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TSH-secreting pituitary adenoma: benefits of pre-operative octreotide.

Wallace IR, Healy E, Cooke RS, Ellis PK, Harper R, Hunter SJ - Endocrinol Diabetes Metab Case Rep (2015)

Bottom Line: TSH-secreting pituitary adenomas are rare and the optimal investigation and management is uncertain.We describe a case of a 43 year-old woman with a TSH-secreting pituitary adenoma, highlighting diagnostic testing and our use, pre-operatively of somatostatin analogue therapy, which induced biochemical euthyroidism and a reduction in tumour size.The differential diagnosis of the syndrome of inappropriate TSH secretion is non-thyroidal illness, medications, assay interference due to heterophilic antibodies, thyroid hormone resistance and TSH-secreting pituitary adenoma.TRH stimulation test and triiodothyronine suppression test assist in differentiating thyroid hormone resistance and TSH-secreting pituitary adenoma.Somatostatin analogue therapy can induce biochemical euthyroidism and reduce tumour size.

View Article: PubMed Central - PubMed

Affiliation: Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital , Grosvenor Road, Belfast, BT12 6BA , UK.

ABSTRACT

Unlabelled: TSH-secreting pituitary adenomas are rare and the optimal investigation and management is uncertain. We describe a case of a 43 year-old woman with a TSH-secreting pituitary adenoma, highlighting diagnostic testing and our use, pre-operatively of somatostatin analogue therapy, which induced biochemical euthyroidism and a reduction in tumour size.

Learning points: The differential diagnosis of the syndrome of inappropriate TSH secretion is non-thyroidal illness, medications, assay interference due to heterophilic antibodies, thyroid hormone resistance and TSH-secreting pituitary adenoma.TRH stimulation test and triiodothyronine suppression test assist in differentiating thyroid hormone resistance and TSH-secreting pituitary adenoma.Somatostatin analogue therapy can induce biochemical euthyroidism and reduce tumour size.

No MeSH data available.


Related in: MedlinePlus

Histology of resected pituitary tissue. (A) Haematoxylin and eosin stain showing chromophobe adenoma tissue completely replacing normal pituitary tissue. (B) Immunohistochemical staining showing cells staining positive for TSH.
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fig2: Histology of resected pituitary tissue. (A) Haematoxylin and eosin stain showing chromophobe adenoma tissue completely replacing normal pituitary tissue. (B) Immunohistochemical staining showing cells staining positive for TSH.

Mentions: Following surgery, the patient had a transient period of diabetes insipidus with an otherwise uneventful post-operative course. Histological appearances were characteristic of a TSH-secreting pituitary adenoma (Fig. 2). At 3 months post-surgery, she remained clinically and biochemically euthyroid (free T4 12.1 pmol/l, TSH 0.930) with normal responses of other pituitary axes to dynamic testing. Repeat MRI demonstrated a residual pituitary mass of 6 mm in maximal diameter. A repeat T3 suppression test showed persistent failure to completely suppress TSH secretion in response to T3 (Table 4).


TSH-secreting pituitary adenoma: benefits of pre-operative octreotide.

Wallace IR, Healy E, Cooke RS, Ellis PK, Harper R, Hunter SJ - Endocrinol Diabetes Metab Case Rep (2015)

Histology of resected pituitary tissue. (A) Haematoxylin and eosin stain showing chromophobe adenoma tissue completely replacing normal pituitary tissue. (B) Immunohistochemical staining showing cells staining positive for TSH.
© Copyright Policy - license
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4477234&req=5

fig2: Histology of resected pituitary tissue. (A) Haematoxylin and eosin stain showing chromophobe adenoma tissue completely replacing normal pituitary tissue. (B) Immunohistochemical staining showing cells staining positive for TSH.
Mentions: Following surgery, the patient had a transient period of diabetes insipidus with an otherwise uneventful post-operative course. Histological appearances were characteristic of a TSH-secreting pituitary adenoma (Fig. 2). At 3 months post-surgery, she remained clinically and biochemically euthyroid (free T4 12.1 pmol/l, TSH 0.930) with normal responses of other pituitary axes to dynamic testing. Repeat MRI demonstrated a residual pituitary mass of 6 mm in maximal diameter. A repeat T3 suppression test showed persistent failure to completely suppress TSH secretion in response to T3 (Table 4).

Bottom Line: TSH-secreting pituitary adenomas are rare and the optimal investigation and management is uncertain.We describe a case of a 43 year-old woman with a TSH-secreting pituitary adenoma, highlighting diagnostic testing and our use, pre-operatively of somatostatin analogue therapy, which induced biochemical euthyroidism and a reduction in tumour size.The differential diagnosis of the syndrome of inappropriate TSH secretion is non-thyroidal illness, medications, assay interference due to heterophilic antibodies, thyroid hormone resistance and TSH-secreting pituitary adenoma.TRH stimulation test and triiodothyronine suppression test assist in differentiating thyroid hormone resistance and TSH-secreting pituitary adenoma.Somatostatin analogue therapy can induce biochemical euthyroidism and reduce tumour size.

View Article: PubMed Central - PubMed

Affiliation: Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital , Grosvenor Road, Belfast, BT12 6BA , UK.

ABSTRACT

Unlabelled: TSH-secreting pituitary adenomas are rare and the optimal investigation and management is uncertain. We describe a case of a 43 year-old woman with a TSH-secreting pituitary adenoma, highlighting diagnostic testing and our use, pre-operatively of somatostatin analogue therapy, which induced biochemical euthyroidism and a reduction in tumour size.

Learning points: The differential diagnosis of the syndrome of inappropriate TSH secretion is non-thyroidal illness, medications, assay interference due to heterophilic antibodies, thyroid hormone resistance and TSH-secreting pituitary adenoma.TRH stimulation test and triiodothyronine suppression test assist in differentiating thyroid hormone resistance and TSH-secreting pituitary adenoma.Somatostatin analogue therapy can induce biochemical euthyroidism and reduce tumour size.

No MeSH data available.


Related in: MedlinePlus