title: Thyrotoxicosis with absence of clinical features of acromegaly in a TSH- and GH-secreting, invasive pituitary macroadenoma.
abstract: A 54-year-old woman presented with bi-temporal hemianopia, palpitations, and diaphoresis. An invasive pituitary macroadenoma was discovered. The patient had biochemical evidence of secondary hyperthyroidism and GH excess; however, she did not appear to be acromegalic. Surgical removal of the pituitary mass revealed a plurihormonal TSH/GH co-secreting pituitary adenoma. TSH-secreting adenomas can co-secrete other hormones including GH, prolactin, and gonadotropins; conversely, co-secretion of TSH from a pituitary adenoma in acromegaly is infrequent.
  
  
  CONCLUSIONS
  This case highlights an unusual patient with a rare TSH/GH co-secreting pituitary adenoma with absence of the clinical features of acromegaly.Plurihormonality does not always translate into the clinical features of hormonal excess.There appears to be a clinical and immunohistochemical spectrum present in plurihormonal tumors.
authors.affiliation: Department of Endocrinology Diabetes and Metabolism, Cleveland Clinic Foundation , 9500 Euclid Avenue Desk F20, Cleveland, Ohio, 44195 , USA.
authors.forename: Philip C
authors.initials: PC
authors.lastname: Johnston
authors.affiliation: Department of Endocrinology Diabetes and Metabolism, Cleveland Clinic Foundation , 9500 Euclid Avenue Desk F20, Cleveland, Ohio, 44195 , USA.
authors.forename: Amir H
authors.initials: AH
authors.lastname: Hamrahian
authors.affiliation: Patholgy and Laboratory Medicine Institute, Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic , Cleveland, Ohio, 44195 , USA.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Prayson
authors.affiliation: Department of Endocrinology Diabetes and Metabolism, Cleveland Clinic Foundation , 9500 Euclid Avenue Desk F20, Cleveland, Ohio, 44195 , USA.
authors.forename: Laurence
authors.initials: L
authors.lastname: Kennedy
authors.affiliation: Department of Neurosurgery and the Neurological Institute, Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic , Cleveland, Ohio, 44195 , USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Weil