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[Hyperthyroidism due to a TSH-secreting pituitary tumor]
Nihon Naibunpi Gakkai Zasshi
|January 20, 1987
Summary
A rare TSH-secreting pituitary adenoma caused persistent hyperthyroidism in a woman. Surgical removal normalized thyroid hormone levels, confirming the adenoma as the cause.
Area of Science:
- Endocrinology
- Neurosurgery
- Oncology
Background:
- A 28-year-old female presented with a 12-year history of goiter and clinical/laboratory evidence of hyperthyroidism.
- She exhibited persistently elevated serum TSH despite antithyroid drug treatment and a blunted TSH response to TRH stimulation.
Observation:
- Despite normal menses, prolactin, LH, and FSH levels, a pituitary adenoma with suprasellar extension was identified.
- Microscopic examination revealed chromophobic cells with calcification, suggestive of thyrotrophs, confirmed by TSH beta positivity on immunoperoxidase staining.
Findings:
- Subtotal thyroidectomy followed by radioactive iodine therapy did not resolve hyperthyroidism.
- Transsphenoidal removal of the pituitary adenoma normalized serum TSH levels and TRH response post-operatively.
- The patient was subsequently diagnosed with hypothyroidism and initiated on thyroid replacement therapy.
Implications:
- This case highlights a rare TSH-secreting pituitary adenoma as a cause of persistent hyperthyroidism.
- Successful surgical resection of the adenoma led to normalization of TSH secretion and reversal of hyperthyroid state.
- The review of previously reported TSH-secreting adenomas associated with hyperthyroidism provides further clinical context.