Case report of recurrent atrial fibrillation induced by thyrotropin-secreting pituitary adenoma with Graves' disease

Abstract

Rationale: Thyrotropin-secreting adenoma (TSHoma) is rare. Even though the thyrotoxicosis is mild in patients with TSHoma, it is still a rare cause of arrhythmia, ignore of mild disfunction of thyroid function of TSHoma can lead to the delayed diagnosis of pituitary tumor or leading to recurring of complications. Graves' disease is an auto-immue endocrinological disorder. Association of TSHoma and Graves's disease is extremely rare. Coexistence of these two diseases made the diagnosis and treatment complicated.

Patient concerns: This patient was a 55-year-old man who had been referred to the department of endocrinology and metabolism of the West China Hospital due to recurrent atrial fibrillation (AF) and thyroxicosis.

Diagnoses: Examinations revealed pituitary thyrotropin-secreting macroadenoma with Graves' disease.

Interventions: We conducted transsphenoidal surgery. Thyrozol was used to treat the recurrence of Graves' disease after pituitary surgery.

Outcomes: The TSHoma was successfully cured, and recurrent Graves' disease was controlled very well.

Lessons: The association of TSHoma and Graves' disease is extremely rare. Even though the clinical features of thyrotoxicosis are milder in patients with TSHoma, thyroid function tests are still important clinical assessment of patients with AF, which is an arrhythmia associated with hyperthyroidism. TSHoma is a rare cause of thyrotoxicosis; however, ignoring of the mild disfunction caused by TSHoma can lead to the delayed diagnosis of pituitary tumors or to recurring of complications of TSHoma.

Figure 1

A pituitary tumor measuring 2.3 × 1.7 × 2.2 cm³ in the sella, involving the cavernous sinuses and extending into the suprasellar cistern.

Figure 2

Histopathological findings: Hematoxylin and eosin staining of the cells in the surgical specimen showed the diffuse proliferation of small atypical cells (A, ×200). Immunostaining for thyroid stimulating hormone revealed the expression of TSHb (B, ×200), and the adenoma shows diffuse staining for the antibody against prolactin (C, ×200).