Hyperthyroidism due to a pituitary TSH secreting tumour with amenorrhoea-galactorrhoea.
A 20-year-old female presented with thyrotoxicosis associated with amenorrhoea and galactorrhoea after oral contraceptive withdrawal. Serum TSH was persistently elevated (mean: 28 +/- 3.1 microU/ml during 24-h sampling and did not vary significantly after TRH, bromocriptine or somatostatin. Prolactin levels remained constantly at the upper limit of normal (mean: 20.6 +/- 2.1 ng/ml, with a minimal increase after TRH, a slight decrease after somatostatin (54%) and a marked decrease after bromocriptine (88.5%). Surgical exploration revealed an unusually firm tumour adherant to the wall of the sella turcia; electron microscopic study showed that it was composed almost exclusively of thyrotrophs. After a transient period of euthyroidism post-operatively, T3 toxicosis occurred with an increased TSH level (15.5 microU/ml) and a rise in TSH and alpha subunit in response to TRH. An increase in T4 followed while prolactin remained low.
D000328:Adult; D000568:Amenorrhea / Q000150:complications*; D005260:Female; D005687:Galactorrhea / Q000150:complications*; D006801:Humans; D006980:Hyperthyroidism / Q000209:etiology*; D007775:Lactation Disorders / Q000150:complications*; D010911:Pituitary Neoplasms / Q000097:blood / Q000150:complications* / Q000378:metabolism; D011184:Postoperative Period; D011247:Pregnancy; D011388:Prolactin / Q000097:blood; D013972:Thyrotropin / Q000097:blood / Q000378:metabolism*; D013974:Thyroxine / Q000097:blood
D011388:Prolactin; D013972:Thyrotropin; D013974:Thyroxine