Clinical response of thyrotropin-secreting macroadenoma to bromocriptine and radiotherapy.
A patient presenting with hyperthyroidism was treated initially with antithyroid drugs and subsequently radioiodine. Thereafter he was noted to have inappropriately elevated thyrotropin. A bitemporal visual field defect was noted and CT scan confirmed the presence of a pituitary tumour. TSH was elevated and unresponsive to TRH stimulation. alpha subunit was not elevated. Long-term bromocriptine therapy (doses up to 50 mg/day) resulted in partial, but incomplete suppression of thyrotropin secretion. Following radiotherapy there was resolution of the visual field defect; the TSH, however, remains elevated at greater than 20 mU/l. Radiotherapy and bromocriptine may provide a clinically useful alternative to pituitary surgery in patients with TSH-secreting macroadenoma with suprasellar extension.
D000236:Adenoma / Q000188:drug therapy / Q000378:metabolism* / Q000532:radiotherapy; D001971:Bromocriptine / Q000627:therapeutic use; D003907:Dexamethasone / Q000008:administration & dosage; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008297:Male; D008787:Metoclopramide; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000188:drug therapy / Q000378:metabolism* / Q000532:radiotherapy; D013972:Thyrotropin / Q000378:metabolism*; D013973:Thyrotropin-Releasing Hormone; D013974:Thyroxine / Q000008:administration & dosage / Q000378:metabolism; D014794:Visual Fields
D007457:Iodine Radioisotopes; D001971:Bromocriptine; D013973:Thyrotropin-Releasing Hormone; D003907:Dexamethasone; D013972:Thyrotropin; D008787:Metoclopramide; D013974:Thyroxine