Abstract
Thyrotoxic Periodic Paralysis (TPP) is a rare manifestation of hyperthyroidism characterized by muscle weakness and hypokalemia. Thyroid-Stimulating Hormone (TSH)-secreting pituitary adenoma is a rare cause of hyperthyroidism. Even more rare is the occurrence of TPP as the first manifestation of a TSH-secreting pituitary adenoma. We report a 31-year-old Asian male patient suffering from TPP caused by a TSH-secreting adenoma, who was evaluated for persistent episodes of muscle paralysis. Laboratory investigation revealed hypokalemia as well as elevated levels of both thyroid hormones and TSH. The Magnetic Resonance Imaging (MRI) of the pituitary gland revealed a microadenoma, thus suggesting the presence of a TSH-secreting adenoma. The patient underwent transphenoidal resection and the pathological investigation confirmed the diagnosis of TSH-secreting pituitary adenoma. After the adenomectomy and the restoration of euthyroidism, the patient did not experience any episode of hypokalemic paralysis or weakness. Despite its rarity, TSH-secreting pituitary adenoma should be included in the differential diagnosis of TPP.
Article PDF
References
Kung AW, 2006 Clinical review: Thyrotoxic periodic paralysis: a diagnostic challenge. J Clin Endocrinol Metab 91: 2490–2495.
McFadzean AJS, Yeung R, 1967 Periodic paralysis complicating thyrotoxicosis in Chinese. Br Med J 1: 451–455.
Okinaka S, Shizume K, Lino S, et al, 1957 The association of periodic paralysis and hyperthyroidism in Japan. J Clin Endocrinol Metab 17: 1454–1459.
Kelley DE, Gharib H, Kennedy FP, et al, 1989 Thyrotoxic periodic paralysis. Report of 10 cases and review of electromyographic findings. Arch Intern Med 149: 2597–2600.
Ko GT, Chow CC, Yeung VT, et al, 1996 Thyrotoxic periodic paralysis in a Chinese population. QJM 89: 463–468.
Links TP, Smit AJ, Molenaar WM, et al, 1994 Familial hypokalemic periodic paralysis. Clinical, diagnostic and therapeutic aspects. J Neurol Sci 122: 33–43.
Beck-Peccoz P, Brucker-Davis F, Persani L, et al, 1996 Thyrotropin-secreting pituitary tumors. Endocr Rev 17: 610–638.
Socin HV, Chanson P, Delemer B, et al, 2003 The changing spectrum of TSH-secreting pituitary adenomas: diagnosis and management in 43 patients. Eur J Endocrinol 148: 433–442.
Beck-Peccoz P, Persani L, 2008 Thyrotropin-secreting pituitary adenomas. In: Thyroid disease manager. Available at: http://www.thyroidmanager.org.
Ober K P, 1992 Thyrotoxic periodic paralysis in the United States. Report of 7 cases and review of the literature. Medicine (Baltimore) 71:109–120.
Gluck FB, Nusynowitz ML, Plymate S, 1975 Chronic lymphocytic thyroiditis, thyrotoxicosis, and low radioactive iodine uptake. Report of four cases. N Engl J Med 293: 624–628.
Tagami T, Usui T, Shimatsu A, Naruse M, 2007 Toxic thyroid adenoma presenting as hypokalemic periodic paralysis. Endocr J 54: 797–803.
Layzer RB, Goldfield E, 1974 Periodic paralysis caused by abuse of thyroid hormone. Neurology 24: 949–952.
Tran HA, 2005 Inadvertent iodine excess causing thyrotoxic hypokalemic periodic paralysis. Arch Intern Med 165: 831–834.
Kiso Y, Yoshida K, Kaise K, et al, 1990 A case of thyrotropin-secreting tumor complicated by periodic paralysis. Jpn J Med 29: 399–404.
Alings AM, Fliers E, de Herder WW, et al, 1998 A thyrotropin-secreting pituitary adenoma as a cause of thyrotoxic periodic paralysis. J Endocrinol Invest 21: 703–706.
Hsu FS, Tsai WS, Chau T, et al, 2003 Thyrotropin-secreting pituitary adenoma presenting as hypokalemic periodic paralysis. Am J Med Sci 325: 48–50.
Brucker-Davis F, Oldfield EH, Skarulis MC, et al, 1999 Thyrotropin-secreting pituitary tumors: diagnostic criteria, thyroid hormone sensitivity, and treatment outcome in 25 patients followed at the National Institutes of Health. J Clin Endocrinol Metab 84: 476–486.
Beck-Peccoz P, Persani L, 2008 Thyrotropinomas. Endocrinol Metab Clin North Am 37: 123–34.
Kienitz T, Quinkler M, Strasburger CJ, Ventz M, 2007 Long-term management in five cases of TSH-secreting pituitary adenomas: a single center study and review of the literature. Eur J Endocrinol 157: 39–46.
Colao A, Filippella M, Pivonello R, et al, 2007 Combined therapy of somatostatin analogues and dopamine agonists in the treatment of pituitary tumours. Eur J Endocrinol 156: Suppl 1: S57–63.
Chan A, Shinde R, Chow CC, et al, 1991 In vivo and in vitro sodium pump activity in subjects with thyrotoxic periodic paralysis. Br Med J 303: 1096–1099.
Lo CS, Edelman IS, 1976 Effect of triiodothyronine on the synthesis and degradation of renal cortical Na+ K+ adenosine triphosphatase. J Biol Chem 251: 7834–7840.
Layzer RB, 1982 Periodic paralysis and the sodiumpotassium pump. Ann Neurol 11: 547–552.
Hundal HS, Marette A, Mitsumoto Y, et al, 1992 Insulin induces translocation of the α2 and β1 subunits of the Na+/K(+)-ATPase from intracellular compartments to the plasma membrane in mammalian skeletal muscle. J Biol Chem 267: 5040–5043.
Hawkins BR, Ma JTC, Lam KSL, et al, 1985 Association of HLA antigens with thyrotoxic Graves’ disease and periodic paralysis in Hong Kong Chinese. Clin Endocrinol (Oxf) 23: 245–252.
Yeo PPB, Chan SH, Lui KF, et al, 1978 HLA and thyrotoxic periodic paralysis. Br Med J 2: 930.
Tamai H, Tanaaha K, Komaki G, et al, 1987 HLA and thyrotoxic periodic paralysis in Japanese patients. J Clin Endocrinol Metab 64: 1075–1078.
Kung AWC, Lau KS, Fong GCY, Chan V, 2004 Association of novel single nucleotide polymorphisms in the calcium channel α1 subunit gene (Cav1.1) and thyrotoxic periodic paralysis. J Clin Endocrinol Metab 89: 1340–1345.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Pappa, T., Papanastasiou, L., Markou, A. et al. Thyrotoxic periodic paralysis as the first manifestation of a thyrotropin-secreting pituitary adenoma. Hormones 9, 82–86 (2010). https://doi.org/10.14310/horm.2002.1257
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.14310/horm.2002.1257