title: Thyroid storm induced by TSH-secreting pituitary adenoma: a case report.
abstract: Thyroid stimulating hormone-secreting pituitary adenomas (TSHomas) are uncommon tumors of the anterior pituitary gland. Patients with TSHomas may present with hyperthyroidism, but the incidence of thyroid storm due to TSHomas has yet to be determined. We report a rare case of thyroid storm caused by TSHoma in a 54-year-old woman. Preoperatively she had symptoms of excessive sweating and palpitation. Blood tests showed inappropriate secretion of TSH with blood TSH 6.86 μ U/mL, fT3 19.8 pg/mL, and fT4 5.95 ng/dL. Magnetic resonance imaging (MRI) revealed a pituitary tumor with maximum diameter of 13 mm that was extirpated through transsphenoidal route. After operation the patient was stuporous and thyroid storm occurred presenting with hyperthermia, hypertension, and tachycardia. It was well managed with nicardipine, midazolam, steroids, and potassium iodide. Immunohistochemical staining of tumor specimen was positive for TSH and growth hormone (GH). One year after operation, fT3 and fT4 levels were still high. As her tumor was diagnosed to be GH- and TSH-producing adenoma, octreotide injection therapy was started, which normalized thyroid hormone levels. This is the second reported case with thyroid storm due to TSHoma and emphasizes the importance of strategies with interdisciplinary cooperation for prevention of such emergency conditions.
authors.affiliation: Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-8520, Japan.
authors.forename: Shingo
authors.initials: S
authors.lastname: Fujio
authors.lastname: Ashari
authors.forename: Mika
authors.initials: M
authors.lastname: Habu
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Yamahata
authors.forename: F M
authors.initials: FM
authors.lastname: Moinuddin
authors.forename: Manoj
authors.initials: M
authors.lastname: Bohara
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Arimura
authors.forename: Yui
authors.initials: Y
authors.lastname: Nishijima
authors.forename: Kazunori
authors.initials: K
authors.lastname: Arita
mesh_terms: D000236:Adenoma / Q000188:drug therapy / Q000378:metabolism* / Q000601:surgery; D005260:Female; D019382:Human Growth Hormone / Q000378:metabolism; D006801:Humans; D008875:Middle Aged; D015282:Octreotide / Q000627:therapeutic use; D010911:Pituitary Neoplasms / Q000188:drug therapy / Q000378:metabolism* / Q000601:surgery; D013958:Thyroid Crisis / Q000209:etiology*; D013972:Thyrotropin / Q000378:metabolism*
chemical_list: D019382:Human Growth Hormone; D013972:Thyrotropin; D015282:Octreotide