Monomorphous Plurihormonal Pituitary Adenoma of Pit-1 Lineage in a Giant Adolescent with Central Hyperthyroidism.
Thyrotropin (TSH)-secreting pituitary adenomas are exceedingly rare at the pediatric age and no cases of co-secretion with other pituitary hormones in these tumors have been described in this age range. We present a case of a monomorphous plurihormonal pituitary adenoma that co-secreted TSH and GH in a pediatric patient. A 13-year-old male presented with increasing height velocity (17.75 cm/year, 9.55SD), weight loss, and visual impairment. Initial biochemical evaluations revealed secondary hyperthyroidism. A giant pituitary tumor compressing the surrounding structures was detected by magnetic resonance, and a transsphenoidal surgery was initially performed. Pathological examinations revealed an atypical, monomorphous plurihormonal Pit-1 lineage tumor with mixed features of silent subtype 3 adenoma and acidophil stem cell adenoma. In the postoperative period, secondary hyperthyroidism recurred with high levels of both GH and IGF1. In addition, due to tumor re-growth, a multimodality treatment plan was undertaken including surgery, somatostatin analogs, and radiotherapy. We report the first pediatric case of a plurihormonal TSH- and GH-secreting pituitary adenoma, further expanding the clinical manifestations of pediatric pituitary tumors. Comprehensive pathological evaluation and close follow-up surveillance are crucial to the prompt delivery of the best therapeutic options in the context of this particularly aggressive pituitary tumor.
Serviço de Endocrinologia e Diabetes, piso 8, Hospital Garcia de Orta, E.P.E, 2801-951, Almada-Setúbal, Portugal. bern1981@gmail.com.
Bernardo Dias
BD
Pereira
Serviço de Endocrinologia e Diabetes, piso 8, Hospital Garcia de Orta, E.P.E, 2801-951, Almada-Setúbal, Portugal.
Luísa
L
Raimundo
Department of Pathology, University Health Network, 200 Elizabeth Street, 11th Floor, Toronto, ON, Canada.
Ozgur
O
Mete
Serviço de Anatomia Patológica, piso 0, Hospital Garcia de Orta, E.P.E, 2801-951, Almada-Setúbal, Portugal.
Ana
A
Oliveira
Serviço de Endocrinologia e Diabetes, piso 8, Hospital Garcia de Orta, E.P.E, 2801-951, Almada-Setúbal, Portugal.
Jorge
J
Portugal
Department of Pathology, University Health Network, 200 Elizabeth Street, 11th Floor, Toronto, ON, Canada.
Sylvia L
SL
Asa
D000236:Adenoma / Q000150:complications / Q000378:metabolism / Q000473:pathology*; D000293:Adolescent; D014408:Biomarkers, Tumor / Q000032:analysis; D005877:Gigantism / Q000209:etiology*; D049912:Growth Hormone-Secreting Pituitary Adenoma / Q000150:complications / Q000378:metabolism / Q000473:pathology*; D006801:Humans; D006980:Hyperthyroidism / Q000209:etiology; D007150:Immunohistochemistry; D008297:Male; D046529:Microscopy, Electron, Transmission; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D013972:Thyrotropin / Q000378:metabolism*; D050817:Transcription Factor Pit-1 / Q000378:metabolism
D014408:Biomarkers, Tumor; D050817:Transcription Factor Pit-1; D013972:Thyrotropin
Adolescent; Gigantism; Hyperthyroidism; Pituitary tumors