title: A Case of a TSH-secreting Pituitary Adenoma Associated with Evans' Syndrome.
abstract: We present a case of a TSH-secreting pituitary adenoma (TSHoma) associated with Evans' syndrome. A 30-year-old woman was referred to our hospital due to purpura and ecchymoses on her limb and body and epistaxis. Evans' syndrome was diagnosed based on idiopathic thrombocytopenic purpura and autoimmune hemolytic anemia. She had a history of malocclusion and thyroid gland enlargement 4 years prior to admission. Endocrinological tests and magnetic resonance imaging also revealed that this patient had hyperthyroidism due to the TSHoma and that this adenoma concomitantly secreted GH. Recently, several cases of Evans' syndrome were associated with hyperthyroidism caused by autoimmune thyroid disease, such as Graves' disease, suggesting that these 2 conditions may have a common immunological basis. To the best of our knowledge, there is no case report of Evans' syndrome associated with hyperthyroidism due to TSHoma. Our report suggests that the excess of thyroid hormone itself promotes autoimmunity in Evans' syndrome. Thus, early treatment for hyperthyroidism is necessary in TSHomas because of the possibility that thyroid hormone normalization may prevent the development of Evans' syndrome.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Yasuda
authors.affiliation: Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Tokai University School of Medicine, 143 Shimokasuya, Iseharashi, Kanagawa 259-1193, Japan. tsekimdpdd@tokai-u.jp.
authors.forename: Toshiro
authors.initials: T
authors.lastname: Seki
authors.forename: Masayuki
authors.initials: M
authors.lastname: Oki
authors.forename: Atsushi
authors.initials: A
authors.lastname: Takagi
authors.forename: Chie
authors.initials: C
authors.lastname: Inomoto
authors.forename: Naoya
authors.initials: N
authors.lastname: Nakamura
authors.forename: Hideki
authors.initials: H
authors.lastname: Atsumi
authors.forename: Tanefumi
authors.initials: T
authors.lastname: Baba
authors.forename: Mitsunori
authors.initials: M
authors.lastname: Matsumae
authors.forename: Noriko
authors.initials: N
authors.lastname: Sasaki
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Suzuki
authors.forename: Masafumi
authors.initials: M
authors.lastname: Fukagawa
mesh_terms: D000328:Adult; D000744:Anemia, Hemolytic, Autoimmune / Q000175:diagnosis / Q000209:etiology* / Q000276:immunology / Q000628:therapy; D015551:Autoimmunity; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D019382:Human Growth Hormone / Q000378:metabolism; D006801:Humans; D006980:Hyperthyroidism / Q000209:etiology / Q000628:therapy; D010911:Pituitary Neoplasms / Q000150:complications* / Q000378:metabolism* / Q000628:therapy; D013921:Thrombocytopenia / Q000175:diagnosis / Q000209:etiology* / Q000276:immunology / Q000628:therapy; D013972:Thyrotropin / Q000378:metabolism*; D016896:Treatment Outcome
chemical_list: D019382:Human Growth Hormone; D013972:Thyrotropin