ECE2022 Poster Presentations Pituitary and Neuroendocrinology (127 abstracts)
Plurihormonal pituitary macroadenoma, co −secreting TSH/GH/and prolactin: a clinical challenge
Ismene Bilbao Garay 1 , Nerea Egaña 1 , Maite Perez De Ciriza 2 , Laura Chinchurreta 2 , Cristina Elias 1 , Inmaculada Venegas 1 , Ane Amilibia 1 , Cristina Garcia 1 , Jorge Rojo 1 & Alfredo Yoldi 1
1Donostia Unibertsitate Ospitalea, Donostia, Spain; 2Zumarragako Ospitalea, Zumarraga, Spain
Background: Co secreting Thyrotropin/growth hormone pituitary adenomas are rare, and their clinical presentation and long term management may be challenging. Clinically, the majority of plurihormonal pituitary adenomas are silent and diagnosis almost always relies on immunohistochemical analysis of the tumor tissue. Early detection is key to optimize patient mamagement. We report a case of pituitary plurihormonal macroadenoma with overt clinical hyperthyroidism and minimal GH excess symptoms.
Case Report: A 68-year-old female patient was admitted to our university hospital for transesphenoidal surgery due to a Thyrotropinoma diagnosed by one of our colleagues in another hospital. She underwent a thyroidectomy 15 years prior to diagnosis due to multiple bilateral thyroid nodules and she was taking levothyroxine replacement, noting that she presented discordance TSH/T4 levels. On review of previous test she consistently had elevated TSH and free T4 levels, and there was no family history of thyroid disease. Slightly high prolactin, IGF-I and elevated pituitary glycoprotein αSubunit were found during investigation and magnetic resonance Imaging(MRI) showed a sellar mass consisting of a pituitary macroadenoma that measured 31x21x29 mm(trxAPXCC) invading both cavernus sinuses and causing compression and superior displacement on the optic chiasm. She underwent successful transphenoidal adenomectomy and histopathology displayed a negative p53, a low KI67 of 1% and positivity for prolactin, GH and TSH in immunostaining. The patient was rendered euthyroid on levothyroxine, with GH<0.1 and normal age-sex adjusted IGFI levels and she is being followed without any recurrence of pituitary tumor or thyrotoxicosis.
Conclusion: Co-secreting occurs in 30% of Thyrotropinomas, requiring diligent inmunohistochemical analyses of all pituitary hormones to make the correct diagnosis and to alert the clinicians to ensure the right follow up.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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