PRESENTATION OF THREE CASES WITH THYROTROPINOMA

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SAT 164-196-Pituitary
Basic/Clinical
Saturday, June 15, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SAT-174
Halit Diri*, Yasin Simsek, Sulbiye Aribas, Zuleyha Karaca, Fatih Tanriverdi, Kursad Unluhizarci and Fahrettin Kelestimur
Faculty of Medicine, Erciyes University, Kayseri, Turkey
Thyrotropinomas have low rates among the pituitary tumors but they have become earlier and increasingly diagnosed due to better health services. Presentation of the patients with thyrotropinomas may have a wide variety and therefore confusing in diagnosis. Herein, we report three patients with thyrotropinoma, including a review of diagnosis and management based on the current literature. Case-1 had a typical acromegalic phenotype and his pituitary adenoma had found to co-secrete both GH and TSH. Methimazole was administered prior to surgery because of the severe hyperthyroidism symptoms. Case-2 underwent pituitary surgery without any anti-thyroid treatments. This removed tumor also showed positive staining for both TSH and GH. Transient central hypothyroidism occured in this case postoperatively. Case-3, who had both thyrotropinoma and autoimmune thyroiditis, accepted surgery after one year of Lanreotide treatment and removed pituitary adenoma was stained only with TSH. To our knowledge, concomitant Graves’ disease and thyrotropinoma is a very rare entity, there is only one patient previously reported. As seen, all three patients had small macroadenomas but different presentations. An important issue about thyrotropinoma is whether euthyroidism is essential or not before the operation. If preoperative hyperthyroidism symptoms are not severe, anti-thyroid treatment might not be essential. Thus, Case-2 and 3 did not given any anti-thyroid treatments before the operation, because their semptoms of hyperthyroidism were not severe.  Early postoperative (1-4 days after surgery) laboratory tests of the patients should not be evaluated as primer hyperthyroidism or thyroid storm, the correct diagnosis was ‘the healing phase of secondary hyperthyroidism’. Note that, decreased TSH with elevated thyroid hormones may firstly be interpreted as ‘primary hyperthyroidism’. However, it would be a false treatment to give any anti-thyroid drugs in that time, because there were no hyperthyroidism symptoms on their examinations. As conclusion, smaller TSH-secreting tumors seem to be more common recently and this event leads to improvement in the prognosis of thyrotropinomas. Nevertheless, their diagnosis and perioperative managements are still difficult problems, suggesting that they should be performed by endocrinologists.

Nothing to Disclose: HD, YS, SA, ZK, FT, KU, FK

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm