SFEBES2009 Poster Presentations Clinical practice/governance and case reports (87 abstracts)
Lessons from a case of pituitary thyrotrophinoma I: not all TSH-omas are macroadenomas II: thyroid autoimmunity can be associated III: associated central hyperthyroidism can be subclinical
V Arutchelvam 1,2 , RDG Neely 1,2 , D Mitra 1,2 , J Hill 1,2 , S Carrie 1,2 , M Gurnell 1,2 & R Quinton 1,2
1Newcastle hospitals NHS trust, Newcastle upon Tyne, UK; 2Addenbrookes Hospital, Cambridge, UK.
A 64-year-old lady presented with weight gain, tiredness, palpitations and tremor. She had no goitre and no other extra thyroidal manifestations. Both TSH and thyroid peroxidase antibodies (>1300) were elevated and she was treated by her GP with Thyroxine 50 mcg daily. She felt a lot worse on this, so it was discontinued and a full thyroid hormone profile was checked (see Table 1) which prompted referral; to Endocrinology.
Other pituitary hormone levels were normal, but MRI showed an 8×4 mm pituitary microadenoma with concordant uptake on pentetriotide scintigraphy. TRH test showed a flat response. Although T3 challenge test was not performed due to her age, genetic screen for thyroid hormone resistance was negative. TSH and alpha subunit levels fell with Octreotide challenge test and she was initiated on Sandostatin therapy, to which she proved so sensitive that only a single depot injection was administered. She chose to undergo trans-sphenoidal pituitary surgery. Immunohistochemistry was positive for TSH, postoperative thyroid biochemistry was greatly improved and MRI showed reduction in adenoma size.
TSH secreting pituitary adenomas are rare accounting to less than 1% of all pituitary tumours and less than 1% of all causes for hyperthyroidism. Historically, these nearly all presented as macroadenoma, often with calcification, but the increasing availability of MRI has resulted in a greater proportion of microadenomas (now estimated to be ~15% of cases).
| At diagnosis | On Sandostatin LAR | Post-operative | |
| TSH (0.3–4.7 mU/l) | 19.9 | 4.8 | 9.0 |
| FT4 (11–23 pmol/l) | 26 | 12 | 21 |
| FT3 (3.5–6.5 mol/l) | 6.2 | 2.8 | 4.8 |
| Alpha sub-unit (<3 IU/l) | 2.85 | 1.80 | 1.30 |
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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