A Case of Thyrotropin-Secreting Pituitary Macroade
nomat
THONGKUM SUNTHORNTHEPVARAKUL, M.D.*, SUPUNNEE NGOWNGARMRATANA, M.D.*,
PRA VIT PRACHASILCHAI, M.D.**, RUNGTHIP DANSIRIKUL, M.D.*,
ARUNLUCK KOMINDR, M.D.***
Affiliation : * Department of Medicine,
** Department of Neurosurgery,
*** Department of Pathology, Rajavithi Hospital, Ministry of Public Health, Bangkok 10400, Thailand.
t Supported in part by Rajavithi Research Funds.
AbstractWe present a 49 year old male patient with thyroid stimulating hormone (TSH) producing
pituitary macroadenoma. He had been mistakenly diagnosed and treated as Graves' disease for 1
year. Serum TSH level was inappropriately elevated in the presence of high serum total and free
thyroid hormone concentrations. Thyrotropin releasing hormone stimulation showed blunt response
of TSH but good response for prolactin. The a-subunit level and a-subunit to TSH molar ratio were
measured and found to be high before surgery. The sex hormone-binding globulin level was also
high. MRI demonstrated a pituitary macroadenoma. Insulin tolerance test and GnRH revealed nor
mal response. The patient was given a high dose of PTU combined with lugol's solution for con
trolling hyperthyroidism preoperatively. Transfrontal surgery was performed and the tumor was par
tially removed. The diagnosis was confirmed by tissue pathology and immunohistochemistry stain
ing of the tumor. The immunohistochemistry staining was performed and found that tumor cells
were strongly reactive to TSH with a relatively mild degree for follicular stimulating hormone and
leutinizing hormone. The tumor cells were not stained for prolactin, growth hormone and ACTH.
Supervoltage irradiation by 60Co was delivered to the pituitary area because of persistence of hyper
thyroidism. While waiting for the remote effect of radiotherapy, the patient was given an anti
thyroid drug to control hyperthyroidism.
Keywords : Thyrotropin-Secreting Pituitary Adenoma, The Syndrome of Inappropriate Secretion
of TSH, TSH Producing Tumor
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