TSH-secreting pituitary adenoma: late diagnosis and effectiveness of therapy

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Abstract


The modern therapeutic and diagnostic algorithms allow timely detection of pituitary disorder to prescribe adequate treatment. Meanwhile, when interpreting the thyroid status, physicians need to take into account the extremely rare but the actually existing possibility of central thyrotoxicosis. The worldwide practice shows that diagnosis of this condition is rather challenging.

We report a clinical case of a TSH-secreting pituitary adenoma in a 47-year-old female who received a long-term thyrostatic therapy for thyrotoxicosis. The patient was diagnosed with Graves’ disease; however, thyrotoxicosis was actually caused by TSH-oma. The key laboratory signs of central thyrotoxicosis included the combination of episodes of normal or elevated TSH level with the high or normal free T4 level. MRI showed a pituitary macroadenoma. The clinical manifestations of thyrotoxicosis made it possible to rule out the thyroid hormone resistance syndrome. The attempted therapy with octreotide eliminated the clinical and laboratory signs of thyrotoxicosis, so the conservative method was selected as first-line therapy. The features of clinical and laboratory signs, as well as the principles of differential diagnosis and modern methods for treating TSH-secreting pituitary adenomas are discussed.


Galina G. Petrik

Author for correspondence.
pgg@mail.ru
ORCID iD: 0000-0003-4145-5602
SPIN-code: 3001-4807
Kuban State Medical University; S.V. Ochapovsky Regional Clinical Hospital no. 1
Russian Federation, 4, Sedina Street, Krasnodar, 350063; 167 Pervogo Maia St., Krasnodar, 350086

PhD, Docent Chair of Therapy N1 and endocrinologist Endocrinology Department

Elena D. Kosmacheva

kosmacheva_h@mail.ru
ORCID iD: 0000-0001-8600-0199
SPIN-code: 5277-2982
Kuban State Medical University; S.V. Ochapovsky Regional Clinical Hospital no. 1
Russian Federation, 4, Sedina Street, Krasnodar, 350063; 167 Pervogo Maia St., Krasnodar, 350086

MD, PhD, Professor, Head of the Department of Therapy № 1 and assistant to the head physician by a medical part

Ulya I. Polyakova

upoll@yandex.ru
ORCID iD: 0000-0003-0064-4917
S.V. Ochapovsky Regional Clinical Hospital no. 1
Russian Federation, 167 Pervogo Maia St., Krasnodar, 350086

endocrinologist Endocrinology Department

Svetlana V. Butaeva

havivi@mail.ru
ORCID iD: 0000-0001-7774-0494
S.V. Ochapovsky Regional Clinical Hospital no. 1
Russian Federation, 167 Pervogo Maia St., Krasnodar, 350086

Head of the Endocrinology Department

Ludmila Ya. Rozhinskaya

Rozhinskaya@rambler.ru
SPIN-code: 5691-7775
Endocrinology Research Centre
Russian Federation, 11 Dm.Ulyanova street, 117036 Moscow

MD, PhD, Professor, endocrinologist

Zhanna E. Belaya

jannabelaya@gmail.com
ORCID iD: 0000-0002-6674-6441
SPIN-code: 4746-7173
Endocrinology Research Centre
Russian Federation, 11 Dm.Ulyanova street, 117036 Moscow

MD, PhD, Head of the Department of Neuroendocrinology and bone disease.

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Copyright (c) Petrik G.G., Kosmacheva E.D., Polyakova U.I., Butaeva S.V., Rozhinskaya L.Y., Belaya Z.E.

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