Monomorphous Plurihormonal Pituitary Adenoma of Pit-1 Lineage in a Giant Adolescent with Central Hyperthyroidism

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• 作者：Bernardo Dias Pereira ; Luísa Raimundo ; Ozgur Mete ; Ana Oliveira…
• 关键词：Adolescent ; Gigantism ; Hyperthyroidism ; Pituitary tumors
• 刊名：Endocrine Pathology
• 出版年：2016
• 出版时间：March 2016
• 年：2016
• 卷：27
• 期：1
• 页码：25-33
• 全文大小：2,918 KB
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• 作者单位：Bernardo Dias Pereira (1)
  Luísa Raimundo (1)
  Ozgur Mete (2)
  Ana Oliveira (3)
  Jorge Portugal (1)
  Sylvia L. Asa (2)
  
  1. Serviço de Endocrinologia e Diabetes, piso 8, Hospital Garcia de Orta, E.P.E, 2801-951, Almada-Setúbal, Portugal
  2. Department of Pathology, University Health Network, 200 Elizabeth Street, 11th Floor, Toronto, ON, Canada
  3. Serviço de Anatomia Patológica, piso 0, Hospital Garcia de Orta, E.P.E, 2801-951, Almada-Setúbal, Portugal
  
• 刊物主题：Pathology; Endocrinology; Oncology;
• 出版者：Springer US
• ISSN：1559-0097

文摘

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. Keywords Adolescent Gigantism Hyperthyroidism Pituitary tumors