Endocrine Abstracts

Thyrotropinoma is a very rare cause of hyperthyroidism. In October 2014 a 41-year-old male patient was examined for anaemia and diarrhoea. Abdomen CT scan, gastroscopy, colonoscopy and parasite tests did not reveal any abnormalities. The patient had lost 18 kg 7 years ago and his weight had been stable since then (BMI 21.3 kg/m²). The laboratory tests revealed high TSH, normal fT₄ and low cortisol level. The patient referred to our department presented with diarrhoea, velvet skin, loss of facial, chest, axillary and pubic hair; he admitted occasional heart palpitations. The results of insulin tolerance test showed secondary adrenal insufficiency. Other laboratory results were: TSH 13.56 μIU/ml (no increase in TRH stimulation test), fT₃ 12.57 pmol/l, fT₄ 55.55 pmol/l, low FSH, LH, DHEA-S, testosterone, GH and IGF-1 levels. Pituitary MRI demonstrated a solid intra- and suprasellar pituitary macroadenoma (25 mm) with sphenoid and cavernous sinus invasion and optic chiasm dislocation. Thyroid ultrasound showed low echogenicity of thyroid gland. Densitometry revealed osteoporosis. Diarrhoea resolved on gluten-free diet (suspected coeliac disease). ASCA antibodies were positive (suspected Crohn disease). The gastroenterological diagnosis has not been clearly stated. We introduced octreotide injections every 4 weeks, hormonal replacement and osteoporosis therapy. TSH, fT₃ and fT₄ still remain above upper limit of normal. Control pituitary MRI will be performed in February 2015 and the patient will be qualified for neurosurgical treatment. We conclude that clinical image of thyrotropinoma may be confusing due to coincident symptoms of pituitary deficiency and potential concomitant diseases. Optimal diagnosis and treatment require a multidisciplinary approach.