Thyroid storm induced by TSH-secreting pituitary adenoma: a case report
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概要
- 論文の詳細を見る
Thyroid stimulating hormone-secreting pituitary adenomas (TSHomas) are uncommon tumors of the anterior pituitary gland. Patients with TSHomas may present with hyperthyroidism, but the incidence of thyroid storm due to TSHomas has yet to be determined. We report a rare case of thyroid storm caused by TSHoma in a 54-year-old woman. Preoperatively she had symptoms of excessive sweating and palpitation. Blood tests showed inappropriate secretion of TSH with blood TSH 6.86 μU/mL, fT3 19.8 pg/mL, and fT4 5.95 ng/dL. Magnetic resonance imaging (MRI) revealed a pituitary tumor with maximum diameter of 13 mm that was extirpated through transsphenoidal route. After operation the patient was stuporous and thyroid storm occurred presenting with hyperthermia, hypertension, and tachycardia. It was well managed with nicardipine, midazolam, steroids, and potassium iodide. Immunohistochemical staining of tumor specimen was positive for TSH and growth hormone (GH). One year after operation, fT3 and fT4 levels were still high. As her tumor was diagnosed to be GH- and TSH-producing adenoma, octreotide injection therapy was started, which normalized thyroid hormone levels. This is the second reported case with thyroid storm due to TSHoma and emphasizes the importance of strategies with interdisciplinary cooperation for prevention of such emergency conditions.
著者
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Arita Kazunori
Department Of Earth And Planetary Sciences Hokkaido University
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Arimura Hiroshi
Department Of Cardiology Kagoshima City Hospital And Department Of Cardiovascular Respiratory And Me
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Yamahata Hitoshi
Department Of Neurosurgery Hokusatsu Hospital
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Fujio Shingo
Department Of Neurosurgery Graduate School Of Medical And Dental Sciences Kagoshima University
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Bohara Manoj
Department Of Neurosurgery Graduate School Of Medical And Dental Sciences Kagoshima University
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Habu Mika
Department Of Biochemistry And Genetics Kagoshima University Graduate School Of Medical And Dental Sciences
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Arita Kazunori
Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-8520, Japan
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Moinuddin F
Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-8520, Japan
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Nishijima Yui
Department of Internal Medicine, Noguchi Thyroid Clinic and Hospital Foundation, Beppu 874-0902, Japan
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