A case of thyrotropin-producing pituitary adenoma, accompanied by an increase in anti-thyrotropin receptor antibody after tumor resection.
We describe a rare, but interesting, case of TSH-producing adenoma (TSHoma), accompanied by increases in both anti-TSH receptor antibody (TRAb) and thyroid-stimulating antibody (TSAb) after tumor resection. A 21-yr-old woman was referred to our department for further evaluation of pituitary tumor. In a nearby hospital, she had been diagnosed as having pituitary tumor. Her serum free T4, free T3, and TSH levels were all elevated concomitantly. On the basis of a diagnosis of pituitary adenoma with TSH production, transsphenoidal resection of the pituitary adenoma was performed. Two weeks after the operation, the blood concentrations of TSH were undetectable, whereas both TRAb and TSAb levels were elevated. TSAb levels gradually increased further from 2 weeks to 3 months after the operation, accompanied by an increase in TSH and free T4 levels. TSH is an important hormone in maintaining physiology and regulating immunomodulators in thyrocytes, as it can influence a variety of immune-regulating cytokine-like activities and inhibit expressions of Fas antigen, intracellular adhesion molecule-1, and class II trans-activator. Changes in TSH would modulate the immune circumstances in the thyroid, and then induce TRAb and TSAb. Autoimmune parameters with thyroid function should be observed carefully when managing patients with TSHoma.
Kageyama
K
K
Department of Endocrinology, Metabolism and Infectious Diseases, Hirosaki University School of Medicine, Hirosaki, Aomori, Japan. kkageyama@hkg.odn.ne.jp
Ikeda
H
H
Sakihara
S
S
Nigawara
T
T
Terui
K
K
Tsutaya
S
S
Matsuda
E
E
Shoji
M
M
Yasujima
M
M
Suda
T
T
D000236:Adenoma / Q000276:immunology / Q000378:metabolism* / Q000601:surgery; D000328:Adult; D000888:Antibodies, Anti-Idiotypic / Q000097:blood*; D005260:Female; D006801:Humans; D018828:Immunoglobulins, Thyroid-Stimulating / Q000097:blood; D010911:Pituitary Neoplasms / Q000276:immunology / Q000378:metabolism* / Q000601:surgery; D011989:Receptors, Thyrotropin / Q000276:immunology*; D013963:Thyroid Hormones / Q000097:blood; D013972:Thyrotropin / Q000378:metabolism*
D000888:Antibodies, Anti-Idiotypic; D018828:Immunoglobulins, Thyroid-Stimulating; D011989:Receptors, Thyrotropin; D013963:Thyroid Hormones; D013972:Thyrotropin