ECE2015 Eposter Presentations Clinical Cases–Pituitary/Adrenal (95 abstracts)
A case of TSH secreting pituitary adenoma with Evans' syndrome
Toshiro Seki 1 , Atsushi Yasuda 1 , Natsumi Kitajima 1 , Masami Seki 2 , Masayuki Oki 1 , Atsushi Takagi 1 & Masafumi Fukagawa 1
1Tokai University School of Medicine, Kanagawa, Japan; 2Seirei Numazu Hospital, Shizuoka, Japan.
Introduction: To the best of our knowledge, there is no case report of Evans’ syndrome associated with TSH secreting pituitary adenoma (TSHoma).
Case report: A 30-year-old woman was admitted to near hospital due to purpura and ecchymoses on her limb and body and epistaxis. A hematologic disease was suspected and she was referred to our hospital. The diagnosis of Evans’ syndrome was made on the bases of idiopathic thrombocytopenic purpura (ITP) and autoimmune haemolytic anaemia (AIHA). Physical examination showed acromegalic features. She had the history of malocclusion and thyroid gland enlargement 4 years prior to admission. Endocrinological tests suggested syndrome of inappropriate secretion of TSH (SITSH) and magnetic resonance imaging (MRI) of the brain demonstrated a pituitary tumor. An oral 75-g glucose tolerance test revealed impaired glucose tolerance, but GH was not suppressed by high serum glucose. Initial studies suggested that this patient had hyperthyroidism due to TSH secreting pituitary adenoma and the adenoma concomitantly secreted GH.
Conclusions: Recently, several cases of Evans’ syndrome associated with hyperthyroidism by autoimmune thyroid disease such as Graves’ disease suggest that these two conditions may have a common immunological background. In our case, hyperthyroidism is due to TSHoma. Thus, it is suggested that thyroid hormone excess itself promote autoimmunity in Evans’ syndrome The early treatment for hyperthyroidism is necessary in TSHoma because there is the possibility that normalisation of thyroid hormone may prevent the development of Evans’ syndrome.
Volume 37
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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