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TSH-induced hyperthyroidism caused by a pituitary tumor

Nature Clinical Practice Endocrinology & Metabolism volume 2, pages 524–528 (2006)Cite this article

Abstract

Background A 45-year-old man presented with frontal headache and visual disturbances to our clinic. For the previous 5 years, he had been receiving treatment for long-lasting mild hyperthyroidism with antithyroid therapy, but therapy had not been carefully followed. During the last 2 years he had also complained of erectile dysfunction and loss of libido. On physical examination, he had a small goiter, normal skin, no Graves' ophthalmopathy, normal BMI, and reduced testis volume and pubic hair.

Investigations Serum levels of free T3 and T4, serum prolactin, testosterone, serum gonadotropins, insulin-like growth factor 1, adrenocorticotropic hormone, and cortisol were measured. MRI scan, TSH-releasing hormone test, and T3 suppression test were carried out. Levels of pituitary glycoprotein hormone α-subunit and sex-hormone-binding protein were also measured.

Diagnosis Hyperthyroidism caused by a mixed pituitary adenoma that secretes prolactin and TSH.

Management Trans-sphenoidal resection of the pituitary tumor. After surgery, T3 suppression test failed to completely suppress TSH secretion, which suggested a persistence of residual adenomatous cells. Hyperthyroidism and hypogonadism recurred after 5 years, therefore, treatment with lanreotide was initiated, and resulted in complete resolution of signs and symptoms of the disease.

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Figure 1: The main clinical parameters that are useful in the differential diagnosis between pituitary adenomas that secrete TSH and syndromes of thyroid hormone resistance

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Acknowledgements

These investigations were supported in part by Fondazione Ospedale Maggiore IRCCS, Milan, Italy.

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Authors and Affiliations

  1. Department of Medical Sciences, University of Milan,

    Paolo Beck-Peccoz & Luca Persani

  2. the Endocrinology and Metabolic Unit at Fondazione Ospedale Maggiore IRCCS,

    Paolo Beck-Peccoz & Luca Persani

  3. the University of Milan and Director of the Laboratory of Endocrinological Research, Istituto Auxologico Italiano IRCCS, Milan, Italy

    Paolo Beck-Peccoz & Luca Persani

Authors
  1. Paolo Beck-Peccoz
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  2. Luca Persani
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Correspondence to Paolo Beck-Peccoz.

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The authors declare no competing financial interests.

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Beck-Peccoz, P., Persani, L. TSH-induced hyperthyroidism caused by a pituitary tumor. Nat Rev Endocrinol 2, 524–528 (2006). https://doi.org/10.1038/ncpendmet0276

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