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An FSH and TSH pituitary adenoma, presenting with precocious puberty and central hyperthyroidism

A 19-year-old woman with a history of isosexual precocious puberty and bilateral oophorectomy at age 10 years because of giant ovarian cysts, presents with headaches and mild symptoms and signs of hyperthyroidism. Hormonal evaluation revealed elevated FSH and LH levels in the postmenopausal range an...

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Autores principales: Vargas, Guadalupe, Balcazar-Hernandez, Lourdes-Josefina, Melgar, Virgilio, Magriña-Mercado, Roser-Montserrat, Gonzalez, Baldomero, Baquera, Javier, Mercado, Moisés
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Bioscientifica Ltd 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5510394/
https://www.ncbi.nlm.nih.gov/pubmed/28721217
http://dx.doi.org/10.1530/EDM-17-0057
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author Vargas, Guadalupe
Balcazar-Hernandez, Lourdes-Josefina
Melgar, Virgilio
Magriña-Mercado, Roser-Montserrat
Gonzalez, Baldomero
Baquera, Javier
Mercado, Moisés
author_facet Vargas, Guadalupe
Balcazar-Hernandez, Lourdes-Josefina
Melgar, Virgilio
Magriña-Mercado, Roser-Montserrat
Gonzalez, Baldomero
Baquera, Javier
Mercado, Moisés
author_sort Vargas, Guadalupe
collection PubMed
description A 19-year-old woman with a history of isosexual precocious puberty and bilateral oophorectomy at age 10 years because of giant ovarian cysts, presents with headaches and mild symptoms and signs of hyperthyroidism. Hormonal evaluation revealed elevated FSH and LH levels in the postmenopausal range and free hyperthyroxinemia with an inappropriately normal TSH. Pituitary MRI showed a 2-cm macroadenoma with suprasellar extension. She underwent successful surgical resection of the pituitary tumor, which proved to be composed of two distinct populations of cells, each of them strongly immunoreactive for FSH and TSH, respectively. This mixed adenoma resulted in two different hormonal hypersecretion syndromes: the first one during childhood and consisting of central precocious puberty and ovarian hyperstimulation due to the excessive secretion of biologically active FSH and which was not investigated in detail and 10 years later, central hyperthyroidism due to inappropriate secretion of biologically active TSH. Although infrequent, two cases of isosexual central precocious puberty in girls due to biologically active FSH secreted by a pituitary adenoma have been previously reported in the literature. However, this is the first reported case of a mixed adenoma capable of secreting both, biologically active FSH and TSH. LEARNING POINTS: Although functioning gonadotrophinomas are infrequent, they should be included in the differential diagnosis of isosexual central precocious puberty. Some functioning gonadotrophinomas are mixed adenomas, secreting other biologically active hormones besides FSH, such as TSH. Early recognition and appropriate treatment of these tumors by transsphenoidal surgery is crucial in order to avoid unnecessary therapeutic interventions that may irreversibly compromise gonadal function.
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spelling pubmed-55103942017-07-18 An FSH and TSH pituitary adenoma, presenting with precocious puberty and central hyperthyroidism Vargas, Guadalupe Balcazar-Hernandez, Lourdes-Josefina Melgar, Virgilio Magriña-Mercado, Roser-Montserrat Gonzalez, Baldomero Baquera, Javier Mercado, Moisés Endocrinol Diabetes Metab Case Rep Unique/Unexpected Symptoms or Presentations of a Disease A 19-year-old woman with a history of isosexual precocious puberty and bilateral oophorectomy at age 10 years because of giant ovarian cysts, presents with headaches and mild symptoms and signs of hyperthyroidism. Hormonal evaluation revealed elevated FSH and LH levels in the postmenopausal range and free hyperthyroxinemia with an inappropriately normal TSH. Pituitary MRI showed a 2-cm macroadenoma with suprasellar extension. She underwent successful surgical resection of the pituitary tumor, which proved to be composed of two distinct populations of cells, each of them strongly immunoreactive for FSH and TSH, respectively. This mixed adenoma resulted in two different hormonal hypersecretion syndromes: the first one during childhood and consisting of central precocious puberty and ovarian hyperstimulation due to the excessive secretion of biologically active FSH and which was not investigated in detail and 10 years later, central hyperthyroidism due to inappropriate secretion of biologically active TSH. Although infrequent, two cases of isosexual central precocious puberty in girls due to biologically active FSH secreted by a pituitary adenoma have been previously reported in the literature. However, this is the first reported case of a mixed adenoma capable of secreting both, biologically active FSH and TSH. LEARNING POINTS: Although functioning gonadotrophinomas are infrequent, they should be included in the differential diagnosis of isosexual central precocious puberty. Some functioning gonadotrophinomas are mixed adenomas, secreting other biologically active hormones besides FSH, such as TSH. Early recognition and appropriate treatment of these tumors by transsphenoidal surgery is crucial in order to avoid unnecessary therapeutic interventions that may irreversibly compromise gonadal function. Bioscientifica Ltd 2017-07-07 /pmc/articles/PMC5510394/ /pubmed/28721217 http://dx.doi.org/10.1530/EDM-17-0057 Text en © 2017 The authors http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en_GB This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en_GB) .
spellingShingle Unique/Unexpected Symptoms or Presentations of a Disease
Vargas, Guadalupe
Balcazar-Hernandez, Lourdes-Josefina
Melgar, Virgilio
Magriña-Mercado, Roser-Montserrat
Gonzalez, Baldomero
Baquera, Javier
Mercado, Moisés
An FSH and TSH pituitary adenoma, presenting with precocious puberty and central hyperthyroidism
title An FSH and TSH pituitary adenoma, presenting with precocious puberty and central hyperthyroidism
title_full An FSH and TSH pituitary adenoma, presenting with precocious puberty and central hyperthyroidism
title_fullStr An FSH and TSH pituitary adenoma, presenting with precocious puberty and central hyperthyroidism
title_full_unstemmed An FSH and TSH pituitary adenoma, presenting with precocious puberty and central hyperthyroidism
title_short An FSH and TSH pituitary adenoma, presenting with precocious puberty and central hyperthyroidism
title_sort fsh and tsh pituitary adenoma, presenting with precocious puberty and central hyperthyroidism
topic Unique/Unexpected Symptoms or Presentations of a Disease
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5510394/
https://www.ncbi.nlm.nih.gov/pubmed/28721217
http://dx.doi.org/10.1530/EDM-17-0057
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