Filter

Refine by subject

Refine by date

—
  • Print
  • Save
  • Print

Diagnosis and Treatment > Signs and Symptoms

You are looking at 1 - 2 of 2 items for :

  • Soft tissue swelling x
  • Face - coarse features x
Clear All
Laura Hamilton Adams Department of Endocrinology, Diabetes, and Metabolism, University of Kentucky, Lexington, Kentucky, USA

Search for other papers by Laura Hamilton Adams in
Google Scholar
PubMed Close
and
Derick Adams Department of Endocrinology, Diabetes, and Metabolism, University of Kentucky, Lexington, Kentucky, USA

Search for other papers by Derick Adams in
Google Scholar
PubMed Close

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
Taiba Zornitzki Endocrinology, Diabetes and Metabolic Unit, Kaplan Medical Center, Hebrew University Medical School of Jerusalem, Bilu 176100, Rehovot, Israel

Search for other papers by Taiba Zornitzki in
Google Scholar
PubMed Close
,
Hadara Rubinfeld Institute of Endocrinology and Felsenstein Medical Research Center, Rabin Medical Center, Petach Tikva, 49100, Israel
Sackler School of Medicine, Tel-Aviv University, Tel Aviv, 69978, Israel

Search for other papers by Hadara Rubinfeld in
Google Scholar
PubMed Close
,
Lyudmila Lysyy Endocrinology, Diabetes and Metabolic Unit, Kaplan Medical Center, Hebrew University Medical School of Jerusalem, Bilu 176100, Rehovot, Israel

Search for other papers by Lyudmila Lysyy in
Google Scholar
PubMed Close
,
Tal Schiller Endocrinology, Diabetes and Metabolic Unit, Kaplan Medical Center, Hebrew University Medical School of Jerusalem, Bilu 176100, Rehovot, Israel

Search for other papers by Tal Schiller in
Google Scholar
PubMed Close
,
Véronique Raverot Laboratoire d'Hormonologie – CBPE, Hospices Civils de Lyon, 59 bd Pinel69677, Bron Cedex, France

Search for other papers by Véronique Raverot in
Google Scholar
PubMed Close
,
Ilan Shimon Institute of Endocrinology and Felsenstein Medical Research Center, Rabin Medical Center, Petach Tikva, 49100, Israel
Sackler School of Medicine, Tel-Aviv University, Tel Aviv, 69978, Israel

Search for other papers by Ilan Shimon in
Google Scholar
PubMed Close
, and
Hilla Knobler Endocrinology, Diabetes and Metabolic Unit, Kaplan Medical Center, Hebrew University Medical School of Jerusalem, Bilu 176100, Rehovot, Israel

Search for other papers by Hilla Knobler in
Google Scholar
PubMed Close

Summary

Acromegaly due to ectopic GHRH secretion from a neuroendocrine tumor (NET) is rare and comprises <1% of all acromegaly cases. Herein we present a 57-year-old woman with clinical and biochemical features of acromegaly and a 6 cm pancreatic NET (pNET), secreting GHRH and calcitonin. Following surgical resection of the pancreatic tumor, IGF1, GH and calcitonin normalized, and the clinical features of acromegaly improved. In vitro studies confirmed that the tumor secreted large amounts of both GHRH and calcitonin, and incubation of pNET culture-derived conditioned media stimulated GH release from a cultured human pituitary adenoma. This is a unique case of pNET secreting both GHRH and calcitonin. The ability of the pNET-derived medium to stimulate in vitro GH release from a human pituitary-cell culture, combined with the clinical and hormonal remission following tumor resection, confirmed the ectopic source of acromegaly in this patient.

Learning points

  • Signs, symptoms and initial work-up of acromegaly due to ectopic GHRH secretion are similar to pituitary-dependent acromegaly. However, if no identifiable pituitary lesion is found, somatostatin receptor scan and further imaging (CT, MRI) should be performed.

  • Detection of GHRH in the blood and in the tumor-derived medium supports the diagnosis of ectopic GHRH secretion.

  • Functional bioactivity of pNET-secreted GHRH can be proved in vitro by releasing GH from human pituitary cells.

Taxonomy:
Clinical Overview, Gland/Organ, Pancreas, Topic, Endocrine-related cancer, Pituitary, Hormone, Calcitonin, GH, GHRH, IGF1, Condition/ Syndrome, Acromegaly, Neuroendocrine tumour, Patient Demographics, Age, Adult, Gender, Female, Ethnicity, White, Country of Treatment, Israel, Diagnosis and Treatment, Signs and Symptoms, Acrochorda, Face - coarse features, Pyrexia, Soft tissue swelling, Investigation, Calcitonin, CD-56, Chromogranin A, CT scan, Fine needle aspiration biopsy, GH, Glucose tolerance (oral), Haematoxylin and eosin staining, IGF1, Immunohistochemistry, MRI, PET scan, Synaptophysin, Ultrasound-guided biopsy, Intervention, Pancreaticoduodenectomy, Resection of tumour, Related Disciplines, Gastroenterology, Publication Details, Case Report Type, Novel diagnostic procedure
DOI:
https://doi.org/10.1530/EDM-15-0134
Volume/Issue:
Volume 2016: Issue 1
Open access