Management of coexisting thyrotropin/growth-hormone-secreting pituitary adenoma and papillary thyroid carcinoma: a therapeutic challenge.
BACKGROUND
A thyrotropin (TSH)-secreting pituitary adenoma coexisting with differentiated thyroid carcinoma is rare. There have been only four previously reported cases; three were treated with thyroidectomy followed by pituitary resection and one was treated with thyroidectomy alone.


METHODS
We hereby report the fifth case, in which a patient presented with a TSH/growth-hormone-secreting pituitary macroadenoma coexisting with papillary thyroid carcinoma (PTC).


RESULTS
She underwent biochemical testing, ophthalmologic examination, thyroid ultrasonography, Tc-99m-pertechnetate thyroid scan, whole-body positron emission tomography, (111)In-octreotide scan, thyroid fine-needle aspiration biopsy, octreotide treatment, total thyroidectomy, recombinant human TSH radioactive iodine remnant ablation, and continued treatment with octreotide and levothyroxine after thyroidectomy. She has remained asymptomatic for 24 months without biochemical or radiological evidence of pituitary hormone oversecretion, pituitary adenoma enlargement, and PTC recurrence.


CONCLUSIONS
To our knowledge, this is the first case of a TSH/growth-hormone-secreting pituitary macroadenoma coexisting with PTC being successfully treated with octreotide and levothyroxine after thyroidectomy and recombinant human TSH-stimulated radioactive iodine remnant ablation.
Nguyen
Huong D
HD
Department of Endocrinology, National Naval Medical Center, Bethesda, Maryland 20889-5600, USA. huong.nguyen@med.navy.mil
Galitz
Michael S
MS
Mai
Vinh Q
VQ
Clyde
Patrick W
PW
Glister
Babette C
BC
Shakir
Mohamed K M
MK
D000236:Adenoma / Q000188:drug therapy / Q000378:metabolism; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D002291:Carcinoma, Papillary / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery; D003131:Combined Modality Therapy; D003692:Delayed-Action Preparations / Q000627:therapeutic use; D005260:Female; D020249:Hormone Replacement Therapy; D019382:Human Growth Hormone / Q000096:biosynthesis* / Q000097:blood / Q000378:metabolism; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000188:drug therapy / Q000601:surgery; D015282:Octreotide / Q000627:therapeutic use; D010911:Pituitary Neoplasms / Q000188:drug therapy / Q000378:metabolism; D011994:Recombinant Proteins / Q000494:pharmacology; D013964:Thyroid Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery; D013965:Thyroidectomy; D013972:Thyrotropin / Q000096:biosynthesis* / Q000097:blood / Q000378:metabolism / Q000494:pharmacology; D013974:Thyroxine / Q000627:therapeutic use; D016896:Treatment Outcome
D018931:Antineoplastic Agents, Hormonal; D003692:Delayed-Action Preparations; D007457:Iodine Radioisotopes; D011994:Recombinant Proteins; D019382:Human Growth Hormone; D013972:Thyrotropin; D013974:Thyroxine; D015282:Octreotide