Endocrine Abstracts

We report a case of a 69-years-old woman who complained about progressive tachycardia, sweat and flush. Her single background was a breast cancer five years ago which was considered in remission. A first blood sample analysis showed an elevated rate of T4 whereas TSH was normal. An IgF1 assay was realised because of an acromegalic appearance and was abnormally high for sex and age. Further biological investigations confirmed central hyperthyroidism and acromegalia. Alpha subunit and prolactin were slowly elevated whereas FSH and LH were considered as normal for a menopausal woman. There was no impairment of the corticotrophin function. Glucose assay showed a diabetes mellitus. MRI (magnetic resonance imaging) revealed the presence of a voluminous macroadenoma with supra and left latero sellar extension added with an atypical localisation in the frontal lobe. Campimetric analysis were normal. Sellar diagnosis biopsy was performed to eliminate breast cancer metastasis. Immunochemistry was positive for TSH and GH. A treatment by somatostatin analogues (octreotide 20 mg/28 days) was started and led quickly to a normal T4 value. IgF1 was not completely normalized after 3 months of treatment so that an increase of octreotide posology up to 30 mg/28 days was decided. One year after starting octreotide, T4, TSH and GH secretions were perfectly normalized. MRI showed a stability of the adenoma size in the last six months whereas it has been initially decreasing. This observation proves the efficacy of somatostatin analogues (octreotide/28 days) in the treatment of a GH and TSH adenoma. Benefit and risk of neurosurgery or radiotherapy as an alternative to medical treatment were also discussed. Nevertheless, it appears that somatostatin analogues could be proposed in first intention, especially when medical context does not allow invasive investigations.