyperthyroidism recurring after drug withdrawal.
Area of Science:
- Endocrinology
- Oncology
- Neoplastic Disorders
Background:
- A 62-year-old male presented with a 14-year history of severe hyperthyroidism and cardiovascular disease, refractory to prior treatments.
- The patient exhibited elevated thyroid-stimulating hormone (TSH) and thyroid hormone levels, alongside a markedly increased alpha-subunit serum level.
Observation:
- Imaging revealed an enlarged sella turcica with an intrasellar tumor, suggestive of a pituitary adenoma.
- The pituitary-thyroid feedback mechanism was altered, with absent TSH response to TRH and domperidone, but a decrease after bromocriptine.
- Methimazole therapy normalized thyroid hormones but paradoxically increased TSH, indicating a higher set-point for pituitary-thyroid feedback.
Findings:
- Neoplastic TSH hypersecretion was diagnosed, likely due to a pituitary tumor.
- Surgical intervention was precluded by cardiac issues during anesthesia.
- Combined radiotherapy and methimazole treatment led to an initial TSH surge followed by a gradual decrease, without normalization.
Implications:
- This case highlights the complexity of managing neoplastic TSH hypersecretion, particularly in patients with comorbidities.
- The altered feedback set-point and treatment responses underscore the unique pathophysiology of TSH-secreting pituitary adenomas.
- Effective long-term management strategies for such rare conditions require further investigation.