Effectiveness of octoreotide administration before surgery for GH-TSH co-secreting pituitary adenoma with thyrotoxicosis: a case report

Shihori Kimura; Osamu Isozaki; Izumi Fukuda; Satoshi Morimoto; Yasufumi Seki; Kaoru Yamashita; Noriyoshi Takano; Akiko Otsuki; Terumi Kaneshige; Kanako Bokuda; Daisuke Watanabe; Takashi Ando; Naomi Hizuka; Kosaku Amano; Takashi Komori; Yoshikazu Okada; Atsuhiro Ichihara

doi:10.1530/endoabs.37.EP1206

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Endocrine Abstracts (2015) 37 EP1206 | DOI: 10.1530/endoabs.37.EP1206

ECE2015 Eposter Presentations Clinical Cases–Pituitary/Adrenal (95 abstracts)

Effectiveness of octoreotide administration before surgery for GH-TSH co-secreting pituitary adenoma with thyrotoxicosis: a case report

Shihori Kimura ¹ , Osamu Isozaki ¹ , Izumi Fukuda ¹ , Satoshi Morimoto ¹ , Yasufumi Seki ¹ , Kaoru Yamashita ¹ , Noriyoshi Takano ¹ , Akiko Otsuki ¹ , Terumi Kaneshige ¹ , Kanako Bokuda ¹ , Daisuke Watanabe ¹ , Takashi Ando ¹ , Naomi Hizuka ¹ , Kosaku Amano ² , Takashi Komori ³ , Yoshikazu Okada ² & Atsuhiro Ichihara ¹

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¹Department of Medicine II, Tokyo Women’s Medical University, Tokyo, Japan; ²Department of Neurosurgery, Tokyo Women’s Medical University, Tokyo, Japan; ³Department of Pathology I, Tokyo Women’s Medical University, Tokyo, Japan.

Introduction: TSH-secreting pituitary adenoma (TSHoma) sometimes brings on rare cause of hyperthyroidism because of its excessive TSH secretion. Though the first line of treatment for TSHoma is surgical removal of tumour, hyperthyroidism often causes perioperative thyroid storm. Here, we report a case of GH-TSH pituitary adenoma whose thyrotoxicosis was controlled by 5 days’ octoreotide (OCT) subcutaneous administration before surgery.

Case report: A 47-year-old woman with hyperhidrosis and palpitation for these 7 years was admitted to our hospital. She also presented acromegalic change, such as the increase in size of finger rings and shoes. In endocrinological examination, serum levels of TSH, fT₄ and fT₃ were 1.500 μU/ml, 3.73 ng/dl and 8.06 pg/ml, and l GH and IGF1 were 10.31 ng/ml and 861 ng/ml. 75gOGTT did not suppress GH (nadir GH: 10.26 ng/ml). MRI demonstrated a pituitary adenoma of 18×12×9 mm. GH-TSH co-secreting pituitary adenoma was suspected, and in order to prevent from perioperative thyroid storm, we scheduled OCT administration. Single OCT administration (50 μg) decreased serum TSH levels from 1.740 to 0.515 μU/ml and GH levels from 11.42 to 0.68 ng/dl respectively. Then, OCT (100 μg/day) was injected additionally for 5 days and serum fT₄, fT₃ and IGF1 levels decreased to 1.53 ng/dl, 2.65 pg/ml, and 350 ng/ml respectively before operation. Pituitary adenoma was completely and uneventfully removed via trans-sphenoidal-surgery and her all hormone levels were normalized without any medication.

Conclusion: A case of GH TSH co-secreting pituitary adenoma with thyrotoxicosis was reported. To prevent from perioperative thyroid storm, OCT administration should be recommended.