Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 64239, Tel Aviv, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Endocr Pathol. 2019 Mar;30(1):74-80. doi: 10.1007/s12022-018-9562-3.
Thyrotropin (TSH)-secreting pituitary tumors are the rarest functioning pituitary tumors. Nonetheless, they are not infrequently plurihormonal, as they may express/secrete hormones made by other pituitary cells derived from the Pit-1 lineage such as growth hormone (GH), prolactin (PRL), and α-subunit (αSU). However, adrenocorticotropin (ACTH) or gonadotropin secretion by such a tumor is exceptional. Although double pituitary tumors are rare, they often combine ACTH and GH secretion. A 41-year-old presented almost 2 years after delivering her 10th child; she had thyrotoxicosis (goiter and palpitations) masquerading as autoimmune postpartum thyroiditis. She was still breastfeeding and amenorrheic. She proved to have TSH, GH, PRL, and ACTH hypersecretion. Imaging revealed an invasive pituitary macrotumor. She had stigmata neither of Cushing's disease nor of acromegaly. Prior to surgery, hormonal control was achieved for close to 1 year by combined octreotide and cabergoline treatment with significant shrinking of the tumor. Following surgery, pathology revealed a collision tumor; the dominant lesion was positive for GH, βTSH, βFSH, and αSU and expressed both Pit-1 and SF-1.The smaller lesion was a corticotroph tumor. We report an unusual plurihormonal tumor co-expressing Pit-1 and SF-1 along with hormones made by cells of both lineages. Its simultaneous occurrence adjacent to a corticotroph tumor raises questions regarding the pathogenesis of these tumors. We propose the possibility of a stem cell tumor with multiple lineage differentiation. We hypothesize that pregnancy might have played a permissive role in tumorigenesis.
促甲状腺激素（TSH）分泌性垂体肿瘤是最罕见的功能性垂体肿瘤。尽管如此，它们并非不常见于多激素分泌，因为它们可能表达/分泌由 Pit-1 谱系衍生的其他垂体细胞产生的激素，如生长激素（GH）、催乳素（PRL）和α亚单位（αSU）。然而，这种肿瘤的促肾上腺皮质激素（ACTH）或促性腺激素分泌是异常的。虽然双垂体肿瘤很少见，但它们通常结合 ACTH 和 GH 分泌。一名 41 岁的女性在生下第十个孩子后近 2 年出现症状；她患有甲状腺毒症（甲状腺肿大和心悸），伪装为自身免疫性产后甲状腺炎。她仍在哺乳且闭经。她被证实存在 TSH、GH、PRL 和 ACTH 分泌过多。影像学显示侵袭性垂体大肿瘤。她既没有库欣病的特征，也没有肢端肥大症的特征。在手术前，通过联合奥曲肽和卡麦角林治疗近 1 年，实现了激素控制，肿瘤显著缩小。手术后，病理显示为碰撞性肿瘤；优势病变对 GH、βTSH、βFSH 和 αSU 呈阳性，表达 Pit-1 和 SF-1。较小的病变是促皮质激素肿瘤。我们报告了一种不常见的多激素肿瘤，同时表达 Pit-1 和 SF-1 以及两种谱系细胞产生的激素。它与促皮质激素肿瘤相邻同时发生，引发了对这些肿瘤发病机制的疑问。我们提出了一种具有多谱系分化的干细胞肿瘤的可能性。我们假设妊娠可能在肿瘤发生中起了许可作用。
