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Case Reports
. 2024 Sep 4:11:1436400.
doi: 10.3389/fmed.2024.1436400. eCollection 2024.

Mixed thyrotropin-secreting pituitary neuroendocrine tumor coexisting with Graves' disease: a case report

Yijing Huang  1 , Xiaoming Wen  1 , Xinxin Liang  1 , Lingling Xu  1   2
Affiliations
Case Reports

Mixed thyrotropin-secreting pituitary neuroendocrine tumor coexisting with Graves' disease: a case report

Yijing Huang et al. Front Med (Lausanne). .

Abstract

Background: Thyrotropin (TSH)-secreting pituitary neuroendocrine tumors (PitNETs) are recognized as a rare disease. Mixed TSH PitNETs account for 20-25% of TSH PitNETs. This study aimed to report an extremely rare case of a mixed TSH PitNET coexisting with Graves' disease (GD) and also to review the literature.

Case presentation: A 36-year-old male patient presented with elevated levels of free triiodothyronine (FT3), free thyroxine (FT4), and insulin-like growth factor 1 (IGF-1) but a non-suppressed thyroid-stimulating hormone (TSH) level. His anti-thyroglobulin antibody (TgAb), anti-thyroid peroxidase autoantibody (TPOAb), and thyrotropin receptor antibody (TRAb) tests were positive. Symptoms of palpitations, hyperhidrosis, heat intolerance, and irritability appeared 2 years before his admission. However, he showed neither any signs nor any symptoms of acromegaly. The contrast-enhanced pituitary magnetic resonance imaging (MRI) showed enlargement of the pituitary fossa, with an irregular abnormal signal mass. The patient underwent endoscopic pituitary tumor resection via a transsphenoidal approach. The postoperative pathology suggested a mixed pituitary adenoma. At 8 months after the surgery, the patient had a postoperative recurrence of hyperthyroidism, and methimazole (MMI) was then administered. The recurrence of the TSH PitNET was confirmed by the positron emission tomography-computed tomography (PET-CT), which was performed 11 months after the surgery, and treatment with lanreotide was initiated. Gradually, his levels of FT3, FT4, TSH, TPOAb, and TgAb became normal and the levels of TRAb and IGF-1 improved.

Conclusion: When the circulating levels of both FT4 and FT3 were upregulated, non-suppressed TSH levels and positive thyroid antibodies were found. TSH PitNETs coexisting with GD should be carefully taken into account to avoid the potential risk of treatment-induced tumor progression.

Keywords: Graves' disease; autoimmune thyroid disease; mixed pituitary neuroendocrine tumor; thyroid antibodies; thyrotropin-secreting pituitary neuroendocrine tumor.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
(A) Fluctuations of the levels of FT3 and FT4. (B) Fluctuations of the levels of TSH and TRAb. (C) Fluctuations of the levels of TgAb and TPOAb. (D) Fluctuations of the level of IGF-1.
Figure 2
Figure 2
Preoperative and postoperative pituitary MRI. (A) Preoperative plain scan and contrast-enhanced sagittal MRI and contrast-enhanced sagittal and coronal MRI; a lesion (19 mm × 19 mm × 15 mm) in the pituitary fossa is indicated by an arrow. (B) Contrast-enhanced sagittal and coronal MRI on the first day after the surgery; the MRI showed postoperative changes in the pituitary gland, and sphenoid hemorrhagic sinus effusion was considered. (C) Contrast-enhanced sagittal and coronal MRI at 3 months after the surgery, which showed no mass lesion in the sella turcica.
Figure 3
Figure 3
Postoperative pathology.
Figure 4
Figure 4
Thyroid ECT at 8 months after the surgery (showed moderate enlargement of the thyroid gland and an increase in the uptake of radionuclides Tc-99).
See this image and copyright information in PMC

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