Journal of Endocrinological Investigation

, Volume 29, Issue 6, pp 555–559 | Cite as

Coexistence of TSH-secreting pituitary adenoma and autoimmune hypothyroidism

Case Report


Objective: TSH-secreting pituitary adenomas account for about 1–2% of all pituitary adenomas. Their diagnosis may be very difficult when coexistence of other diseases masquerades the clinical and biochemical manifestations of TSH-hypersecretion. Clinical presentation: A 41-yr-old female patient, weighing 56 kg, was referred for evaluation of an intra- and suprasellar mass causing menstrual irregularities. Eight yr before, the patient had been given a diagnosis of subclinical autoimmune hypothyroidism because of slightly elevated TSH levels and low-normal free T4 (FT4). Menses were normal. Despite increasing doses of levo-T4 (L-T4; up to 125 µg/day), TSH levels remained elevated and the patient developed mild symptoms of hyperthyroidism. After 7 yr, the menstrual cycle ceased. Gonadotropins were normal, whereas PRL level was elevated at 70 µg/l and magnetic resonance imaging (MRI) of the hypothalamic-pituitary region revealed a pituitary lesion with slight suprasellar extension. The tumor was surgically removed and histological examinations revealed a pituitary adenoma strongly positive for TSH. Three months after surgery the patient was well while receiving L-T4 75 µg/day and normal menses had resumed. MRI of the hypothalamic-pituitary region showed no evidence of residual tumor. At the last follow-up, 16 months after surgery, serum TSH, free T3 (FT3), and FT4 levels were normal. Conclusions: Coexistence of autoimmune hypothyroidism and TSH-secreting pituitary adenoma may cause further delays in the diagnosis of the latter. In patients with autoimmune hypothyroidism, one should be aware of the possible presence of a TSH-secreting pituitary adenoma when TSH levels do not adequately suppress in the face of high doses of L-T4 replacement therapy and elevated serum thyroid hormone levels.


Pituitary neoplasm pituitary surgery thyrotropin thyroid 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Mindermann T, Wilson CB. Thyrotropin-producing pituitary adenomas. J Neurosurg 1993, 79: 521–7.PubMedCrossRefGoogle Scholar
  2. 2.
    Beck-Peccoz P, Brucker-Davis F, Persani L, Smallridge RC, Weintraub BD. Thyrotropin-secreting pituitary tumors. Endocr Rev 1996, 17: 610–38.PubMedGoogle Scholar
  3. 3.
    Losa M, Giovanelli M, Persani L, Mortini P, Faglia G, Beck-Peccoz P. Criteria of cure and follow-up of central hyperthyroidism due to thyrotropin-secreting pituitary adenomas. J Clin Endocrinol Metab 1996, 81: 3084–90.PubMedGoogle Scholar
  4. 4.
    Sanno N, Teramoto A, Yoshiyuki, Osamura R. Thyrotropin-secreting pituitary adenomas. Clinical and biological heterogeneity and current treatment. J Neuro-oncol 2001, 54: 167–77.CrossRefGoogle Scholar
  5. 5.
    Losa M, Mortini P, Franzin A, Barzaghi R, Mandelli C, Giovanelli M. Surgical management of thyrotropin-secreting pituitary adenomas. Pituitary 1999, 2: 127–31.PubMedCrossRefGoogle Scholar
  6. 6.
    Beck-Peccoz P, Roncoroni R, Mariotti S, et al. Sex hormone-binding globulin measurement in patients with inappropriate secretion of thyrotropin (IST): evidence against selective pituitary thyroid hormone resistance in nonneoplastic IST. J Clin Endocrinol Metab 1990, 71: 19–25.PubMedCrossRefGoogle Scholar
  7. 7.
    Sarlis NJ, Brucker-Davis F, Doppman JL, Skarulis MC. MRI-demonstrable regression of a pituitary mass in a case of primary hypothyroidism after a week of acute thyroid hormone therapy. J Clin Endocrinol Metab 1997, 82: 808–11.PubMedCrossRefGoogle Scholar
  8. 8.
    Ma W, Ikeda H, Watabe N, Kanno M, Yoshimoto T. A plurihormonal TSH-producing pituitary tumor of monoclonal origin in a patient with hypothyroidism. Horm Res 2003, 59: 257–61.PubMedCrossRefGoogle Scholar
  9. 9.
    Ghannam NN, Hammami MM, Muttair Z, Bakheet SM. Primary hypothyroidism-associated TSH-secreting pituitary adenoma/hyperplasia presenting as a bleeding nasal mass and extremely elevated TSH level. J Endocrinol Invest 1999, 22: 419–23.PubMedCrossRefGoogle Scholar
  10. 10.
    Khalil A, Kovacs K, Sima AAF, Burrow GN, Horvath E. Pituitary thyrotroph hyperplasia mimicking prolactin-secreting adenoma. J Endocrinol Invest 1984, 7: 399–404.PubMedGoogle Scholar
  11. 11.
    Idiculla JM, Beckett G, Statham PFX, Ironside JW, Atkin SL, Patrick AW. Autoimmune hypothyroidism coexisting with a pituitary adenoma secreting thyroid-stimulating hormone, prolactin and a-subunit. Ann Clin Biochem 2001, 38: 566–571.PubMedGoogle Scholar
  12. 12.
    Langlois MF, Lamarche JB, Bellabarba D. Long-standing goiter and hypothyroidism: an unusual presentation of a TSH-secreting adenoma. Thyroid 1996, 6: 329–35.PubMedCrossRefGoogle Scholar

Copyright information

© Italian Society of Endocrinology (SIE) 2006

Authors and Affiliations

  • M. Losa
    • 1
  • P. Mortini
    • 1
  • R. Minelli
    • 2
  • M. Giovanelli
    • 1
  1. 1.Pituitary Unit, Department of Neurosurgery, Istituto Scientifico San RaffaeleUniversità Vita-SaluteMilano
  2. 2.Endocrinology Unit, Department of Internal Medicine and Biomedical ScienceUniversità degli Studi di ParmaParmaItaly

Personalised recommendations