多激素（TSH-GH-泌乳素分泌）PIT-1 阳性垂体大腺瘤/垂体神经内分泌肿瘤（PitNET）伴 Graves 病：病例报告。

Plurihormonal (TSH-GH-prolactin Secreting) PIT-1-Positive pituitary Macroadenoma/Pituitary Neuroendocrine Tumor (PitNET) Associated with Graves' Disease: A Case Report.

机构信息

Division of Endocrinology, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy.

Pituitary Unit, Center for the Diagnosis and Treatment of Hypothalamic-Pituitary Diseases, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.

出版信息

Endocr Metab Immune Disord Drug Targets. 2023;23(12):1557-1561. doi: 10.2174/1871530323666230623161631.

DOI:10.2174/1871530323666230623161631

PMID:37357515

Abstract

BACKGROUND

Differential diagnosis of primary and secondary hyperthyroidism can be challenging. Moreover, although extremely rare, the two conditions can coexist.

CASE PRESENTATION

A 58-year-old woman presented with symptoms of thyrotoxicosis, gradual changes in face shape, headache and progressive enlargement of hands and feet in the last year. When she was 46 years old, she was diagnosed with Graves' disease, and treated with 4-year methimazole therapy. Since 2016, a progressive increase of free-T4 and free-T3 with normal-TSH and positive TrAb was noticed.

RESULTS

At biochemical examination, fT3 was 5.3pg/ml (n. v. 2.5 - 3.9 pg/ml), fT4 was 20.6 pg/ml (n.v 6-12 pg/ml), IGF1 was 698 ng/ml (57 - 240 ng/ml*), GH (basally and after OGTT), and prolactin were significantly increased; while TSH was 1.8 (n.v. 0.35-4.0 mcUI/ml). A pituitary MRI demonstrated a large sellar tumor with suprasellar extension. The patient underwent endoscopic transsphenoidal surgery. Histological examination revealed a plurihormonal (GH-PRLTSH- secreting) PIT-1-positive pituitary adenoma/pituitary neuroendocrine tumor (PitNET). At 3- month follow-up, the pituitary function was normal, and no residual tumor was detected at the MRI.

CONCLUSION

We report a rare case of Graves' disease coexisting with a plurihormonal PIT-1-positive pituitary adenoma/PitNET.

摘要

背景

原发性和继发性甲状腺功能亢进症的鉴别诊断具有一定挑战性。此外，尽管极其罕见，但这两种情况也可能同时存在。

病例介绍

一位 58 岁女性以甲状腺毒症症状、面部形状逐渐改变、头痛和手脚逐渐增大为表现就诊，这些症状在过去一年中逐渐加重。她在 46 岁时被诊断为 Graves 病，并接受了 4 年的甲巯咪唑治疗。自 2016 年以来，发现游离 T4 和游离 T3 逐渐升高，而 TSH 正常，TRAb 阳性。

结果

生化检查发现，游离 T3 为 5.3pg/ml（正常值 2.5-3.9pg/ml），游离 T4 为 20.6pg/ml（正常值 6-12pg/ml），IGF1 为 698ng/ml（正常值 57-240ng/ml*），GH（基础和 OGTT 后）和催乳素显著升高；而 TSH 为 1.8（正常值 0.35-4.0mcUI/ml）。垂体 MRI 显示鞍内和鞍上大垂体瘤。患者接受了经鼻内镜蝶窦手术。组织学检查显示为多激素（GH-PRL-TSH 分泌）PIT-1 阳性垂体腺瘤/垂体神经内分泌肿瘤（PitNET）。术后 3 个月随访时，垂体功能正常，MRI 未发现残留肿瘤。