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Diagnosis and Treatment > Signs and Symptoms

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  • Hands - enlargement x
  • Soft tissue swelling x
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Laura Hamilton Adams Department of Endocrinology, Diabetes, and Metabolism, University of Kentucky, Lexington, Kentucky, USA

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Derick Adams Department of Endocrinology, Diabetes, and Metabolism, University of Kentucky, Lexington, Kentucky, USA

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Summary

Co-secreting TSH and growth hormone pituitary adenomas are rare. We present a case of a 55-year-old woman who presented with symptoms of neck fullness. Ultrasound revealed multiple thyroid nodules and examination revealed several clinical features of acromegaly. She was found to have a co-secreting TSH and growth hormone pituitary macroadenoma. She underwent surgical resection followed by gamma knife radiation, which resulted in complete remission of her TSH and GH-secreting adenoma.

Learning points:

  • TSH-secreting pituitary adenomas are rare and about one-third co-secrete other hormones.

  • Thyroid nodules are common in acromegaly and can be the presenting sign of a growth hormone-secreting pituitary adenoma.

  • In the workup of acromegaly, assessment of other pituitary hormones is essential, even in the absence of symptoms of other pituitary hormone dysfunction.

  • Complete remission of co-secreting GH and TSH pituitary macroadenomas is possible with surgery and radiation alone.

Taxonomy:
Clinical Overview, Gland/Organ, Pituitary, Topic, Pituitary, Hormone, Cortisol, FSH, GH, IGF1, IGF2, LH, Prolactin, Thyroxine (T4), TSH, Condition/ Syndrome, Acromegaly, Diabetes insipidus - neurogenic/central, Hyperthyroidism, Hypogonadism, Plurihormonal pituitary adenoma, Thyroid nodule, Patient Demographics, Age, Adult, Gender, Female, Ethnicity, White, Country of Treatment, United States, Diagnosis and Treatment, Signs and Symptoms, Amenorrhoea, Diabetes insipidus, Face - coarse features, Feet - increased size, Hands - enlargement, Headache, Hyperthyroidism, Hypogonadism, Neck mass, Neck pain/discomfort, Polyuria, Soft tissue swelling, Thyroid nodule, Investigation, ACTH stimulation, Cortisol (9am), FSH, FT4, GH, Histopathology, IGF1, IGF2, LH, MRI, Plasma osmolality, Prolactin, Sodium, Thyroid function, Thyroid ultrasonography, TSH, Urine osmolality, Intervention, Gamma knife radiosurgery, Resection of tumour, Transsphenoidal surgery, Medication, Desmopressin, Glucocorticoids, Hydrocortisone, Publication Details, Case Report Type, Unique/unexpected symptoms or presentations of a disease
DOI:
https://doi.org/10.1530/EDM-18-0067
Volume/Issue:
Volume 2018: Issue 1
Open access