Autoimmune hypothyroidism coexisting with a pituitary adenoma secreting thyroid-stimulating hormone, prolactin and α-subunit

J. M. Idiculla, G. Beckett, P. F X Statham, J. W. Ironside, Stephen Atkin, A. W. Patrick

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

A 44-year-old woman presented to her GP with excessive tiredness. She had positive thyroid microsomal and thyroglobulin autoantibodies and was found to have an elevated serum thyroid-stimulating hormone (TSH) concentration of 8.37 (normal = 0.15-3.5) mU/L and a low normal total thyroxine (T4) of 86 (reference range 60-145) nmol/L. She was rendered symptom free on a dose of 150 μg of thyroxine per day. However, her TSH failed to return to normal, and following a further increase in her thyroxine dose she was referred to the endocrine clinic for further assessment. Her TSH at this stage was 14 mU/L, free T4 (fT4) 28 (normal = 10-27) pmol/L and free T3 (fT3) 10 (normal = 4.3-7.6) pmol/L. She denied any problems with adherence to her medication. Her serum prolactin was elevated at 861 (normal = 60-390) mU/L. A pituitary tumour was suspected and an MRI scan showed a macroadenoma of the right lobe of the pituitary, extending into the suprasellar cistern. The tumour was resected trans-sphenoidally. Electron microscopy showed a dual population of neoplastic cells compatible with a thyrotroph cell and prolactin-secreting adenoma. Immunocytochemistry and cell culture studies confirmed the secretion of TSH, prolactin and α-subunit. Postoperative combined anterior pituitary function tests did not demonstrate any deficiency of anterior pituitary hormones. A repeat MRI scan showed no significant residual tumour; however, her serum TSH and prolactin levels remained high and she was given a course of pituitary irradiation. This case illustrates the difficulty of diagnosing a TSHoma when it coexists with autoimmune hypothyroidism. We believe the combination of pathologies reported here is unique.

Original languageEnglish
Pages (from-to)566-571
Number of pages6
JournalAnnals of Clinical Biochemistry
Volume38
Issue number5
DOIs
Publication statusPublished - 2001
Externally publishedYes

Fingerprint

Pituitary Neoplasms
Thyrotropin
Prolactin
Thyroxine
Tumors
Pituitary Function Tests
Pituitary Irradiation
Serum
Magnetic Resonance Imaging
Thyrotrophs
Anterior Pituitary Hormones
Medication Adherence
Thyroglobulin
Residual Neoplasm
Pathology
Cell culture
Adenoma
Autoantibodies
Electron microscopy
Electron Microscopy

ASJC Scopus subject areas

  • Clinical Biochemistry

Cite this

Autoimmune hypothyroidism coexisting with a pituitary adenoma secreting thyroid-stimulating hormone, prolactin and α-subunit. / Idiculla, J. M.; Beckett, G.; Statham, P. F X; Ironside, J. W.; Atkin, Stephen; Patrick, A. W.

In: Annals of Clinical Biochemistry, Vol. 38, No. 5, 2001, p. 566-571.

Research output: Contribution to journalArticle

Idiculla, J. M. ; Beckett, G. ; Statham, P. F X ; Ironside, J. W. ; Atkin, Stephen ; Patrick, A. W. / Autoimmune hypothyroidism coexisting with a pituitary adenoma secreting thyroid-stimulating hormone, prolactin and α-subunit. In: Annals of Clinical Biochemistry. 2001 ; Vol. 38, No. 5. pp. 566-571.
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