Christian Trummer1, Hannes Reiher2, Verena Theiler-Schwetz1, Marlene Pandis1, Christian Gstettner3, Peter Potzinger4, Tilman Keck4, Thomas R Pieber1, Sigurd Lax5,6,7, Johannes Haybaeck8,9,10, Vinzenz Stepan2, Stefan Pilz1. 1. Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria. 2. Department of Internal Medicine, Krankenhaus der Elisabethinen, Graz, Austria. 3. Division of Nuclear Medicine, Department of Radiology, Medical University of Graz, Graz, Austria. 4. Department of Otorhinolaryngology, Krankenhaus der Elisabethinen, Graz, Austria. 5. Department of Pathology, General Hospital Graz Sued-West, Graz, Austria. 6. Institute of Pathology, Medical University of Graz, Graz, Austria. 7. Institute for Clinical Pathology, Johannes Kepler University, Linz, Austria. 8. Department of Pathology, Medical Faculty, Otto-von-Guericke University Magdeburg, Magdeburg, Germany. 9. Department of Neuropathology, Institute of Pathology, Medical University of Graz, Graz, Austria. 10. Department of Pathology, Neuropathology and Molecular Pathology, Medical University of Innsbruck, Innsbruck, Austria.
Abstract
INTRODUCTION: The main differential diagnoses of secondary hyperthyroidism include thyrotropin-secreting neuroendocrine pituitary tumors (TSH-PitNETs) and resistance to thyroid hormone. As a rare cause of secondary hyperthyroidism, ectopic thyrotropin-producing neuroendocrine pituitary tumors must also be considered. CASE PRESENTATION: A 48-year-old female patient with overt hyperthyroidism and elevated thyrotropin was admitted to the endocrine outpatient clinic of a secondary care hospital in March 2018. The patient had an inconspicuous pituitary MRI and F18-F-DOPA PET-CT, but showed a tumor mass located at the pharyngeal roof. Most biochemical tests and an increased tracer uptake of the pharyngeal mass in a Ga68-DOTANOC PET-CT argued for the presence of an ectopic TSH-PitNET. After treatment with octreotide over 5 days and a consecutive normalization of free thyroxine and free triiodothyronine, the tumor was endoscopically resected. Histologically, the mass consisted of small partially spindle, partially polygonal monomorphic to mildly pleomorphic cells with immunoreactivity for thyrotropin and luteinizing hormone. Postoperatively, the patient required intermittent levothyroxine therapy. DISCUSSION AND CONCLUSIONS: Ectopic TSH-PitNETs represent an extremely rare cause for secondary hyperthyroidism. While the diagnostic process may be complicated by negative imaging studies of the pituitary gland, family history, biochemical tests, and functional imaging using gallium-labelled somatostatin analogues may be helpful in establishing the diagnosis.
INTRODUCTION: The main differential diagnoses of secondary hyperthyroidism include thyrotropin-secreting neuroendocrine pituitary tumors (TSH-PitNETs) and resistance to thyroid hormone. As a rare cause of secondary hyperthyroidism, ectopic thyrotropin-producing neuroendocrine pituitary tumors must also be considered. CASE PRESENTATION: A 48-year-old female patient with overt hyperthyroidism and elevated thyrotropin was admitted to the endocrine outpatient clinic of a secondary care hospital in March 2018. The patient had an inconspicuous pituitary MRI and F18-F-DOPA PET-CT, but showed a tumor mass located at the pharyngeal roof. Most biochemical tests and an increased tracer uptake of the pharyngeal mass in a Ga68-DOTANOC PET-CT argued for the presence of an ectopic TSH-PitNET. After treatment with octreotide over 5 days and a consecutive normalization of free thyroxine and free triiodothyronine, the tumor was endoscopically resected. Histologically, the mass consisted of small partially spindle, partially polygonal monomorphic to mildly pleomorphic cells with immunoreactivity for thyrotropin and luteinizing hormone. Postoperatively, the patient required intermittent levothyroxine therapy. DISCUSSION AND CONCLUSIONS: Ectopic TSH-PitNETs represent an extremely rare cause for secondary hyperthyroidism. While the diagnostic process may be complicated by negative imaging studies of the pituitary gland, family history, biochemical tests, and functional imaging using gallium-labelled somatostatin analogues may be helpful in establishing the diagnosis.
Authors: Hannah Seok; Eun Young Lee; Eun Yeong Choe; Woo In Yang; Joo Young Kim; Dong Yeob Shin; Ho Jin Cho; Tae Sung Kim; Mi Jin Yun; Jong Doo Lee; Eun Jig Lee; Sung-Kil Lim; Yumie Rhee Journal: Korean J Intern Med Date: 2012-12-28 Impact factor: 2.884
Authors: C Campana; F Nista; L Castelletti; M Caputo; E Lavezzi; P Marzullo; A Ferrero; G Gaggero; F R Canevari; D C Rossi; G Zona; A Lania; D Ferone; F Gatto Journal: J Endocrinol Invest Date: 2022-02-11 Impact factor: 5.467