Clinicopathologic Features in a TSH Secreting Pituitary Tumor : a Case Report

Yuriz Bakhtiar; Irfan Kesumayadi; Shingo Fujio; Muhamad Thohar Arifin

doi:10.33533/jpm.v17i2.6530

Authors

Yuriz Bakhtiar Departement of Neurosurgery, Faculty of Medicine, Diponegoro University / DR Kariadi Hospital, Central Java, Semarang, Indonesia
Irfan Kesumayadi Departemen Bedah Saraf, Fakutas Kedokteran, Universitas Diponegoro
Shingo Fujio Graduate School of Medical and Dental Sciences, Kagoshima University
Muhamad Thohar Arifin Departemen Bedah Saraf, Fakutas Kedokteran, Universitas Diponegoro

DOI:

https://doi.org/10.33533/jpm.v17i2.6530

Keywords:

Pituitary adenoma, TSHoma, Hyperthyroid, Transsphenoidal surgery

Abstract

Thyrotropin-stimulating hormone-producing adenoma (TSHoma) is a rare cause of hyperthyroidism. Patients with this condition are often diagnosed when the tumor has already grown significantly, as the diagnosis of TSHoma is frequently delayed and confused with primary hyperthyroidism. Our case describes a 60-year-old woman with a goiter who was referred to our center from the otolaryngology department. Her thyroid panel in endocrinology showed elevated free hormone levels (fT3: 4.6 mg/ml and fT4: 1.93 mg/ml) and an unsuppressed TSH: 12.85 μ mIU/l, suggesting central hyperthyroidism. A thyroid gland sample obtained by a fine needle aspiration biopsy did not show malignant cells. An MRI scan of the pituitary gland revealed a macroadenoma with KNOSP grade 1. She underwent transsphenoidal surgery for the tumor. Histopathology revealed an acidophilic adenoma with the expression of TSH and prolactin by immunostaining. The proliferation rate, as indicated by MIB-1 staining, was only 0.6%. The decrease in thyroid hormones after the operation confirmed the effectiveness of the surgery. In conclusion, TSHoma, a rare tumor associated with hyperthyroidism, requires a careful diagnosis for effective management. Our article serves as reference material for understanding cases of pituitary-secreting tumors in Indonesia.

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