TSH-containing pituitary adenoma associated with primary hypothyroidism manifested by amenorrhoea and galactorrhoea

Abstract

A 30 year old woman with primary hypothyroidism due to an ectopic (sublingual) thyroid, with a pituitary tumour invasive to the sphenoidal sinus presented with hyperprolactinaemia, amenorrhoea and galactorrhoea not corrected by long-term thyroid replacement. High basal TSH and TRH hyperresponsiveness were suppressed by thyroid therapy. After transsphenoidal removal of the tumour the Prl returned to normal. Light microscopy including differential staining and immunocytochemistry demonstrated that the tumour was composed of TSH cells. Ultrastructurally the adenoma cell contained small granules (90\p=n-\150nm) as described in TSH cells. This case provides evidence that a TSH cell adenoma probably arising from protracted overstimulation secondary to thyroid deficiency can induce hyperprolactinaemia. This did not appear to be produced directly by the adenoma nor was there any evidence of compression of the pituitary stalk. Samaan et al. (1977) and Katz et al. (1980) de¬ scribed adult patients with hypothyroidism asso¬ ciated with pituitary adenomas which were resected and proved to be TSH cell adenomas. We report a woman who had primary hypothyroidism asso¬ ciated with an ectopie (sublingual) thyroid and a pituitary adenoma presenting with amenorrhoea and galactorrhoea. Immunocytochemistry and ultrastructural examination was applied to the tum¬ our.A 30 year old woman was admitted to the hospital in January 1978 for menstrual irregularities since menarche and galactorrhoea for 1 year. Since the age of 2 months, when the diagnosis of hypothyoridism was made, the patient was placed on thyroid hormone re¬ placement taken regularly only until she was 10 years old.Menarche occurred at the age of 13 years. Because of reduction in the frequency of menses she was started on cyclic oral ethinyloestradiol 0.03 mg + levonorgestrel 0.1 mg at the age of 27 years, with normal withdrawal bleeding. On interruption of the oral steroids, for the last 18 months, she became amenorrhoeic. Galactorrhoea was found 1 year before admission and since then she had been treated with 120 µg i.-thyroxine and 30 µg I.-triiodothyronine (T, + T3) daily but galactorrhoea and amenorrhoea persisted. At the age of 22 years, with the patient off thyroid therapy, 2-and 24-h neck 131I uptake by aberrant thyroid tissue was 6.5 and 19%, respectively.The neck scintiscan revealed an ectopie thyroid (sublin¬ gual localization). No stigmata of hypothyroidism were found and the thyroid gland was not palpable. The breast had expressible milk. The remaining physical examination was normal. A lateral skull X-ray showed a slightly enlarged sella turcica with a double floor; hypocycloidal polytomography of the pituitary fossa indicated thinning of its floor and localized erosion at the left of the midline with a herniation of soft tissue into the sphenoidal sinus. CAT-scan of the skull confirmed the pre¬ sence of an intrasellar mass invading the left sphenoidal sinus. Pneumoencephalography did not show suprasellar extension of the tumour, and air did not enter the sel...

TSH-Secreting Pituitary Macroadenoma in a Girl with Lingual Thyroid

“…Occurrence of TSH macroadenoma in a long-standing untreated hypothyroidism is unusual, and has only been rarely reported, mostly in adult subjects [11, 12]. Myers et al report a 54-year-old woman with primary hypothyroidism who presented with symptoms of increased intracranial pressure and worsening vision due to thyrotropin-secreting adenoma [13].…”