SAT-255 Pituitary Adenoma With TSH and GH Co Secretion

Introduction: Thyrotropinomas are rare pituitary adenomas, representing 2% of pituitary tumors. They are characterized by autonomous secretion of thyrotropin (TSH) and elevated levels of peripheral hormones. A third can secrete other hormones, including growth hormone (GH). We present the case of a patient with hypersecretion TSH and GH with clinical manifestations. Clinical case: 44-year-old woman with a history of palpitations and weight loss of 8 kilos of 3 months of evolution, as well as decreased visual acuity and headache. Physical exam: tachycardia, fine tremor, prognathism, thickening of the lips, increase in the base of the nose, hands and feet. TSH; 8.8mU / L (0.4-4), FT4: 35.59pg / ml (8-17), GH: 3.93 (less than 1.88), IGF-1: 716ng / ml (101-267), ANTI TPO negative, FSH, LH, Estradiol, Prolactin, Cortisol in range. Thyroid profile is repeated: TSH: 12.92mIU / ml (0.34-4.94); FT4 and T3 high. Campimetry: left temporal hemianopia Pituitary MRI: a heterogeneous 51x42x47mm Turkish chair mass with sphenoid sinus invasion and right cavernosum with vascular structures encompassing. Thyroid ultrasound: normal Methimazole and octeotride LAR are initiated and in June 2018, a transcranial approach and partial resection of the pituitary macroadenoma is performed. In August 2019, hormonal profile IGF1: 470 ng / ml, TSH: 2.7 uUI / ml, T3 207 ng / dl. Pituitary MRI showing evidence of selar, sphenoid expansive lesion with bilateral carotid invasion, bitemporal hemiapnosia, acromegalics facial features and acral growth without signs of hyperthyroidism. Neurosurgery decides to perform a tranesphenoidal approach and partial tumor resection without postoperative complications; The immunohistochemical study reveals GH positive, nonspecific TSH, KI 7% P53 20%. LAR octeotride is suspended. In September 2019, the homonal profile reports IGF1 177ng / ml, TSH: 4.39 uUI / ml, FT4 7.14 ug / dl and T3 50ng / dl, the signs of acromegaly disappear. Discussion. Thyrotropinomas are rare, even more so if they are multi-hormonal, usually they secrete one hormone or another or they are silent. Thyrotropic and somatotropic cells share common transcription factors: Pit-1 and Prop-1. Most of these tumors are silent or manifest clinically with TSH secretion. The case presented has the particularity of expressing clinical characteristics of both GH and TSH secretion. Preoperative treatment with somatostatin analogues can reduce tumor size and control hormonal hypersecretion. Radiation therapy is an alternative in case of unsatisfactory results after surgery. Multi-hormonality predicts a higher risk of recurrence than the secretory tumors of only one hormone, so monitoring these patients is essential.