Thyrotropin-Secreting Pituitary Adenoma: A Case Report
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We report a 44-year-old male with a thyrotropin (TSH)-secreting pituitary adenoma. Basal serum free triiodothyronine (FT<SUB>3</SUB>, 12.1pmol/<I>l</I>) and free thyroxine (FT<SUB>4</SUB>, 28 pmol/<I>l</I>) were increased with normal basal TSH (3.1mU/<I>l</I>). There was impaired TSH response to thyrotropin releasing hormone (TRH) test. Serum TSH was suppressed to 59% of the basal level after oral administration of 1.4mg 3, 3-5-triiodothyroacetic acid (triac), whereas no suppression was observed after 75 μg daily administration of triiodothyronine (T<SUB>3</SUB>). Serum concentrations of a-subunit of TSH (TSH-α) and TSH-α/TSH molar ratio were high, being 1.95μg/<I>l</I>, and 4.4, respectively. Pituitary CT and MRI scan showed the presence of a macroadenoma in the anterior lobe of the pituitary gland. Histopathology of the excised pituitary confirmed the diagnosis of a TSH-producing adenoma. A positive correlation between TSH and FT<SUB>3</SUB> (r=0.66, <I>P</I><0.01) or FT<SUB>4</SUB> (r=0.54, <I>P</I><0.01) was observed in serial sera obtained before and after operation.
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