Division of Endocrinology, UT Southwestern Medical Center at Dallas, Dallas, Texas 75390-9073, USA.
Endocr Pract. 2011 Nov-Dec;17(6):e135-9. doi: 10.4158/EP11127.CR.
To describe a patient who developed a thyrotropin (TSH)-secreting adenoma in the setting of primary hypothyroidism.
We report the clinical, laboratory, and radiologic findings of a patient with a history of primary hypothyroidism who presented with headache, a bitemporal visual field deficit, and elevated TSH despite long-term levothyroxine therapy. We discuss the diagnostic challenges of this case and review the relevant literature.
A 54 year old woman with a history of primary hypothyroidism presented with a 3-year history of headache and a week of worsening vision. Imaging revealed a heterogeneous sellar mass elevating the optic chiasm. Her serum TSH was 46.5 mIU/L and free thyroxine concentration was 0.1 ng/dL. The differential diagnosis included pituitary hyperplasia and a TSH-secreting adenoma in a patient with primary hypothyroidism. The pathologic characteristics of the tumor were consistent with the latter.
In a patient with an elevated TSH concentration and a previous diagnosis of hypothyroidism, it is important to consider other entities besides medication noncompliance. TSH-secreting adenomas can also cause elevated levels of TSH.
描述 1 例在原发性甲状腺功能减退症基础上发生促甲状腺激素（TSH）分泌性腺瘤的患者。
我们报告了 1 例有原发性甲状腺功能减退症病史的患者的临床、实验室和影像学发现，该患者有头痛、双颞侧视野缺损，尽管长期服用左甲状腺素，但 TSH 升高。我们讨论了该病例的诊断挑战，并复习了相关文献。
1 名 54 岁女性，有原发性甲状腺功能减退症病史，表现为头痛 3 年，视力恶化 1 周。影像学显示蝶鞍内不均匀肿块抬高视交叉。血清 TSH 为 46.5 mIU/L，游离甲状腺素浓度为 0.1 ng/dL。鉴别诊断包括垂体增生和原发性甲状腺功能减退症患者的 TSH 分泌性腺瘤。肿瘤的病理特征符合后者。
在 TSH 浓度升高且既往诊断为甲状腺功能减退症的患者中，除了药物不依从外，还需要考虑其他原因。TSH 分泌性腺瘤也可导致 TSH 水平升高。
