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Journal of Clinical Endocrinology & Metabolism, Vol 72, 415-421, Copyright © 1991 by Endocrine Society

ARTICLES

Hyperthyroidism due to a pituitary adenoma composed of two different cell types, one secreting alpha-subunit alone and another cosecreting alpha-subunit and thyrotropin

M Terzolo, F Orlandi, M Bassetti, G Medri, D Paccotti, D Cortelazzi, A Angeli and P Beck-Peccoz
Department of Clinical and Biological Sciences, University of Turin, Italy.

A 37-yr-old female presented with clinical signs and symptoms of mild hyperthyroidism, high serum levels of free T4 (24.2 pmol/L), free T3 (11.7 pmol/L), and sex hormone-binding globulin (157 nmol/L) as well as measurable (by immunofluorometric assay) serum TSH concentrations (1.9 mU/L) in the absence of any known methodological interference. The above finding indicated the presence of hyperthyroidism due to inappropriate secretion of TSH, whose neoplastic origin was documented by computed tomographic scan showing a 1-cm pituitary adenoma. The diagnosis was confirmed by elevated alpha-subunit levels (9.2 micrograms/L) and alpha-subunit/TSH molar ratio (25.2) as well as absent TSH suppression after T3 administration. TRH injection (200 microgram, iv) caused impaired TSH (from 3.0 to 4.8 mU/L) and unexpectedly exaggerated alpha-subunit (from 8.8 to 18.2 micrograms/L) responses. Such a discrepancy was also observed after other dynamic tests. Double gold particle immunostaining of the adenomatous tissue removed at surgery showed that all of the cells contained secretory granules positive for alpha-subunit, while very few cells were positive for TSH beta and alpha-subunit. In conclusion, the present study demonstrates the existence of TSH-induced hyperthyroidism due to a pituitary adenoma composed of two different cell types: one secreting alpha-subunit alone and another cosecreting alpha-subunit and TSH.


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T. Kienitz, M. Quinkler, C. J Strasburger, and M. Ventz
Long-term management in five cases of TSH-secreting pituitary adenomas: a single center study and review of the literature
Eur. J. Endocrinol., July 1, 2007; 157(1): 39 - 46.
[Abstract] [Full Text] [PDF]


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