title: [Endocrine abnormalities in a patient with borderline personality disorder--case 8/2014].
abstract: METHODS
  We report on a 44-year-old woman who was treated for borderline personality disorder in the Department of Psychiatry. In addition, symptoms of hyperthyroidism (anxiety, weight loss, hyperdefecation) were noticeable. Thyroid stimulating hormone (TSH) was marginally elevated, free triiodothyronine (T3) and free thyroxine (T4) were clearly elevated. Hence, the patient was transferred to the Department of Endocrinology.
  
  
  METHODS
  Thyroid ultrasound revealed a diffuse goiter with a total volume of 24,8 ml. Antibody screening did not show elevated titers. The thyrotropin releasing hormone (TRH) test depicted a blunted TSH response. Serum levels of free glycoprotein hormone alpha-subunit, prolactin and insulin-like growth factor 1 were increased.
  
  
  METHODS
  In cranial magnetic resonance imaging (MRI), a hypointense lesion on the left side of the anterior pituitary gland was detected indicating a thyrotropin-secreting microadenoma with concomitant secretion of prolactin and possible secretion of human growth hormone (HGH). A thyreostatic therapy was initiated aiming at euthyreosis. For symptom control, betablockers were administered. Subsequently, the patient underwent an uncomplicated transsphenoidal resection. Histological examination confirmed the diagnosis of a pituitary adenoma with expression of TSH, prolactin and HGH. As expected, thyroid hormones declined afterwards.
  
  
  CONCLUSIONS
  TSHoma is rare. Diagnosis is confirmed by endocrinological testing and cranial imaging. Therapeutic options comprise transsphenoidal adenomectomy, drug therapy (somatostatin analogues, dopaminergic agonists) and irradiation. Resistance to thyroid hormones should be included in the differential diagnosis.
authors.affiliation: Medizinische Klinik IV, Universitätsklinikum Tübingen.
authors.forename: Christoph
authors.initials: C
authors.lastname: Gassenmaier
authors.affiliation: Institut für Pathologie und Neuropathologie, Universitätsklinikum Tübingen.
authors.forename: Jens
authors.initials: J
authors.lastname: Schittenhelm
authors.affiliation: Neuroradiologie, Universitätsklinkum Tübingen.
authors.forename: Nadja
authors.initials: N
authors.lastname: Selo
authors.affiliation: Medizinische Klinik IV, Universitätsklinikum Tübingen.
authors.forename: Günter
authors.initials: G
authors.lastname: Schnauder
mesh_terms: D000236:Adenoma / Q000175:diagnosis* / Q000378:metabolism* / Q000523:psychology / Q000601:surgery; D000328:Adult; D001883:Borderline Personality Disorder / Q000175:diagnosis* / Q000523:psychology*; D003937:Diagnosis, Differential; D005260:Female; D019382:Human Growth Hormone / Q000378:metabolism; D006801:Humans; D006964:Hyperpituitarism / Q000175:diagnosis* / Q000523:psychology* / Q000601:surgery; D006980:Hyperthyroidism / Q000175:diagnosis* / Q000523:psychology* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D010911:Pituitary Neoplasms / Q000175:diagnosis* / Q000378:metabolism* / Q000523:psychology / Q000601:surgery; D011183:Postoperative Complications / Q000175:diagnosis / Q000523:psychology; D011388:Prolactin / Q000378:metabolism; D013960:Thyroid Function Tests; D013972:Thyrotropin / Q000378:metabolism*; D014463:Ultrasonography
chemical_list: D019382:Human Growth Hormone; D011388:Prolactin; D013972:Thyrotropin