Endocrine Abstracts

Purpose: The purpose is to draw attention to rare cases of Pituitary Macroadenoma co-secreting Growth Hormone and Thyroid Stimulating Hormone with Polynodular Goiter and their importance and approach in current practice.

Background: Pituitary adenomas with no hormonal clinical picture are known as ‘silent’ tumors. They are rarely reported and lacking pathogenic explanations.

Method: We describe a case of Pituitary Macroadenoma with both growth hormone (GH) and thyroid stimulating hormone (TSH) secretion, but with no clinical manifestations, such as features of acromegaly or hyperthyroidism.

Results: A 58-year-old male patient, diagnosed with essential arterial hypertension 3^rd grade, persistent atrial fibrillation, carotid sinus syndrome, permanent cardiostimulation type VVI, overweight status, hepatic steatosis and hyperglycemic status was hospitalized to investigate a syncope episode two years ago. The CT scan revealed a pituitary adenoma, in the absence of any clinical signs. The diagnosis of Polynodular Goiter and Pituitary Macroadenoma co-secreting GH and TSH was confirmed by the following investigations:

1. CT: a nodular image with moderate contrast in diameter of 19/17.5/17 mm, moving normal pituitary tissue and the pituitary stem to the left, bombing the selar diaphragm on the right side without overtaking it and passing inferior to the sphenoidal sinus and extending laterally approximately 3 mm to the right cavernous sinus, without exceeding the plane of the internal carotid wall.

2. Pituitary Hormone profile: TSH: 3.03 lIU/ml (0.3–4.0); fT4: 2.23 pm/L (9–25)w; GH: 1.51 ng/ml (0.0–5.0); IGF-1: 404.00 ng/ml (70–197).

3. Thyroid ultrasound: Right thyroid lobe 3.2/4.22/1.86 cm, nodular formation (1) 0.69/0.86 cm, nodular formation (2) 1/1.13/1 cm, non-vascularized formations; left thyroid lobe 2.39/3.65/2.16 cm.

4. HGPO Test with GH values not exceeding 1 ng/ml.

Conclusion: Taking into account the associated cardiovascular pathology, treatment with Somatostatin analogues (Somatuline PR 30 mg/14 days), associated with Cabergolina and gamma knife radiotherapy has been established with clinical and biological re-evaluation every 6 months for the past two years, observing a slight dimensional reduction of the formation.