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A 31-year-old gentleman presented with clinical hyperthyroidism, goiter, bitemporal hemianopia, and discordant thyroid function test. The high α-subunit and absence of throtropin (thyroid-stimulating hormone; TSH) response to thyrotropin-releasing hormone stimulation indicated a TSH-secreting pituitary tumor. Elevation in prolactin and growth hormone as well as secondary hypogonadism were also observed. A sellar-suprasellar mass displacing the optic chiasm was revealed upon magnetic resonance imaging. The patient was rendered euthyroid with carbimazole and Lugol's iodine before undergoing endoscopic transsphenoidal surgery. Due to the incomplete tumor excision during surgery, patient experienced recurrence of symptoms and rising thyroxine (T4) with nonsuppressed TSH. The histopathology examination demonstrated a plurihormonal tumor with positive immunohistochemical stain for TSH, growth hormone, and prolactin, with invasive and proliferative features. Subsequently he was initiated with a long-acting somatostatin analogue and underwent stereotactic radiosurgery. To date, his symptoms have improved, with a reduction of insulin-like growth factor 1 and normalization of other pituitary hormones as well as a slightly reduced size of the pituitary tumor. [ABSTRACT FROM AUTHOR]

Introduction: Pituitary disorders during pregnancy are uncommon. The approach should include a close follow-up in order to reduce maternal and fetal risks associated with physiological changes during pregnancy or treatment side effects. Materials and methods: We report a 21-year-old woman with a thyroid-stimulating hormone-secreting pituitary macroadenoma and positive antithyroid antibodies. She was initially treated using transsphenoidal pituitary surgery. The patient relapsed 17-month post-surgery. Somatostatin analog therapy was started which rapidly controlled the hyperthyroidism. Eleven months later, while receiving octreotide, the patient reported to be pregnant and the medication was stopped. Gestation and delivery went well with a healthy full-term newborn. The patient developed a postpartum thyroiditis 15 weeks after giving birth. Twenty-eight months postpartum the patient remains euthyroid without medication. Conclusions: The overall positive outcomes of the four cases reported in literature, including this new case, suggest that pregnancy should not be absolutely contraindicated in women with thyrotropinomas. We emphasize the effectiveness of octreotide to control hyperthyroidism, as well as stopping medication when a patient is found to be pregnant. In our case, close observation following octreotide cessation had a positive outcome. [ABSTRACT FROM AUTHOR]

Thyrotropinomas are rare pituitary tumors that are difficult to diagnose due to their variety of clinical presentations. We describe three patients with thyrotropinoma and review the management of this disease based on current literature. Patient 1 had a typical acromegalic phenotype with a pituitary adenoma that secreted both growth hormone (GH) and thyroid-stimulating hormone (TSH). Patient 2 underwent pituitary surgery without antithyroid treatment; this tumor was also positive for both TSH and GH on pathological examination, and the patient experienced transient central hypothyroidism postoperatively. Patient 3, who had both a thyrotropinoma and autoimmune thyroiditis, underwent surgery after one year of treatment with lanreotide; the removed pituitary adenoma was positive only for TSH. To our knowledge, concomitant Graves' disease and thyrotropinoma is very rare, with only two patients previously reported. In conclusion, thyrotropinomas are increasingly being encountered when they are smaller, which has improved patient prognosis. Nevertheless, the diagnosis and perioperative management of thyrotropinomas remain challenging, which suggests that patients with such tumors should be managed by endocrinologists. [ABSTRACT FROM AUTHOR]

Background: Graves' disease is the commonest cause of thyrotoxicosis whilst thyrotropin (TSH)-producing pituitary adenomas (thyrotropinomas, TSHomas) are very rare and account for just 1–2% of all pituitary adenomas. Coexistence of a TSHoma and Graves' disease has been very rarely reported. Here, we report a case of a patient whose initial presentation with primary thyrotoxicosis due to Graves' disease, was subsequently followed by a relapse of thyrotoxicosis due to a probable TSHoma. Case: A sixty-eight year old woman was referred to our department with classical features of thyrotoxicosis. Initial biochemistry confirmed hyperthyroxinaemia [free thyroxine (fT4) 20.4 pmol/L (reference range 7.0–16.0)] and a suppressed TSH [< 0.02mIU/L (0.50–4.20)]. A technetium pertechnetate uptake scan was consistent with Graves' Disease. She was treated with carbimazole for 18 months and remained clinically and biochemically euthyroid. After stopping carbimazole her fT4 started to rise but TSH remained normal. Laboratory assay interference was excluded. A TRH stimulation test demonstrated a flat TSH response and pituitary MRI revealed a microadenoma. Remaining pituitary hormones were in the normal range other than a slightly raised IGF-1. An 11C-methionine PET/CT scan coregistered with volumetric MRI (Met-PET-MRICR) demonstrated high tracer uptake in the left lateral sella region suggestive of a functioning adenoma. The patient declined surgery and was unable to tolerate cabergoline or octreotide. Thereafter, she has elected to pursue a conservative approach with periodic surveillance. Conclusion: This is a very unusual case of thyrotoxicosis caused by two different processes occurring in the same patient. It highlights the importance of considering dual pathology when previously concordant thyroid function tests become discordant. It also highlights a potential role of Met-PET-MRICR in the localisation of functioning pituitary tumours. [ABSTRACT FROM AUTHOR]

Introduction: Thyrotropinoma (TSH-secreting pituitary adenomas, TSH-oma) are rare tumor of the pituitary (0.5-2% of all pituitary adenomas). Localization of the tumor with the appropriate neuroendocrine disorders has features. 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. Objectives: To study the emotional disturbances in the structure of the clinical picture of thyrotropinoma. Methods: 26 patients with TSH-oma, normal or elevated TSH levels in combination with elevated levels of St.4, St.3 (2002-2018). 14 women (54%) and 12 men (46%), 15-67 years old (median 38.5). All tumors belonged to macroadenomas (by MRI), the diameter is 14-64 mm (median 26 mm). The criteria for inclusion in the study were high levels of free fractions of thyroid hormones and elevated levels of TSH. Results: The clinical picture was presented with symptoms of hyperthyroidism in 21 (80.7%) patients, anamnesis from 1 to 13 years (median 3). Emotional pathology was detected in 57.6% (n=15): anxiety-phobic disorders 50%, panic attacks-46.1%, depression-11.5%. Patients complained of: increased fatigue and weakness - 8 patients, heartbeat - 13, anxiety - 9, mood lability - 14, sleep disorders - 5, sweating - 5, hand tremor - 3, subfebrile temperature - 2, weight loss - 2. These symptoms were combined with each other. Conclusions: Emotional disturbances occur in 57.6% of patients with TSH-oma. The interdisciplinary approach will allow: 1) to carry out an early diagnosis of these tumors; 2) to conduct adequate medical treatment. [ABSTRACT FROM AUTHOR]

Ectopic thyrotropin-secreting pituitary adenomas are rare, with only 10 published cases. We report the case of a 52-year-old woman who was referred for primary hypothyroidism, who showed clinical signs of hyperthyroidism and had been under treatment with levothyroxine. Her exams revealed high levels of thyroid stimulating hormone (TSH), at odds with free thyroxin (FT4) and raised triiodothyronine (T3), which remained elevated after medication suspension, suggesting possible central hyperthyroidism. Sellar MRI showed normal pituitary gland, with a mass in the sphenoid sinus of 24 mm. A possible ectopic TSH secreting pituitary tumor of sphenoid sinus was hypothesized. After a intramuscularly (IM) single dose of a sustained-relase of a somatostatin analog (octreotide) 20 mg, plasma levels of thyroid hormones were normalized and a significant tumor reduction was demonstrated in MRI control at 7-weeks' follow-up. The tumor was removed by transsphenoidal endoscopy, and the biopsy confirmed an adenoma with positive immunostaining for TSH and GH. Hyperthyroidism recurrence was observed in hormonal controls 4 weeks after surgery. Treatment with sustained-release octreotide was reinitiated, every 60-days for two years, with normalization of the thyroid hormone profile, but with a residual lesion with the appearance of a tumor in the MRI. A second tumor resection was performed, achieving sustained hormonal cure and no residual tumor lesion at 2-years' follow-up. To our knowledge, this is the first report of an ectopic thyrotropin-secreting pituitary adenoma of the sphenoid sinus. Clinical and laboratory aspects relevant to this entity are reviewed, emphasizing the usefulness of octreotide in the management of the reported case. [ABSTRACT FROM AUTHOR]

An abstract of the article "Thyrotropin-Secreting Pituitary Adenoma in an Adolescent Boy: Challenges in Management," by Marion Kessler and colleagues is presented.