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Hypothyroidism Secondary to Biologically Inactive Thyroid-Stimulating Hormone Secretion by a Pituitary Chromophobe Adenoma: Recovery After Removal of the Tumor

Hypothyroidism Secondary to Biologically Inactive Thyroid-Stimulating Hormone Secretion by a... Abstract A 50-year-old man, suffering from a large pituitary adenoma and panhypopituitarism, was found to have severely elevated thyrotrophin (thyroid-stimulating hormone [TSH]) levels (<20.0 μU/mL). The thyroxine (T4) level was low (<3.0 μg/dL). Thyroid sodium iodide 1131 uptake was low (5% at 24 hours). A TSH test result was normal, with a 24-hour 131I uptake of 52% and a normal-looking thyroid gland on scintiscan. After surgical removal of the pituitary chromophobe adenoma, T4 levels returned to normal (6.8 μg/dL) and TSH levels improved substantially (9.0 μU/mL). Findings from repeated 131I uptake tests were normal (22% at 24 hours). Other pituitary functions improved also. These results suggest that the patient had biologically inactive TSH produced by the tumor. Removal of the tumor probably enabled recovery of the active TSH with the return of normal thyroid uptake and T4 production. Whenever hypothyroidism and high levels of TSH coexist with pituitary dysfunction, a TSH test is needed to distinguish between primary hypothyroidism and hypothyroidism secondary to biologic inactive TSH. (Arch Intern Med 1982;142:1544-1545) References 1. Kourides IA, Ridgway EC, Weintraub BD, et al: Thyrotropin-induced hyperthyroidism: Use of a and β subunit levels to identify patients with pituitary tumors. J Clin Endocrinol Metab 1977;45:534-543.Crossref 2. Vagenakis AG, Dole K, Braverman LE: Pituitary enlargement, pituitary failure, and primary hypothyroidism. Ann Intern Med 1976;85:195-198.Crossref 3. Samaan NA, Osborne BM, Mackay B, et al: Endocrine and morphologic studies of pituitary adenomas secondary to primary hypothyroidism. J Clin Endocrinol Metab 1977;45:903-911.Crossref 4. Yamada T, Tsukui T, Ikejiri K, et al: Volume of sella turcica in normal subjects and in patients with primary hypothyroidism and hyperthyroidism. J Clin Endocrinol Metab 1976;42:817-822.Crossref 5. Keye WR, Yuen BH, Knopf RF, et al: Amenorrhea, hyperprolactinemia, and pituitary enlargement secondary to primary hypothyroidism: Successful treatment with thyroid replacement. Obstet Gynecol 1976;48:697-702. 6. Stokigt JR, Essex WB, West RM, et al: Visual failure during replacement therapy in primary hypothyroidism with pituitary enlargement. J Clin Endocrinol Metab 1976;43:1094-1100.Crossref 7. Burke G: The thyrotropin stimulation test. Ann Intern Med 1968;69:1127-1139.Crossref 8. Peterson VB, McGregor AM, Belshetz PE, et al: Secretion of thyrotropin with impaired biologic activity in patients with hypothalamic-pituitary disease. Clin Endocrinol 1978;8:397-402.Crossref 9. Illig R, Krawczynska H, Torresani T, et al: Elevated plasma TSH and hypothyroidism in children with hypothalamic hypopituitarism. J Clin Endocrinol Metab 1975;41:722-728.Crossref 10. Patel YC, Burger HG: Serum thyrotropin (TSH) in pituitary and/or hypothalamic hypothyroidism: Normal or elevated basal levels and paradoxical responses to thyrotropin-releasing hormone. J Clin Endocrinol Metab 1973;37:190-196.Crossref 11. Faglia G, Bitensky L, Pinchera A, et al: Thyrotropin secretion in patients with central hypothyroidism: Evidence for reduced biological activity of immunoreactive thyrotropin. J Clin Endocrinol Metab 1979;48:989-999.Crossref 12. Spitz IM, Le Roith D, Hirsch H, et al: Increased high-molecular-weight thyrotropin with impaired biologic activity in a euthyroid man. N Engl J Med 1981;304:278-282.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Hypothyroidism Secondary to Biologically Inactive Thyroid-Stimulating Hormone Secretion by a Pituitary Chromophobe Adenoma: Recovery After Removal of the Tumor

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References (13)

Publisher
American Medical Association
Copyright
Copyright © 1982 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1982.00340210142025
Publisher site
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Abstract

Abstract A 50-year-old man, suffering from a large pituitary adenoma and panhypopituitarism, was found to have severely elevated thyrotrophin (thyroid-stimulating hormone [TSH]) levels (<20.0 μU/mL). The thyroxine (T4) level was low (<3.0 μg/dL). Thyroid sodium iodide 1131 uptake was low (5% at 24 hours). A TSH test result was normal, with a 24-hour 131I uptake of 52% and a normal-looking thyroid gland on scintiscan. After surgical removal of the pituitary chromophobe adenoma, T4 levels returned to normal (6.8 μg/dL) and TSH levels improved substantially (9.0 μU/mL). Findings from repeated 131I uptake tests were normal (22% at 24 hours). Other pituitary functions improved also. These results suggest that the patient had biologically inactive TSH produced by the tumor. Removal of the tumor probably enabled recovery of the active TSH with the return of normal thyroid uptake and T4 production. Whenever hypothyroidism and high levels of TSH coexist with pituitary dysfunction, a TSH test is needed to distinguish between primary hypothyroidism and hypothyroidism secondary to biologic inactive TSH. (Arch Intern Med 1982;142:1544-1545) References 1. Kourides IA, Ridgway EC, Weintraub BD, et al: Thyrotropin-induced hyperthyroidism: Use of a and β subunit levels to identify patients with pituitary tumors. J Clin Endocrinol Metab 1977;45:534-543.Crossref 2. Vagenakis AG, Dole K, Braverman LE: Pituitary enlargement, pituitary failure, and primary hypothyroidism. Ann Intern Med 1976;85:195-198.Crossref 3. Samaan NA, Osborne BM, Mackay B, et al: Endocrine and morphologic studies of pituitary adenomas secondary to primary hypothyroidism. J Clin Endocrinol Metab 1977;45:903-911.Crossref 4. Yamada T, Tsukui T, Ikejiri K, et al: Volume of sella turcica in normal subjects and in patients with primary hypothyroidism and hyperthyroidism. J Clin Endocrinol Metab 1976;42:817-822.Crossref 5. Keye WR, Yuen BH, Knopf RF, et al: Amenorrhea, hyperprolactinemia, and pituitary enlargement secondary to primary hypothyroidism: Successful treatment with thyroid replacement. Obstet Gynecol 1976;48:697-702. 6. Stokigt JR, Essex WB, West RM, et al: Visual failure during replacement therapy in primary hypothyroidism with pituitary enlargement. J Clin Endocrinol Metab 1976;43:1094-1100.Crossref 7. Burke G: The thyrotropin stimulation test. Ann Intern Med 1968;69:1127-1139.Crossref 8. Peterson VB, McGregor AM, Belshetz PE, et al: Secretion of thyrotropin with impaired biologic activity in patients with hypothalamic-pituitary disease. Clin Endocrinol 1978;8:397-402.Crossref 9. Illig R, Krawczynska H, Torresani T, et al: Elevated plasma TSH and hypothyroidism in children with hypothalamic hypopituitarism. J Clin Endocrinol Metab 1975;41:722-728.Crossref 10. Patel YC, Burger HG: Serum thyrotropin (TSH) in pituitary and/or hypothalamic hypothyroidism: Normal or elevated basal levels and paradoxical responses to thyrotropin-releasing hormone. J Clin Endocrinol Metab 1973;37:190-196.Crossref 11. Faglia G, Bitensky L, Pinchera A, et al: Thyrotropin secretion in patients with central hypothyroidism: Evidence for reduced biological activity of immunoreactive thyrotropin. J Clin Endocrinol Metab 1979;48:989-999.Crossref 12. Spitz IM, Le Roith D, Hirsch H, et al: Increased high-molecular-weight thyrotropin with impaired biologic activity in a euthyroid man. N Engl J Med 1981;304:278-282.Crossref

Journal

Archives of Internal Medicine – American Medical Association

Published: Aug 1, 1982

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