title: [TSH secreting adenoma of pituitary gland (TSHom) -  rare cause of hyperthyroidism in pregnancy].
abstract: METHODS
  A 28 year-old woman in her first pregnancy was referred to the department of obstetrics and gynecology at 24 weeks of gestation because of pregnancy-induced hypertension.
  
  
  METHODS
  Thyroid stimulating hormone (TSH), free T3 and free T4 were elevated. Antibody screening did not show antithyroid peroxidase (anti-TPO) antibodies and TSH receptor antibodies. Clinical findings were suspicious of TSH secreting pituitary tumour (TSH-om) or thyroid hormone resistance (RTH). In absence of clinical sings of elevated intracranial pressure magnetic resonance imaging (MR) was discussed but not carried out and planned after delivery. A visual-field defect was ruled out by orbital field evaluation.
  
  
  METHODS
  Treatment with 3 × 50 mg propylthiouracil daily was initiated. However, normal fT3/fT4 titers could not be achieved. Serum levels were in the high normal ranges and TSH remained increased. The clinical situation of the patient improved resulting in a normal delivery at term. The healthy newborn was breast feed and MR imaging of the mother revealed a 5×8 mm tumor of the pituitary gland.
  
  
  CONCLUSIONS
  In pregnant women with pregnancy-induced hypertension thyroid diseases have to be ruled out. Rare causes of hyperthyreoidism are TSH secreting pituitary tumors or thyroid hormone resistance (RTH). Treatment of choice for hyperthyreoidism in pregnancy is propylthiouracil. Normal vaginal delivery and breast feeding are possible. Following delivery it is mandatory to determine an individual treatment strategy.
authors: Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt Rostock.
authors: M
authors: M
authors: Bolz
authors: S
authors: S
authors: Körber
authors: H-C
authors: HC
authors: Schober
mesh_terms: D000236:Adenoma / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy / Q000378:metabolism*; D013956:Antithyroid Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006964:Hyperpituitarism / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy; D006980:Hyperthyroidism / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D010902:Pituitary Gland / Q000473:pathology; D010911:Pituitary Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy / Q000378:metabolism*; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy; D011262:Pregnancy Trimester, Second; D011441:Propylthiouracil / Q000008:administration & dosage; D035583:Rare Diseases; D013960:Thyroid Function Tests; D013972:Thyrotropin / Q000097:blood / Q000378:metabolism*
chemical_list: D013956:Antithyroid Agents; D011441:Propylthiouracil; D013972:Thyrotropin