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Ectopic thyrotropin secreting pituitary adenoma concomitant with papillary thyroid carcinoma: Case report.

Abstract Ectopic thyrotropin (TSH)-secreting pituitary adenomas are exceedingly rare. To date, there are only 6 cases reported. Here, we describe an even rarer ectopic TSH-secreting pituitary adenoma (TSH-oma) concomitant with papillary thyroid carcinoma.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 29390279
OWN - NLM
STAT- In-Process
LR  - 20180202
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 96
IP  - 50
DP  - 2017 Dec
TI  - Ectopic thyrotropin secreting pituitary adenoma concomitant with papillary
      thyroid carcinoma: Case report.
PG  - e8912
LID - 10.1097/MD.0000000000008912 [doi]
AB  - RATIONALE: Ectopic thyrotropin (TSH)-secreting pituitary adenomas are exceedingly
      rare. To date, there are only 6 cases reported. Here, we describe an even rarer
      ectopic TSH-secreting pituitary adenoma (TSH-oma) concomitant with papillary
      thyroid carcinoma. PATIENT CONCERNS: A 27-year-old female was admitted to the
      hospital in 2002 for neck enlargement and palpitation. Thyroid function test
      showed increased thyroid hormones and unrepressed TSH. Thyroid ultrasound
      examination displayed diffuse goiter. The patient was presumptively diagnosed as 
      primary hyperthyroidism and treated with anti-thyroid drugs. Her condition was
      then improved, but the serum TSH was persistently unrepressed. Therefore, central
      hyperthyroidism due to TSH-oma or pituitary resistance to thyroid hormone (PRTH) 
      was suspected. Pituitary magnetic resonance imaging (MRI) examination was
      deservedly performed to rule out TSH-oma, which turned out to be normal. In
      addition, T3 suppression test was negative. Thus, PRTH, as an uncommon cause of
      inappropriate TSH secretion, was regarded as the working diagnosis.
      Triiodothyroacetic acid, which was reported to be effective for PRTH, was then
      administrated. But it did not work well. To control the symptoms completely and
      normalize the level of thyroid hormones, radioiodine therapy was carried out in
      2007, followed by levothyroxine replacement therapy. Consequently, the symptoms
      were relieved, whereas serum TSH remained at high levels even with adequate
      levothyroxine. Unexpected, thyroid papillary carcinoma and a neoplasm in her
      nasopharynx were successively detected in 2012, which were then removed by
      surgery. Somewhat interestingly, the serum TSH declined to normal after the
      operation. DIAGNOSES: The patient was ultimately diagnosed as an ectopic
      TSH-secreting pituitary adenoma concomitant with papillary thyroid carcinoma.
      INTERVENTIONS: Thyroidectomy and removal of the ectopic TSH-secreting pituitary
      adenoma by surgery were carried out, followed by levothyroxine replacement
      therapy. OUTCOME: Three years after the surgery, the patient felt well with
      levothyroxine 125ug daily. Serum thyroid hormones and TSH kept in normal and no
      signs of neoplasm recurrence. LESSONS: Although extremely rare, ectopic
      TSH-secreting pituitary adenoma, as an uncommon cause of thyrotoxicosis, should
      be taken into consideration among those who have a longstanding hyperthyroidism
      with unsuppressed TSH.
CI  - Copyright (c) 2017 The Authors. Published by Wolters Kluwer Health, Inc. All
      rights reserved.
FAU - Yang, Jing
AU  - Yang J
AD  - Department of Endocrinology.
FAU - Liu, Shu
AU  - Liu S
AD  - Department of Endocrinology.
FAU - Yang, Zhe
AU  - Yang Z
AD  - Department of Pathology, the First Affiliated Hospital of Xi'an Jiaotong
      University, Xi'an, the People's Republic of China.
FAU - Shi, Yin Bing
AU  - Shi YB
AD  - Department of Endocrinology.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
EDAT- 2018/02/03 06:00
MHDA- 2018/02/03 06:00
CRDT- 2018/02/03 06:00
PHST- 2018/02/03 06:00 [entrez]
PHST- 2018/02/03 06:00 [pubmed]
PHST- 2018/02/03 06:00 [medline]
AID - 10.1097/MD.0000000000008912 [doi]
AID - 00005792-201712150-00029 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2017 Dec;96(50):e8912. doi: 10.1097/MD.0000000000008912.