Resumen

PIGNATTA, A et al. TSH Secreting Pituitary Adenoma (Thyrotropinoma): Five Case Reports. Rev. argent. endocrinol. metab. [online]. 2014, vol.51, n.3, pp.141-150. ISSN 1851-3034.

Thyrotropinomas are the less frequent adenomas (< 2 %). Because of their infrequency, we report 5 cases. Case 1: 23-year-old man, with sudden atrial fibrillation. The hormonal profile showed: TSH: 4.2 uIU/ml (0.3-4), T4: 14.8 ug/dl (4.5-12.5), FT4: 2.2 ng/dl (0.8-1.9), T3: 170 ng/dl (80-180), FT3: 7.8 pg/ml (1.8-4.6) and flat TRH test. MRI revealed a macroadenoma. Therapy with metimazol was initiated, without response. Subsequently, treatment with octreotide-Lar was started and euthyroidism was reached. He underwent transsphenoidal surgery. Immunohistochemistry was positive for TSH. One week after surgery, TSH was suppressed. He has been free of disease for the last 5 years. Case 2: 41-year-old woman with biochemical hyperthyroidism and hypertension. Labs showed: TSH: 3.21 uIU/ml (0.4-4), T4: 16.9 ug/dl (4.5-10.9), FT4: 2.2 ng/dl (0.8-1.5), T3: 245 ng/dl (60-180) and flat TRH test. On MRI a microadenoma of 2 mm was diagnosed. Therapy with cabergoline did not normalize thyroid hormones. The tumor grew to 10.8 mm after 2 years. Transsphenoidal surgery was performed. Immunohistochemical staining was positive for TSH and GH. She evolved with suppressed TSH for 15 days. She has been free of disease for the last 18 months. Case 3: 53-year-old man, with loss of libido, sexual impotence and weight gain. Laboratory tests revealed: TSH: 9.1 uIU/ml, FT4: 1.79 ng/dl (0.9-1.8), T3: 164 ng/dl (40-181). MRI showed a macroadenoma. Trans­sphenoidal surgery was performed, the adenoma was positive for TSH and GH. The patient evolved with primary hypothyroidism. Case 4: 36-year-old woman who presented with hyperthyroidism. The thyroid profile revealed: TSH: 3.76 uIU/ml (0.4-4), T4: 13.2 ug/dl (4-12), FT4: 2.3 ng/dl (0.9-1.7), T3: 247 ng/dl (70-200) and TRH test was flat. MRI showed an adenoma of 10 mm. She underwent transsphenoidal surgery. Immunohistochemical staining was positive for TSH and GH. She evolved with suppressed TSH for 15 days. She has been free of disease for the last 8 years. Case 5: 49-year-old man, with decreased libido and occasional headaches. The hormonal evaluation revealed: TSH: 14.4 uIU/ml (0.3-4.9), T4: 14.8 ug/dl (4.5-12), T4L: 4.1 ng/dl (0.8-1.5). On MRI an invasive macroadenoma was found. Therapy with octreotide-Lar was started and he was lost to follow-up. Conclusions: We report these cases because of their low prevalence. We emphasize that clinical presentation was variable. We can speculate on the secretion of a less biologically active TSH for cases with no symptoms of hyperthyroidism. Five out of five (5/5) showed non-suppressed TSH, 3/5 presented a macrodenoma at ini­tial diagnosis, 3/5 showed TSH suppression one week after surgery, which might be considered as a criteria of cure. Four out of four patients operated on were cured. Rev Argent Endocrinol Metab 51:141-150, 2014 No financial conflicts of interest exist.

Palabras clave : Thyrotropinoma; Pituitary adenoma.

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