Hyperthyroidism caused by a TSH-secreting pituitary adenoma

被引:0
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作者
Prasch, F
Knosp, SE
Steinbach, R
Wogritsch, S
Hurtl, I
Greifeneder, M
Holm, C
Najemnik, C
Dudczak, R
机构
[1] Krankenhaus Stadt Wien Lainz, Inst Nukl Med, A-1130 Vienna, Austria
[2] Donauspital, Neurochirurg Abt, Sozialmed Zentrums Ost, Vienna, Austria
[3] Krankenhaus Lainz, Schnittbildzentrum, Vienna, Austria
[4] Univ Vienna, Klin Nucl Med, Vienna, Austria
关键词
pituitary adenoma; thyrotropin; central hyperthyroidism; hyperthyroidism;
D O I
暂无
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Elevated levels of free triiodothyronine (fT3) of 8.8 ng/dl (normal range 2.0 to 4.2) and free thyroxin (fT4) of 3.5 pg/ml (0.8 to 1.7) were found in the course of an examination of a 53-year old patient due to a planned hysterectomy. As thyrotropin (TSH) also was elevated with 5.8 mU/l (0.4 to 4.5), these findings corresponded to an inappropriate secretion of TSH (IST). Additional examinations revealed a blunted rise of TSH secretion after i,v. injection of 200 mu g thyrotropin releasing hormone (TRH) as well as lacking suppression of TSH secretion after oral doses of 75 mu g T3 during one week.: alpha-TSH levels with 3.7 mu g/l were elevated in comparison to a matched normal sample just as the molar ratio alpha-TSH/TSH with 6.95 and sex hormone-binding globulin (SHBG) with 175 nmol/l and showed an absence of inhibition in the T3 suppression test. These results were suggestive of neoplastic inappropriate secretion of TSH (nIST) due to a TSH-secreting pituitary adenoma. In concordance, the magnetic resonance imaging (MRI) showed a I cm tumor in the sella. The adenoma could also be visualized by In-111-octreotide and I-123-epidepride scintigraphies of the pituitary gland. After transsphenoidal resection, histological examination of the tumor resulted in the finding of a TSH-secreting adenoma. Postoperative TSH levels were not detectable, indicating the complete removal of the adenoma. Levels of fT3 and fT4 were slightly below normal with 1.9 pg/ml and 0.7 ng/dl, respectively. A control scintigraphy with In-111-octreotide following an equivocal MRI showed no uptake in the pituitary.
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页码:32 / 36
页数:5
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