Huang Yijing, Wen Xiaoming, Liang Xinxin, Xu Lingling
Department of Endocrinology, Shenzhen Hospital, Southern Medical University, Shenzhen, China.
The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China.
Front Med (Lausanne). 2024 Sep 4;11:1436400. doi: 10.3389/fmed.2024.1436400. eCollection 2024.
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.
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.
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.
促甲状腺素（TSH）分泌型垂体神经内分泌肿瘤（PitNETs）是一种罕见疾病。混合性TSH PitNETs占TSH PitNETs的20% - 25%。本研究旨在报告一例极其罕见的混合性TSH PitNETs合并格雷夫斯病（GD）的病例，并对相关文献进行综述。
一名36岁男性患者，游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）和胰岛素样生长因子1（IGF - 1）水平升高，但促甲状腺激素（TSH）水平未被抑制。他的抗甲状腺球蛋白抗体（TgAb）、抗甲状腺过氧化物酶自身抗体（TPOAb）和促甲状腺激素受体抗体（TRAb）检测均为阳性。心悸、多汗、不耐热和易怒症状在入院前2年就已出现。然而，他既没有任何肢端肥大症的体征也没有症状。垂体增强磁共振成像（MRI）显示垂体窝扩大，有不规则异常信号肿块。患者接受了经蝶窦入路的内镜垂体肿瘤切除术。术后病理提示为混合性垂体腺瘤。术后8个月，患者出现甲亢术后复发，随后给予甲巯咪唑（MMI）治疗。术后11个月进行的正电子发射断层扫描 - 计算机断层扫描（PET - CT）证实了TSH PitNETs的复发，并开始使用兰瑞肽治疗。逐渐地，他的FT3、FT4、TSH、TPOAb和TgAb水平恢复正常，TRAb和IGF - 1水平有所改善。
当FT4和FT3的循环水平上调、TSH水平未被抑制且甲状腺抗体呈阳性时，应仔细考虑TSH PitNETs与GD共存的情况，以避免治疗引起肿瘤进展的潜在风险。
