A Case of Pituitary Adenoma with Simultaneous Secretion of TSH and GH

Eun Young Lee; Cheol Ryong Ku; Hyun Min Kim; Woo Kyoung Lee; Jung Soo Lim; Sena Hwang; Do Hwan Kim; Dong Yeob Shin; Eun Jig Lee

doi:10.3803/EnM.2011.26.2.160

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Lee, Ku, Kim, Lee, Lim, Hwang, Kim, Shin, and Lee: A Case of Pituitary Adenoma with Simultaneous Secretion of TSH and GH

Case Report

Endocrinol Metab 2011;26(2):160-165.

Published online: 5 June 2011

DOI: https://doi.org/10.3803/EnM.2011.26.2.160

A Case of Pituitary Adenoma with Simultaneous Secretion of TSH and GH

Eun Young Lee, Cheol Ryong Ku, Hyun Min Kim, Woo Kyoung Lee, Jung Soo Lim, Sena Hwang, Do Hwan Kim¹, Dong Yeob Shin, Eun Jig Lee

¹Division of Endocrinology and Metabolism, Yonsei University College of Medicine, Seoul, Korea

Departments of Internal Medicine and Pathology, Yonsei University College of Medicine, Seoul, Korea

Corresponding author: Eun Jig Lee Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, 250 Seongsan-ro, Seodaemoon-gu, Seoul 120-752, Korea Tel: +82-2-2228-1983, Fax: +82-2-364-3636, E-mail: ejlee423@yuhs.ac

Received 3 September 2010 Accepted 13 October 2010

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

초록

Thyrotropin (TSH)-secreting pituitary adenoma is a very rare disease. In one-quarter of patients suffering from this disease, the pituitary tumor secretes other anterior pituitary hormones. Herein, we report a case of pituitary adenoma with simultaneous secretion of TSH and growth hormone (GH). A 34-year-old female visitied local hospital complaining of sweating, intermittent palpita-tion, and weight loss of 8 kg within 1 year. The patient had undergone trans-sphenoidal surgery 3 years prior for resolution of a TSH and GH co-secreting pituitary adenoma. She had been administered somatostatin analogue prior to visiting our hospital. The patient's GH levels were suppressed to below 1 ng/mL on the 75 g oral glucose tolerance test, and her basal insulin-like growth factor-I (IGF-I) level was within normal range. Thyroid function tests demonstrated increased levels of both free thyroxine and TSH. Sella-MRI revealed pituitary adenoma at the floor of the pituitary fossa, approximately 2 cm in height. Therefore, she was diagnosed with residual TSH-secreting pituitary adenoma. The patient again underwent trans-sphenoidal surgery and entered complete remission, based on hormone levels and MRI findings.

Keywords: Thyrotropin, Growth hormone, Pituitary adenoma

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Fig. 1.

A coronal view of TSH-secreting macroadenoma by MRI, which was taken before and after the surgery. A. About 30 mm sized macroadenoma displacing the enhanced pituitary gland cranially (arrows) before the first TSA (upper panel) and residual tumor (arrow heads) after the first TSA (lower panel). B. About 20 mm sized macroadenoma (arrows) at the floor of pituitary fossa before the second TSA (upper panel) and completely resected tumor after the second the TSA (lower panel). TSA, trans-sphenoidal surgery; TSH, thyroid stimulating hormone.

Fig. 2.

A high-power view of the pituitary adenoma. A. Tumor tissues show regular thin fibrous septa surrounding tumor cells and chromophobe adenoma (H&E stain, × 200). B-D. Immunohistochemical staining of the tumor cells was positive to TSH (B). and GH (C). and negative to PRL (D). (× 100). GH, growth hormone; RPL, prolactin; TSH, thyroid stimulating hormone.

Fig. 3.

Clinical course of the patient (changes in free T4 and TSH levels). MMI, methima-zole; POD, postoperative days; T4, thyroxine; TSA, trans-sphenoidal surgery; TSH, thyroid stimulating hormone

Table 1.

Results of 75 g glucose-GH suppression test

	Basal	60 min	120 min
Glucose (mg/dL)	82	193	160
GH (ng/mL)	2.66	0.63	0.58

GH normal, 0-9.5 ng/mL. GH, growth hormone.

Table 2.

Result of combined pituitary stimulation test (Regular insulin 0.1 U/kg, TRH 400 µ g, LHRH 100 µ g IV)

	Basal	30 min	60 min	90 min	120 min
Glucose (mg/dL)	83	34	46	59	80
GH (ng/mL)	1.98	9.31	10.87	9.99	5.6
TSH (µ IU/mL)	4.84	5.56	5.75	5.38	4.48
Prolactin (ng/mL)	9.32	45.64	50.13	61.5	32.64
Cortisol (µ g/dL)	3.64	7.42	18.40	20.09	22.67
ACTH (pg/mL)	3.21	184.50	155.20	114.80	39.57
LH (mIU/mL)	4.15	13.63	24.49	20.55	14.72
FSH (mIU/mL)	2.45	3.38	5.41	5.67	5.51

ACTH, adrenocorticotropic hormone; FSH, follicle stimulating hormone; GH, growth hormone; LH, luteinizing hormone; LHRH, luteinizing hormone-releasing hormone; TRH, thyrotropin-releasing hormone; TSH, thyroid stimulating hormone.

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