Endocrine Abstracts

Thyrotropinoma (TSH-secreting pituitary adenomas, TSH-AG) are rare tumor of the pituitary (0.5–2% of all pituitary adenomas). Localization of the tumor with the appropriate neuroendocrine disorders has features in the clinic. This is due to the direct damage to the nucleus and structures of the pituitary with hypersecretion of TSH, which leads to overstimulation of the thyroid gland and the emergence of the clinical picture of ‘central’ hyperthyroidism. Differentiated diagnosis of these disorders will help doctors to set the correct diagnosis of thyrotropinoma with an interdisciplinary approach.

Objective: To study the emotional disturbances in the structure of the clinic of thyrotropinoma.

Materials and methods: 26 patients with pituitary adenoma, normal or elevated TSH levels in combination with elevated levels of St.T4, St.T3. They admitted to the Institute for treatment (2002–2017). 14 women (54%) and 12 men (46%), 15–67 years old (median 38.5 years). All tumors belonged to macroadenomas (by MRI), the diameter is 14–64 mm (median 26 mm). All patients underwent a study of the levels of TSH, St. T4, St. T3, prolactin, cortisol, LH, FSH, estradiol/testosterone, in 18 cases - the study of the levels of ICF-1. The reference values were: TSH (0.4–4.0) mU/l, St. T4 (11.5–22.7) mmol/l, St. T3 (3.5–6.5) mmol/l, antibodies to the TSH receptor (<1.0 mU/l).

Results: The clinic was presented with symptoms of hyperthyroidism in 21 (80.7%) patients, anamnesis from 1 to 13 years (median 3 years). Emotional pathology was detected in 57.6% (n=15): anxiety-phobic disorders in 50%, panic attacks-46.1%, depression-11.5%. Patients complained of: increased fatigue and weakness - eight patients, heartbeat - 13, ‘anxiety’ - 9, mood lability - 14, sleep disorders - 5, sweating - 5, hand tremor - 3, subfebrile temperature - 2, weight loss - 2. And these symptoms combined with each other. The severity of psychopathological symptoms was often moderately severe (65%). eight patients received psychotropic therapy before a diagnosis, 5 of them were seen by a psychiatrist for a long time.

Conclusion: The clinical picture of TSH-AH consists of the symptoms of hyperthyroidism and the mass-effect of the tumor. Emotional disturbances are detected in 57.6%. The interdisciplinary approach will allow: 1) to carry out an early diagnosis of these tumors with the specification of the differential diagnosis of conditions with hyperthyroidism; 2) to conduct adequate medical treatment, including specialized neuropsychopharmacotherapy.