Thyrotropin-Secreting Adenoma in a Patient with Primary Hypothyroidism |
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| Affiliation: | 1. Department of Pharmaceutical Care, School of Pharmacy, Walailak University, Tha Sala, Nakhon Si Thammarat, 80160, Thailand;2. Drug and Cosmetics Excellence Center, Walailak University, Tha Sala, Nakhon Si Thammarat, 80161, Thailand;1. Ecology, Evolutionary Biology and Behavior, Michigan State University, East Lansing, MI, U.S.A.;2. BEACON Center for the Study of Evolution in Action, Michigan State University, East Lansing, MI, U.S.A.;3. Department of Psychology, University of Michigan, Ann Arbor, MI, U.S.A.;4. Department of Ecology and Evolutionary Biology, University of Michigan, Ann Arbor, MI, U.S.A.;5. Las Vegas Natural History Museum, Las Vegas, NV, U.S.A.;6. Department of Zoology and Physiology, University of Wyoming, Laramie, WY, U.S.A.;7. Program in Ecology, University of Wyoming, Laramie, WY, U.S.A.;1. Department of Endocrinology, University of Tunis El Manar, Faculty of Medicine of Tunis, La Rabta Hospital, Tunis, Tunisia;2. Department of Medical Epidemiology, University of Tunis El Manar, Faculty of Medicine of Tunis, Pasteur Institute of Tunis, Tunis, Tunisia;3. Department of Biochemistry, University of Tunis El Manar, Faculty of Medicine of Tunis, La Rabta Hospital, Tunis, Tunisia;1. Pôle spécialités médicales, Centre Hospitalier Côte Basque, Bayonne, France;2. UMR CNRS 5199 PACEA, Université de Bordeaux, Pessac, France;3. Department of Anthropology, University of Cincinnati, Cincinnati, OH, USA;4. Department of Geology, University of Cincinnati, Cincinnati, OH, USA |
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| Abstract: | ObjectiveTo describe a patient who developed a thyrotropin (TSH)-Secreting adenoma in the setting of primary hypothyroidism.MethodsWe report the clinical, laboratory, and radiologic findings of a patient with a history of primary hypothyroidism who presented with headache, a bitemporal visual field deficit, and elevated TSH despite long-term levothyroxine therapy. We discuss the diagnostic challenges of this case and review the relevant literature.ResultsA54-year-old woman with a history of primary hypothyroidism presented with a 3-year history of headache and a week of worsening vision. Imaging revealed a heterogeneous sellar mass elevating the optic chiasm. Her serum TSH was 46.5 mIU/L and free thyroxine concentration was 0.1 ng/dL. The differential diagnosis included pituitary hyperplasia and a TSH-secreting adenoma in a patient with primary hypothyroidism. The pathologic characteristics of the tumor were consistent with the latter.ConclusionIn a patient with an elevated TSH concentration and a previous diagnosis of hypothyroidism, it is important to consider other entities besides medication noncompliance. TSH-secreting adenomas can also cause elevated levels of TSH. (Endocr Pract. 2011;17: e135-e139) |
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