Thyroid hypophyseal adenomas correspond to about 0.5 to 1% of pituitary adenomas. Tumor hypersecretion of TSH may also be present in plurihormonal adenomas that simultaneously secrete growth hormone and/or prolactin or FSH and LH glycoprotein hormones. A 37-year-old patient complaining of ears, hands, feet and face growth for 1 year. He reported amenorrhea for 04 years, sweating and joint pains. Associated comorbidities: Systemic arterial hypertension for 4 years in the use of enalapril and hydrochlorothiazide, pre-diabetes using metformin with diagnosis for 3 months of osteoarthrosis and carpal tunnel syndrome.The physical examination showed acrocodons in the umbilical region. Face with prominence of the zygomatic arch, discrete prognathism and Macroglossia. Galactorrhea in the left breast to digitoexpressao. Laboratory revealing increased IGF-1 and prolactin, TSH in the normality range with elevation of free T4. Basal gonadotropins within the normality range with low estradiol. Normal basal Cortisol. A GH suppression test was performed with glucose revealing not suppression, despite hyperglycemia. Nuclear Magnetic Resonance (NMR) of a hypophyseal region showing enlargement of turcica saddle with glandular indefinition and hypophyseal stem, the costs of large expansive sealing, with supra-sealing extension, predominantly solid, compressing cranially the optic chiasm, insinuating itself to both cavernous sinuses, involving about 180 degrees in both carotid, with discontinuity of the sealing floor, with component of the lesion extending and obliterating the sphenoid sinus It features heterogenous enhancement, measuring 3.9×4.1×3.5 cm. Started treatment with Somatostatin analog, Octreotide LAR, with progressive increase of dose to 40 mg/day and posterior association with Cabergoline. Transsphenoid surgery was performed with immunohistochemistry compatible with pituitary Adenoma producing TSH, GH and prolactin. Ki-67:2%. NMR post surgery: Empty saddle. Colonoscopy without alterations. DXA Osteopenia. It evolved with non-normalized and increasing IGF-1 unresponsive to Octreotide 40 mg monthly, beginning of response after association with Cabergoline. New NMR showed recurrent lesion with FSH/LH, TSH and ACTH preserved axes. In programming for a new surgical intervention. Thyrotropinomas are rare tumors. The exposed case reveals a patient with a plurihormonal adenoma evolving with post-surgical recurrence and lack of response to somatostatin analogs and decreasing IGF-1 levels after introduction of cabergoline.
18 - 21 May 2019
European Society of Endocrinology