Arai Nobuhiko, Inaba Makoto, Ichijyo Takamasa, Kagami Hiroshi, Mine Yutaka
Department of Neurosurgery, Saiseikai Yokohamashi, Tobu Hospital, Yokohama, Japan.
Department of Endocrinology and Metabolism, Saiseikai Yokohamashi, Tobu Hospital, Yokohama, Japan.
J Med Case Rep. 2017 Jan 6;11(1):9. doi: 10.1186/s13256-016-1172-4.
Thyrotropin-producing pituitary tumor is relatively rare. In particular, concurrent cases associated with Graves' disease are extremely rare and only nine cases have been reported so far. We describe a case of a thyrotropin-producing pituitary adenoma concomitant with Graves' disease, which was successfully treated.
A 40-year-old Japanese woman presented with mild signs of hyperthyroidism. She had positive anti-thyroid-stimulating hormone receptor antibody, anti-thyroglobulin antibody, and anti-thyroid peroxidase antibody. Her levels of serum thyroid-stimulating hormone, which ranged from low to normal in the presence of high levels of serum free thyroid hormones, were considered to be close to a state of syndrome of inappropriate secretion of thyroid-stimulating hormone. Magnetic resonance imaging showed a macropituitary tumor. The coexistence of thyrotropin-producing pituitary adenoma and Graves' disease was suspected. Initial therapy included anti-thyroid medication, which was immediately discontinued due to worsening symptoms. Subsequently, surgical therapy for the pituitary tumor was conducted, and her levels of free thyroid hormones, including the thyroid-stimulating hormone, became normal. On postoperative examination, her anti-thyroid-stimulating hormone receptor antibody levels decreased, and the anti-thyroglobulin antibody became negative. The coexistence of thyrotropin-producing pituitary adenoma and Graves' disease is rarely reported. The diagnosis of this condition is complicated, and the appropriate treatment strategy has not been clearly established.
This case suggests that physicians should consider the coexistence of thyrotropin-producing pituitary adenoma with Graves' disease in cases in which thyroid-stimulating hormone values range from low to normal in the presence of thyrotoxicosis, and the surgical treatment of thyrotropin-producing pituitary adenoma could be the first-line therapy in patients with both thyrotropin-producing pituitary adenoma and Graves' disease.
促甲状腺素分泌型垂体瘤相对罕见。特别是与格雷夫斯病相关的并发病例极为罕见，迄今为止仅报道了9例。我们描述了一例成功治疗的促甲状腺素分泌型垂体腺瘤合并格雷夫斯病的病例。
一名40岁的日本女性出现轻度甲亢症状。她的抗促甲状腺激素受体抗体、抗甲状腺球蛋白抗体和抗甲状腺过氧化物酶抗体呈阳性。在血清游离甲状腺激素水平较高的情况下，她的血清促甲状腺激素水平从低到正常，被认为接近促甲状腺激素分泌异常综合征状态。磁共振成像显示有一个大垂体瘤。怀疑存在促甲状腺素分泌型垂体腺瘤与格雷夫斯病并存。初始治疗包括抗甲状腺药物，但由于症状恶化而立即停用。随后对垂体瘤进行了手术治疗，她的包括促甲状腺激素在内的游离甲状腺激素水平恢复正常。术后检查发现，她的抗促甲状腺激素受体抗体水平下降，抗甲状腺球蛋白抗体转阴。促甲状腺素分泌型垂体腺瘤与格雷夫斯病并存的情况鲜有报道。这种疾病的诊断较为复杂，尚未明确确立合适的治疗策略。
该病例表明，对于甲状腺毒症患者中促甲状腺激素值从低到正常的情况，医生应考虑促甲状腺素分泌型垂体腺瘤与格雷夫斯病并存，并且对于促甲状腺素分泌型垂体腺瘤和格雷夫斯病并存的患者，手术治疗促甲状腺素分泌型垂体腺瘤可能是一线治疗方法。
