A case of TSH-secreting pituitary adenoma with cyclic fluctuations in serum TSH levels

Endocrine journal

Takuya Ohashi¹  Hajime Izumiyama²  Hideyuki Okuma³  Isao Minami⁴  Koshi Hashimoto⁵  Masatomo Mihara⁶ 

[1] Center for Medical Welfare and Liaison Services, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo 113-8510, Japan;Department of Hypothalamic and Pituitary Surgery, Toranomon Hospital, Minato-ku, Tokyo 105-8470, Japan;Department of Molecular Endocrinology and Metabolism, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo 113-8510, Japan;Department of Pathology, Toranomon Hospital, Minato-ku, Tokyo 105-8470, Japan;Department of Preemptive Medicine and Metabolism, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo 113-8510, Japan;Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka 431-3192, Japan

关键词: TSH-secreting pituitary adenoma;    Cyclic fluctuation of serum TSH levels;   

DOI  :  10.1507/endocrj.EJ18-0006

学科分类：内分泌与代谢学

来源: Japan Endocrine Society

【 摘 要 】

A 29-year-old man was referred to our department due to adrenal insufficiency with the inappropriate secretion of TSH (SITSH). Magnetic resonance imaging revealed a pituitary tumor. A weak TSH response in the TRH test, elevated sex hormone binding globulin (SHBG) levels, and the absence of a family medical history of SITSH or TRβ gene mutations supported the diagnosis of TSH-secreting pituitary adenoma (TSHoma). However, complete TSH suppression and a blunted cholesterol response in the T3 suppression test as well as normal glycoprotein α-subunit (α-GSU) levels were not compatible with TSHoma. Since TSH, FT3, and FT4 spontaneously returned to normal ranges after admission, he was discharged. One month after his discharge, thyrotoxicosis with elevated serum TSH levels relapsed. After admission, his serum TSH levels returned to within the normal range. After his discharge from the second admission, his serum TSH levels fluctuated in accordance with serum FT3 and FT4 levels and symptoms, such as palpitations. Ten months after his discharge, he was admitted to our department again due to adrenal insufficiency and thyrotoxicosis with elevated serum TSH levels, suggesting cyclic SITSH. Although resistance to thyroid hormone (RTH) was not completely excluded, the pituitary tumor was removed by transsphenoidal surgery (TSS). A pathological diagnosis confirmed TSHoma. We herein report a case of TSHoma in which serum TSH, FT3, and FT4 levels fluctuated periodically. To the best of our knowledge, this is the first case report of “cyclic TSHoma”, which needs to be considered when making a differential diagnosis of SITSH.

【 授权许可】

Unknown