A rare case of TSH-oma in a frail patient: diagnostic and therapeutic challenges

Hamza Elfekih; Balkis Abidi; Wiem Saafi; Imen Halloul; Elaa Youssef; Sawssen Mrad; Taieb Ach; Salima Ferchichi; Ghada Saad; Yosra Hasni

doi:10.1530/endoabs.110.EP1206

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Endocrine Abstracts (2025) 110 EP1206 | DOI: 10.1530/endoabs.110.EP1206

ECEESPE2025 ePoster Presentations Pituitary, Neuroendocrinology and Puberty (220 abstracts)

A rare case of TSH-oma in a frail patient: diagnostic and therapeutic challenges

Hamza Elfekih ¹ , Balkis Abidi ¹ , Wiem Saafi ¹ , Imen Halloul ¹ , Elaa Youssef ¹ , Sawssen Mrad ¹ , Taieb Ach ¹ , Salima Ferchichi ¹ , Ghada Saad ¹ & Yosra Hasni ¹

Author affiliations

¹University of Sousse, Faculty of Medicine of Sousse, Farhat Hached University Hospital, Endocrinology Diabetology Department, 4000, Sousse, Tunisia

JOINT3494

Introduction: Thyrotropin-secreting pituitary adenomas (TSH-omas) are rare causes of hyperthyroidism, accounting for 0.5% to 2% of all pituitary adenomas, with an estimated incidence of 1 to 2 cases per million. These tumors autonomously secrete TSH, leading to inappropriate stimulation of the thyroid gland and subsequent hypersecretion of thyroxine and triiodothyronine. Unlike other thyroid disorders, TSH-omas exhibit equal gender distribution and are typically diagnosed around the age of 46 ± 6 years. This report presents a rare case of a TSH-oma in a frail patient with multiple comorbidities, highlighting diagnostic and therapeutic challenges.

Case Presentation: A 74-year-old Tunisian male with a history of well-controlled type 2 diabetes of 8 years, hypertension, stage 3 chronic kidney disease, iron deficiency anemia, global heart failure with preserved ejection fraction, and stage 4 peripheral artery disease presented with a 3-month history of asthenia and hand tremors. Biochemical analysis revealed severe hypocalcemia and hyperphosphatemia. Hormonal assays confirmed central hyperthyroidism with elevated TSH and FT4. There was no anterior pituitary deficiency. Pituitary MRI revealed a macroadenoma measuring 29x26 mm, with extension to sphenoid and cavernous sinuses, especially on the left, with filling of the suprasellar cisterns leading to a slight dilation of the lateral ventricles. Fundus examination revealed minimal diabetic retinopathy and dense bilateral cataract.

Discussion: The first line treatment for TSH-omas is transsphenoidal pituitary surgery, aimed at reducing thyroid hormone levels to prevent thyrotoxicosis and thyroid storm. However, due to the patient’s multiple comorbidities and potential contraindications to general anesthesia, medical management with somatostatin analogs was considered as an alternative. Early diagnosis and appropriate treatment are crucial to preventing complications.