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Case Reports
. 2021 Mar 20:2021:5573231.
doi: 10.1155/2021/5573231. eCollection 2021.

Central Hyperthyroidism due to Thyroid-Stimulating Hormone-Secreting Pituitary Microadenoma in an Adolescent Boy: Case Report and Review of the Literature

Le Hoang Bao  1 , Nguyen Minh Duc  2   3   4 , Phan Cong Chien  5 , Thieu-Thi Tra My  2 , Tran Viet Thang  1 , Tran Quang Nam  1
Affiliations
Case Reports

Central Hyperthyroidism due to Thyroid-Stimulating Hormone-Secreting Pituitary Microadenoma in an Adolescent Boy: Case Report and Review of the Literature

Le Hoang Bao et al. Case Rep Endocrinol. .

Abstract

Thyroid-stimulating hormone- (TSH-) secreting pituitary adenoma (TSH-oma) is a rare cause of secondary hyperthyroidism and can be misdiagnosed as primary hyperthyroidism. We report a case of a 15-year-old male patient who was one of two monozygotic twins and exhibited hyperthyroidism syndrome. The laboratory results showed secondary hyperthyroidism, with increased levels of free T3 (FT3) and free T4 (FT4) and no TSH inhibition. Magnetic resonance imaging (MRI) and histopathological examination of the pituitary gland confirmed pituitary microadenoma. The patient was treated with methimazole, propranolol, and somatostatin analogs to restore euthyroidism before undergoing an endoscopic transsphenoidal resection of the pituitary tumor. After surgery, the hyperthyroidism symptoms improved, thyroid hormones normalized, and MRI of the pituitary gland showed the complete removal of the tumor with no recurrence after 2 years of follow-up.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
The patient (left) did not gain weight as well as his monozygotic twin brother (right).
Figure 2
Figure 2
Preoperative (a, b) and postoperative (c, d) pituitary MRI results. Coronal T2-weighted image (a) and T1-weighted image with contrast enhancement (b) showed a pituitary lesion that was hyperintense on T2-weighted image and hypoenhancing compared with the surrounding pituitary parenchyma on T1-weighted image (arrows). The postoperative pituitary MRI showed no evidence of recurrence (c, d).
Figure 3
Figure 3
Hematoxylin and eosin staining of the patient's pituitary adenoma (a, b, × 200). Tumor tissue was composed of cytoplasmic-rich glandular cells arranged in clusters and featuring rounded nuclei. Cells arranged around the blood vessels and formed papillary structures with little mitosis.
Figure 4
Figure 4
TSH and FT4 assay results showed decreasing trends after treatment.
See this image and copyright information in PMC

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