Gonadotrophinoma and parathyroid adenoma
Aikaterini Chronaiou, Ifigenia Kostoglou-Athanassiou, Georgios Klangos, Dimitris Stefanopoulos, Aikaterini Michou, Razvan Alexandros Badila, Stylianos Kotanoglou & Areti Karfi
The coexistence of multiple adenomas in endocrine glands has been described in the context of the syndromes of multiple endocrine neoplasia. However, recently the presence of adenomas in multiple endocrine glands has been described in patients not fulfilling the criteria of the syndromes of multiple endocrine neoplasia.
The aim was to describe the case of a patient with a pituitary gonadotrophinoma who presented with primary hyperparathyroidism caused by a parathyroid adenoma.
A patient, female aged 60 years, presented with headache. In MRI scan a pituitary adenoma was observed, which was removed transsphenoidally. Histology showed a gonadotrophinoma measuring 1×0.7×0.5 cm. Immunohistochemistry showed intense positivity for beta-FSH and beta-LH. Four years later the patient developed diffuse bone pain affecting the lower extremities and constipation. Laboratory investigations revealed a blood calcium of 11 mg/dl and parathyroid hormone of 150 pg/ml. Alendronate was administered. Three years later the patient presented with kidney stones and underwent lithotripsy treatment. In further investigation with ultrasonography a parathyroid adenoma was visualized measuring 2.7×1.1 cm, which became also apparent in scintigraphy with 99 mTc methoxyisobutylisonitrile under the left lower thyroid lobe. The adenoma was removed surgically. Histology showed a parathyroid adenoma encapsulated by a thin fibrous capsule and remnants of normal parathyroid tissue. Postsurgically the patient is well and no recurrence of hypercalcemia was observed.
Conclusion: An extremely rare case of a patient with a pituitary gonadotrophinoma who presented with primary hyperparathyroidism caused by a parathyroid adenoma is described. The patient presented with adenomas in multiple endocrine glands, not fulfilling though the criteria of the syndrome of multiple endocrine neoplasia type 1, as this syndrome is known to be associated with parathyroid hyperplasia.