Abstract
Thyroid-stimulating hormone- (TSH-) secreting pituitary adenoma (TSH-oma) is a rare cause of secondary hyperthyroidism and can be misdiagnosed as primary hyperthyroidism. We report a case of a 15-year-old male patient who was one of two monozygotic twins and exhibited hyperthyroidism syndrome. The laboratory results showed secondary hyperthyroidism, with increased levels of free T3 (FT3) and free T4 (FT4) and no TSH inhibition. Magnetic resonance imaging (MRI) and histopathological examination of the pituitary gland confirmed pituitary microadenoma. The patient was treated with methimazole, propranolol, and somatostatin analogs to restore euthyroidism before undergoing an endoscopic transsphenoidal resection of the pituitary tumor. After surgery, the hyperthyroidism symptoms improved, thyroid hormones normalized, and MRI of the pituitary gland showed the complete removal of the tumor with no recurrence after 2 years of follow-up.
Highlights
Case PresentationA 15-year-old male patient presented to the clinic reporting exertion palpitations and feeling hot, with no other complaints. e patient had no growth chart until he came to our hospital. e patient did not gain weight as well as his monozygotic twin brother (Figure 1)
Le Hoang Bao,1 Nguyen Minh Duc,2,3,4 Phan Cong Chien,5 Thieu-Thi Tra My,2 Tran Viet Thang,1 and Tran Quang Nam1
We report a case of a 15-year-old male patient who was one of two monozygotic twins and exhibited hyperthyroidism syndrome. e laboratory results showed secondary hyperthyroidism, with increased levels of free T3 (FT3) and free T4 (FT4) and no TSH inhibition
Summary
A 15-year-old male patient presented to the clinic reporting exertion palpitations and feeling hot, with no other complaints. e patient had no growth chart until he came to our hospital. e patient did not gain weight as well as his monozygotic twin brother (Figure 1). E monozygotic twin brother presented no clinical symptoms of hyperthyroidism, with a normal thyroid function test. E patient could not afford the cost of somatostatin analog; thyroid hormone levels were normalized by methimazole (20 mg per day) and propranolol (10 mg three times per day) before performing an endoscopic transsphenoidal resection of the pituitary tumor. The patient presented no clinical symptoms of hyperthyroidism His weight was 50 kg before surgery and, 2 years later, it was 60 kg (gain 10 kg in 2 years); his height was 173 cm before surgery and later, his height was 175 cm. Hormonal testing after discharge was performed after 2 months, 6 months, and 18 months, and serum TSH, FT4, ACTH, and cortisol levels were detected in the normal range. MRI of the pituitary gland after 1 (Figure 2(c)) and 2 years (Figure 2(d)) showed the complete removal of the tumor, with no recurrence
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