التفاصيل البيبلوغرافية
| العنوان: |
Autoimmune hypothyroidism coexisting with a pituitary adenoma secreting thyroid-stimulating hormone, prolactin and α-subunit. |
| المؤلفون: |
Idiculla, Jyothi M., Beckett, Geoff, Statham, Patrick F. X., Ironside, James W., Atkin, Stephen L., Patrick, Alan W. |
| المصدر: |
Annals of Clinical Biochemistry; Sep2001, Vol. 38 Issue 5, p566-571, 6p |
| مصطلحات موضوعية: |
PITUITARY hormones, THYROID diseases, HYPOTHYROIDISM, AUTOANTIBODIES, IMMUNOGLOBULINS, MEDICAL imaging systems, THYROID hormones, THYROXINE |
| مستخلص: |
A 44-year-old woman presented to her GP with excessive tiredness. She had positive thyroid microsomal and thyroglobulin autoantibodies and was found to have an elevated serum thyroid-stimulating hormone (TSH) concentration of 8.37 (normal = 0.15-3.5) mU/L and a low normal total thyroxine (T4) of 86 (reference range 60-145) nmol/L. She was rendered symptom free on a dose of 150 μg of thyroxine per day. However, her TSH failed to return to normal, and following a further increase in her thyroxine dose she was referred to the endocrine clinic for further assessment. Her TSH at this stage was 14 mU/L, free T4 (fT4) 28 (normal = 10-27) pmo/L and free T3 (fT3) 10 (normal = 4.3-7.6) pmol/L. She denied any problems with adherence to her medication. Her serum prolactin was elevated at 861 (normal = 60-390) mU/L. A pituitary tumour was suspected and an MRI scan showed a macroadenoma of the right lobe of the pituitary, extending into the suprasellar cistern. The tumour was resected trans-sphenoidally. Electron microscopy showed a dual population of neoplastic cells compatible with a thyrotroph cell and prolactin-secreting adenoma. Immunocytochemistry and cell culture studies confirmed the secretion of TSH, prolactin and a-subunit. Postoperative combined anterior pituitary function tests did not demonstrate any deficiency of anterior pituitary hormones. A repeat MRI scan showed no significant residual tumour; however, her serum TSH and prolactin levels remained high and she was given a course of pituitary irradiation. This case illustrates the difficulty of diagnosing a TSHoma when it coexists with autoimmune hypothyroidism. We believe the combination of pathologies reported here is unique. [ABSTRACT FROM AUTHOR] |
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| قاعدة البيانات: |
Complementary Index |
