A Rare Case of Thyrotropin-Secreting Pituitary Adenoma Coexisting with Papillary Thyroid Carcinoma Presenting with Visual Disturbance without Hyperthyroidism.

Abstract

BACKGROUND:

Thyroid-stimulating hormone-secreting pituitary adenomas (TSHomas) are uncommon, and majority of the patients present with symptoms of hyperthyroidism. Herein, we report the first case of TSHoma with differentiated thyroid carcinoma (DTC) that presented with visual disturbance without any clinical feature of hyperthyroidism.

CASE DESCRIPTION:

A 57-year-old man presented with left temporal hemianopsia of his left eye without any sign of hyperthyroidism. A mass lesion in the sellar and suprasellar region compressing the optic nerves was identified via magnetic resonance imaging. Free thyroxine and free triiodothyronine levels were slightly elevated, whereas the serum level of thyroid-stimulating hormone remained within normal range. Further endocrinologic examination led to the preoperative diagnosis of TSHoma. Ultrasonography and 111In-octreotide scan showed a mass lesion in left lobe of the thyroid gland, and subsequent thyroid aspiration biopsy confirmed the diagnosis of papillary thyroid carcinoma. After administration of short-acting octreotide to prevent thyrotoxic crisis in the perioperative period, the tumor was removed via endoscopic transnasal-transsphenoidal surgery, and the pathologic diagnosis of TSHoma was made. His visual acuity improved, and free triiodothyronine and free thyroxine levels normalized. He underwent thyroidectomy 3 months later after endoscopic transnasal-transsphenoidal surgery.

CONCLUSIONS:

Herein, we report the first case of TSHoma with DTC that presented with visual disturbance without any clinical feature of hyperthyroidism and reviewed the 13 reported cases of TSHoma coexisting with DTC. The optimal treatment strategy in patients with TSHoma and coexistent DTC has not been established, and individualized therapeutic strategies are needed.

• Authors: Hirotaka Inoue, Naoki Shinojima, Ryuta Ueda, Keizo Yamamoto, Norio Ishii, Motoyuki Igata, Junji Kawashima, Eiichi Araki, Hirotaka Iwase, Yoshiki Mikami, Shigetoshi Yano, Akitake Mukasa
• Journal: World neurosurgery (World Neurosurg) Vol. 119 Pg. 394-399 (Nov 2018) ISSN: 1878-8769 [Electronic] United States
• PMID: 30096503 (Publication Type: Case Reports, Journal Article)
• Copyright: Copyright © 2018 Elsevier Inc. All rights reserved.

Chemical References

• Ki-67 Antigen
• MKI67 protein, human
• Thyrotropin

Topics

• Adenoma (complications, diagnostic imaging)
• Databases, Bibliographic (statistics & numerical data)
• Humans
• Hyperthyroidism (complications)
• Ki-67 Antigen (metabolism)
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Pituitary Neoplasms (complications, diagnostic imaging)
• Thyroid Cancer, Papillary (complications, diagnostic imaging)
• Thyrotropin (metabolism)
• Vision Disorders (complications, diagnostic imaging)