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

Cover Page
Open Access Open Access
Restricted Access Subscription Access


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.
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

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

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

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

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

MD, PhD, Professor, endocrinologist

Zhanna E. Belaya

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.

  • Бузиашвили И., Фадеев В.В., Мельниченко Г.А. Лечение токсического зоба. // Врач. — 2005. — №3. – С. 32-35. [Buziashvili I, Fadeyev VV, Mel`nichenko GA. Lechenie toksicheskogo zoba. Vrach. 2005;(3):32-35. (In Russ.)].
  • Мазеркина Н.А., Трунин Ю.Ю., Горелышев С.К., и др. Тиреотропинома у ребенка: описание клинического случая и обзор литературы. // Вопросы нейрохирургии им. Н.Н. Бурденко. — 2012. – Т.76. — №5. – C.63-69. [Mazerkina NA, Trunin II, Gorelyshev SK, et al. Thyrotropin secreting pituitary adenoma in a child: case report and literature review. Zh Vopr Neirokhir im NN. Burdenko. 2012;76(5):63-69. (In Russ.)].
  • Пржиялковская Е.Г., Газизова Д.О., Григорьев А.Ю., и др. Тиреотропинома: трудности дифференциальной диагностики (клинический случай) // Клиническая и экспериментальная тиреоидология. - 2011. - Т.7. - №2 - C. 68-73. [Prgijalkovskaja EG, Gasisova DO, Grigoriev AYu, et al. Thyrotropin-producing adenoma: diagnostic challenges (сase report). Clinical and experimental thyroidology. 2011;7(2):68-73. (In Russ.)]. doi: 10.14341/ket20117268-73.
  • Beck-Peccoz P, Lania A, Persani L. TSH-producing adenomas. In: Jameson JL, Degroot LJ, editors. Endocrinology. 7th ed. USA: W.B. Saunders Pub.; 2015;266-274.
  • Beck-Peccoz P, Lania A, Beckers A, et al. 2013 European thyroid association guidelines for the diagnosis and treatment of thyrotropin-secreting pituitary tumors. Eur Thyroid J. 2013;2(2):76-82. doi: 10.1159/000351007.
  • Webster J, Peters JR, John R, et al. Pituitary stone: two cases of densely calcified thyrotrophin-secreting pituitary adenomas. Clin Endocrinol (Oxf). 1994;40(1):137-143.
  • Mixson AJ, Friedman TC, Katz DA, et al. Thyrotropin-secreting pituitary carcinoma. J Clin Endocrinol Metab. 1993;76(2):529-533. doi: 10.1210/jcem.76.2.8432799.
  • Yamakita N, Ikeda T, Murai T, et al. Thyrotropin-producing pituitary adenoma discovered as a pituitary incidentaloma. Intern Med. 1995;34(11):1055-1060.
  • Hsu FS, Tsai WS, Chau T, et al. Thyrotropin-secreting pituitary adenoma presenting as hypokalemic periodic paralysis. Am J Med Sci. 2003;325(1):48-50.
  • George JT, Thow JC, Matthews B, et al. Atrial fibrillation associated with a thyroid stimulating hormone-secreting adenoma of the pituitary gland leading to a presentation of acute cardiac decompensation: a case report. J Med Case Rep. 2008;2:67. doi: 10.1186/1752-1947-2-67.
  • Abs R, Stevenaert A, Beckers A. Autonomously functioning thyroid nodules in a patient with a thyrotropin-secreting pituitary adenoma: possible cause—effect relationship. Eur J Endocrinol. 1994;131(4):355-358.
  • Kishida M, Otsuka F, Kataoka H, et al. Hyperthyroidism in a patient with tsh-producing pituitary adenoma coexisting with thyroid papillary adenocarcinoma. Endocr J. 2000;47(6):731-738. doi: 10.1507/endocrj.47.731.
  • Losa M, Mortini P, Minelli R, Giovanelli M. Coexistence of TSH-secreting pituitary adenoma and autoimmune hypothyroidism. J Endocrinol Invest. 2014;29(6):555-559. doi: 10.1007/bf03344147.
  • Yovos JG, Falko JM, O’Dorisio TM, et al. Thyrotoxicosis and a thyrotropin-secreting pituitary tumor causing unilateral exophthalmos. J Clin Endocrinol Metab. 1981;53(2):338-343. doi: 10.1210/jcem-53-2-338.
  • Bertholon-Gregoire M, Trouillas J, Guigard MP, et al. Mono- and plurihormonal thyrotropic pituitary adenomas: pathological, hormonal and clinical studies in 12 patients. Eur J Endocrinol. 1999;140(6):519-527.
  • Beck-Peccoz P, Roncoroni R, Mariotti S, et al. Sex hormone-binding globulin measurement in patients with inappropriate secretion of thyrotropin (IST): evidence against selective pituitary thyroid hormone resistance in nonneoplastic IST. J Clin Endocrinol Metab. 1990;71(1):19-25. doi: 10.1210/jcem-71-1-19.
  • Persani L, Preziati D, Matthews CH, et al. Serum levels of carboxyterminal cross-linked telopeptide of type I collagen (ICTP) in the differential diagnosis of the syndromes of inappropriate secretion of TSH. Clin Endocrinol (Oxf). 1997;47(2):207-214.
  • Калдымова В.А., Кияев А.В., Тюльпаков А.Н. Синдром резистентности к тиреоидным гормонам. // Клиническая и экспериментальная тиреоидология. — 2013. — Т.9. — №1. — C. 51-53. [Kaldymova VA, Kiyaev AV, Tyulpakov AN. Syndromes of resistance to thyroid hormone. Clinical and experimental thyroidology. 2013;9(1):51-53. (In Russ.)]. doi: 10.14341/ket20139151-53.
  • Malchiodi E, Profka E, Ferrante E, et al. Thyrotropin-secreting pituitary adenomas: outcome of pituitary surgery and irradiation. J Clin Endocrinol Metab. 2014;99(6):2069-2076. doi: 10.1210/jc.2013-4376.
  • Yamada S, Fukuhara N, Horiguchi K, et al. Clinicopathological characteristics and therapeutic outcomes in thyrotropin-secreting pituitary adenomas: a single-center study of 90 cases. J Neurosurg. 2014;121(6):1462-1473. doi: 10.3171/2014.7.jns1471. doi: http://dx.doi.org/10.14341/probl201763139-45

Supplementary files

There are no supplementary files to display.


Abstract - 631

PDF (Russian) - 9

PDF (English) - 0

Remote (Russian) - 0

Remote (English) - 0

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

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.