Thyroid-Stimulating Hormone/Growth Hormone Cosecreting Pituitary Adenoma With Normal Thyroid-Stimulating Hormone Level.

JCEM case reports Pub Date : 2025-04-11 eCollection Date: 2025-05-01 DOI:10.1210/jcemcr/luaf063
Feyza Erenler, Benjamin Katcher, Van Phan, Knarik Arkun, Mina G Safain
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Abstract

Thyroid-stimulating hormone (TSH; thyrotropin) adenoma is a rare pituitary tumor that can be missed due to its subtle symptoms. We are reporting a 67-year-old man with history of ventricular fibrillation on amiodarone who presented with acute headache and right third cranial nerve palsy. His computed tomography (CT) scan revealed a 2.2-cm suprasellar mass, consistent with pituitary apoplexy, and he underwent pituitary tumor resection. Preoperational hormonal workup revealed TSH 0.25 mIU/mL (0.25 IU/L) (normal reference range: 0.35-4.94 mIU/mL; 0.35-4.94 IU/L), free thyroxine (T4) 3.17 ng/dL (40.80 pmol/L) (normal reference range: 0.7-1.48 ng/dL; 9.78-19.05 pmol/L), and total triiodothyronine (T3) 91 ng/dL (140 nmol/L) (normal reference range: 58-159 ng/dL; 89-244 nmol/L). Initial differential diagnoses included TSH-producing pituitary adenoma (TSH-oma) and amiodarone-induced thyrotoxicosis. His free T4 declined significantly postoperatively, favoring a TSH-oma diagnosis. The pathology report showed a TSH and growth hormone (GH) cosecreting adenoma. Furthermore, he had a normal thyroid uptake scan, as well as negative thyroid antibodies, making primary thyroid diseases less likely. A high free T4 with normal TSH 3 years ago, prior to the start of amiodarone, suggested a long disease duration. This case demonstrates challenges in diagnosing TSH-oma, especially in patients with normal TSH and concurrent amiodarone use.

促甲状腺激素/生长激素共分泌垂体腺瘤促甲状腺激素水平正常。
促甲状腺激素(TSH;促甲状腺素腺瘤是一种罕见的垂体肿瘤,因其症状不易察觉而易被漏诊。我们报告一位67岁的男性患者,因服用胺碘酮而有心室颤动史,并表现为急性头痛和右第三脑神经麻痹。他的计算机断层扫描(CT)显示一个2.2厘米的鞍上肿块,符合垂体中风,他接受了垂体肿瘤切除术。术前激素检查显示TSH 0.25 mIU/mL (0.25 IU/L)(正常参考范围:0.35-4.94 mIU/mL;0.35-4.94 IU/L),游离甲状腺素(T4) 3.17 ng/dL (40.80 pmol/L)(正常参考范围:0.7-1.48 ng/dL;9.78-19.05 pmol/L),总三碘甲状腺原氨酸(T3) 91 ng/dL (140 nmol/L)(正常参考范围:58-159 ng/dL;89 - 244 nmol / L)。最初的鉴别诊断包括产生tsh的垂体腺瘤(TSH-oma)和胺碘酮诱导的甲状腺毒症。术后游离T4明显下降,有利于tsh瘤的诊断。病理报告显示为TSH和生长激素(GH)共分泌腺瘤。此外,他的甲状腺摄取扫描正常,甲状腺抗体阴性,原发性甲状腺疾病的可能性较小。3年前,在开始使用胺碘酮之前,游离T4高,TSH正常,提示病程长。本病例显示了诊断TSH瘤的挑战,特别是在TSH正常且同时使用胺碘酮的患者中。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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