A pituitary carcinoma secreting TSH and prolactin: a non-secreting adenoma gone awry.
To our knowledge, only one case of a TSH-secreting carcinoma has previously been reported. We describe here a second patient with a pituitary carcinoma producing TSH and prolactin (PRL). A 37-year-old male underwent a left frontotemporal craniotomy in 1996 for a sellar mass. Except for mildly increased PRL and elevated alpha-subunit, hormone evaluation was normal. Pathologic examination revealed a chromophobe adenoma with increased mitotic forms. The patient completed a course of external beam radiation to the pituitary and was prescribed l-thyroxine, bromocriptine, and hydrocortisone. He was lost to follow-up but did well for 6 years, until 2002, when he presented with TSH-dependent thyrotoxicosis and hyperprolactinemia. The patient was started on bromocriptine and propylthiouracil and was, again, lost to follow-up. In 2004, 9 years after his initial presentation, he presented after falling. Magnetic resonance imaging showed two brain masses with associated midline shift. Emergent resection of the larger mass revealed a pituitary cancer with positive staining for PRL, but not for TSH. Nine months later, the patient underwent further debulking of metastatic disease. Although development of a carcinoma from a pituitary adenoma is very rare (<0.5%), macroadenomas that become hormonally active should be suspect for transformation into pituitary cancer.
Brown
Rebecca L
RL
Thyroid Study Unit, Department of Medicine, University of Chicago, 5841 S Maryland Ave, Mail Code 3090, Chicago, Illinois 60645, USA.
Muzzafar
Tariq
T
Wollman
Robert
R
Weiss
Roy E
RE
D000328:Adult; D002454:Cell Differentiation; D018450:Disease Progression; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D010911:Pituitary Neoplasms / Q000378:metabolism* / Q000473:pathology; D011388:Prolactin / Q000378:metabolism*; D015175:Prolactinoma / Q000378:metabolism* / Q000473:pathology; D013972:Thyrotropin / Q000378:metabolism*
D011388:Prolactin; D013972:Thyrotropin