Endocrine Abstracts

Introduction: The mixed tumor which secretes an excess of both GH and TSH causing acromegaly and hyperthyroidism is rare. The main problem is the late diagnosis, especially in men, even 10 years after the occurrence of the first symptoms.

Case report: A 53-year-old men, was admitted to the our department, with complaints of excessive sweating and enlargement of the hands. His medical history included arterial hypertension. Past medical history revealed thyroidectomy 20 years ago. Physical examination showed typical signs of acromegaly and nodules in both lobes of the thyroid gland. Performed laboratory test revealed elevated plasma concentrations of the PRL levels: 79.52 (0–29 ng/ml), IGF1: 593 (87–267 ng/ml) and lack of the suppression of GH after 75 g glucose (6.67 ng/ml). Additionally, we observed central hyperthyroidism: fT₄: 3.09 (0.7–1.48 ng/ml), fT₃: 17.49 (1.45–3.48 pg/ml) and TSH level: 6.095 (0.35–4.94 mU/ml) with normal anti-TPO: 0.4 (0–4.1 ng/dl). Diagnosis was confirmed by dynamic testing with TRH. An ultrasound scan of the thyroid showed a multinodular goitre. MRI revealed a large pituitary macroadenoma measuring 5×6×6 cm with left cavernous and sphenoid sinus invasion, with compression of the optic chiasm, the third ventricle as well as the brainstem. Firstly, patient was treated with thiamazol, octreotide LAR and bromocriptine during 6 months. Then, he proceeded twice to the transsphenoidal resection of the pituitary macroadenoma with consecutive partial reduction of the tumor mass. After neurosurgery laboratory signs of hyperthyroidism resolved but serum GH was still elevated. Currently, the patient is under octreotide LAR therapy.

Conclusions: We presented an unusual case with a huge pituitary macroadenoma secreting TSH and GH who was successfully treated with transsphenoidal adenomectomy. This case showed that despite of symptoms and size of mixed tumour, diagnosis could be missed for the long time. On the other hand, the proper preparation for surgery, lets avoid the complications during the perioperative period.