Plurihormonal Pituitary Adenoma Immunoreactive for Thyroid-Stimulating Hormone,Growth Hormone,Follicle-Stimulating Hormone,and Prolactin |
| |
| Institution: | 1. Division of Endocrinology and Metabolism,;2. Department of Laboratory Medicine, Division of Pathology,;3. Department of Surgery, Division of Neurosurgery, St. Michael’s Hospital, University of Toronto;4. Department of Medicine, University of Toronto, Toronto, Ontario, Canada.;1. From the Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, Minnesota;2. Evidence Practice Center, Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota;3. Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota;4. Pediatric Endocrinology and Metabolism, Mayo Clinic, Rochester, Minnesota;5. Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru;6. Library Public Services, Mayo Clinic, Rochester, Minnesota;7. Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota;8. Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, Minnesota;9. Mayo Graduate School, Rochester, Minnesota.;1. From the Endocrine Institute, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel;2. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel;3. Endocrine Institute, Soroka Medical Center and Ben Gurion University of the Negev, Beer Sheva, Israel;4. Endocrinology Clinic, Division of Maternal and Fetal Medicine, Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel;5. Endocrine Institute, Meir Medical Center, Kfar Saba, Israel. |
| |
| Abstract: | ObjectiveTo describe the case of a patient with an unusual plurihormonal pituitary adenoma with immunoreactivity for thyroid-stimulating hormone (TSH), growth hormone, follicle-stimulating hormone, prolactin, an α-subunit.MethodsWe report the clinical, laboratory, imaging, and pathology findings of a patient symptomatic from a plurihormonal pituitary adenoma and describe her outcome after surgical treatment.ResultsA 60-year-old woman presented to the emergency department with headaches, blurry vision, fatigue, palpitations, sweaty hands, and weight loss. Her medical history was notable for hyperthyroidism, treated intermit with methimazole. Magnetic resonance imaging disclosed a pituitary macroadenoma (2.3 by 2.2 by 2.0 cm), and preoperative blood studies revealed elevated levels of TSH at 6.11 mIU/L, free thyroxine at 3.6 ng/dL, and free triiodothyronine at 6.0 pg/mL. She underwent an uncomplicated transsphenoidal resection of the pituitary adenoma. Immunostaining of tumor tissue demonstrated positivity for not only TSH but also growth hormone, follicle-stimulating hormone, prolactin, and α-subunit. The Ki-67 index of the tumor was estimated at 2% to 5%, and DNA repair enzyme O6-methylguanine-DNA methyltransferase immunostaining was mostly negative. Electron microscopy showed the ultrastructural phenotype of a glycoprotein-producing adenoma. Postoperatively, her symptoms and hyperthyroidism resolved.ConclusionThyrotropin-secreting pituitary adenomas are rare. Furthermore, recent reports suggest that 31% to 36% of adenomas may show evidence of secretion of multiple pituitary hormones. This case emphasizes the importance of considering pituitary causes of thyrotoxicosis and summarizes the clinical and pathology findings in a patient with a plurihormonal pituitary adenoma. (Endocr Pract. 2012;18:e121-e126) |
| |
| Keywords: | |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
