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<front>
<journal-meta>
<journal-id journal-id-type="nlm-ta">Endocrinol Metab</journal-id>
<journal-id journal-id-type="publisher-id">ENM</journal-id>
<journal-title>Endocrinology and Metabolism</journal-title>
<issn pub-type="ppub">2093-596X</issn>
<issn pub-type="epub">2093-5978</issn>
<publisher>
<publisher-name>Korean Endocrine Society</publisher-name>
</publisher>
</journal-meta>

<article-meta>
<article-id pub-id-type="doi">10.3803/EnM.2010.25.4.378</article-id>
<article-categories>
<subj-group>
<subject>Case Report</subject>
</subj-group>
</article-categories>
<title-group>
<article-title>The Effect of Octreotide LAR on GH and TSH Co-Secreting Pituitary Adenoma</article-title>
</title-group>

<contrib-group>

<contrib contrib-type="author">
<name>
<surname>Kim</surname>
<given-names>Nam Keong</given-names>
</name>
<xref ref-type="aff" rid="A1"></xref>
</contrib>

<contrib contrib-type="author">
<name>
<surname>Hah</surname>
<given-names>Yu Jin</given-names>
</name>
<xref ref-type="aff" rid="A1"></xref>
</contrib>

<contrib contrib-type="author">
<name>
<surname>Lee</surname>
<given-names>Ho Young</given-names>
</name>
<xref ref-type="aff" rid="A1"></xref>
</contrib>

<contrib contrib-type="author">
<name>
<surname>Kim</surname>
<given-names>Sang Jin</given-names>
</name>
<xref ref-type="aff" rid="A1"></xref>
</contrib>

<contrib contrib-type="author">
<name>
<surname>Kim</surname>
<given-names>Mi Kyung</given-names>
</name>
<xref ref-type="aff" rid="A1"></xref>
</contrib>

<contrib contrib-type="author">
<name>
<surname>Park</surname>
<given-names>Keun Gyu</given-names>
</name>
<xref ref-type="aff" rid="A1"></xref>
</contrib>

<contrib contrib-type="author">
<name>
<surname>Kim</surname>
<given-names>Ealmaan</given-names>
</name>
<xref ref-type="aff" rid="A2">1</xref>
</contrib>

<contrib contrib-type="author">
<name>
<surname>Chang</surname>
<given-names>Hyukwon</given-names>
</name>
<xref ref-type="aff" rid="A3">2</xref>
</contrib>

<contrib contrib-type="author" corresp="yes">
<name>
<surname>Kim</surname>
<given-names>Hye Soon</given-names>
</name>
<xref ref-type="aff" rid="A1"></xref>
</contrib>

</contrib-group>

<aff id="A1">Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea.</aff>
<aff id="A2"><label>1</label>Department of Neurosurgery, Keimyung University School of Medicine, Daegu, Korea.</aff>
<aff id="A3"><label>2</label>Department of Radiology, Keimyung University School of Medicine, Daegu, Korea.</aff>

<author-notes>
<corresp>Corresponding author: Hye Soon Kim. Department of Internal Medicine, Keimyung University School of Medicine, Dongsan-dong, Jung-gu, Daegu 700-712, Korea. Tel: +82-53-250-7417, Fax: +82-53-250-7434, <email>hsk12@dsmc.or.kr</email></corresp>
</author-notes>

<pub-date pub-type="ppub">
<month>12</month>
<year>2010</year>
</pub-date>
<pub-date pub-type="epub">
<day>31</day>
<month>12</month>
<year>2010</year>
</pub-date>
<volume>25</volume>
<issue>4</issue>
<fpage>378</fpage>
<lpage>381</lpage>
<history>
<date date-type="received">
<day>28</day>
<month>05</month>
<year>2010</year>
</date>
<date date-type="accepted">
<day>19</day>
<month>08</month>
<year>2010</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright &#x00A9; 2010 Korean Endocrine Society</copyright-statement>
<copyright-year>2010</copyright-year>
</permissions>

<abstract>
<p>Growth hormone (GH) and thyroid stimulating hormone (TSH)-secreting pituitary adenomas are very rare and they account for only 0.5&#x0025; for all pituitary adenomas. These adenomas are usually treated with surgery, but this surgery is not easy because the tumor is usually huge and invasive. We reported here on a case of a GH-TSH-secreting adenoma in a 23-year-old male patient who was initially treated with octreotide LAR. He presented with symptoms of headache, palpitation and a visual defect that he had for the 3 months. He had hypertrophy of the frontal bone and enlargement of both the hands and feet. The visual field test showed bitemporal hemianopsia. The laboratory examinations showed high serum levels of free T4, TSH and free alpha-subunit. Additionally, the serum levels of GH and insulin-like growth factor-I (IGF-I) were increased. GH was not suppressed below 1&#x00B5;g/L by an oral 75g glucose loading test, and TSH was not stimulated by thyrotropin-releasing hormone (TRH). Because sellar MRI showed invasive macroadenoma encasing the vessels, we initially tried octreotide LAR for treatment. A year later, the IGF-I and thyroid function tests were normalized and the size of the tumor was reduced with cystic change. The symptoms of palpitation and headache were improved without a change of the visual field defect.</p>
</abstract>

<kwd-group>
<kwd>Acromegaly</kwd>
<kwd>Octreotide LAR</kwd>
<kwd>Pituitary adenoma</kwd>
<kwd>TSH-secreting tumor</kwd>
</kwd-group>

</article-meta>
</front>

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<floats-wrap>

<fig position="float" id="F1">
<label>Fig. 1</label>
<caption>
  <p>Radiologic findings. (A) T2 weighted image (T2W1) sagittal scan of sellar shows a large lobulated mass lesion on the pituitary gland. (B) T2 weighted image (T2W1) sagittal scan of sella after 1 year using octreotide LAR shows reduction of previous mass with cystic change.</p>
</caption>
<graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="enm-25-378-g001" alt-version="no"></graphic>
</fig>

<table-wrap position="float" id="T1">
<label>Table 1</label>
<caption>
  <p>The response of TSH and the &#x03B1;-subunit to TRH stimulation test</p>
</caption>
<graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="enm-25-378-i001" alt-version="no"></graphic>
<table-wrap-foot>
<fn>
  <p>TSH, thyroid stimulating hormone; TRH, thyrotropin-releasing hormone.</p>
</fn>
</table-wrap-foot>
</table-wrap>

<table-wrap position="float" id="T2">
<label>Table 2</label>
<caption>
  <p>Serial follow up of the response of GH to 75 g glucose suppression test</p>
</caption>
<graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="enm-25-378-i002" alt-version="no"></graphic>
<table-wrap-foot>
<fn>
  <p>GH, growth hormone.</p>
</fn>
</table-wrap-foot>
</table-wrap>

<table-wrap position="float" id="T3">
<label>Table 3</label>
<caption>
  <p>Serial follow up of thyroid function tests and IGF-I levels</p>
</caption>
<graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="enm-25-378-i003" alt-version="no"></graphic>
<table-wrap-foot>
<fn>
  <p>IGF, insulin-like growth factor-I; TSH, thyroid stimulating hormone.</p>
</fn>
</table-wrap-foot>
</table-wrap>

</floats-wrap>

</article>