Thyrotropinoma with silent somatotroph and lactotroph adenoma during pregnancy
Thyrotropinomas are an uncommon cause of hyperthyroidism and are exceedingly rarely identified during pregnancy, with limited evidence to guide management. Most commonly they present as macroadenomas and may cause symptoms of mass effect including headache, visual field defects and hypopituitarism....
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| Format: | Article |
| Language: | English |
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Bioscientifica
2022-09-01
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| Series: | Endocrinology, Diabetes & Metabolism Case Reports |
| Online Access: | https://edm.bioscientifica.com/view/journals/edm/2022/1/EDM21-0194.xml |
| _version_ | 1811258398384062464 |
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| author | Yu-Fang Wu Hui Yi Ng Divya Namboodiri David Lewis Andrew Davidson Bernard Champion Veronica Preda |
| author_facet | Yu-Fang Wu Hui Yi Ng Divya Namboodiri David Lewis Andrew Davidson Bernard Champion Veronica Preda |
| author_sort | Yu-Fang Wu |
| collection | DOAJ |
| description | Thyrotropinomas are an uncommon cause of hyperthyroidism and are exceedingly rarely identified during pregnancy, with limited evidence to guide management. Most commonly they present as macroadenomas and may cause symptoms of mass effect including headache, visual field defects and hypopituitarism. We present a case of a 35-year-old woman investigated for headaches in whom a 13 mm thyrotropinoma was found. In the lead-up to planned trans-sphenoidal surgery (TSS), she spontaneously conceived and surgery was deferred, as was pharmacotherapy, at her request. The patient was closely monitored through her pregnancy by a multi-disciplinary team and delivered without complication. Pituitary surgery was performed 6 months post-partum. Isolated secondary hypothyroidism was diagnosed postoperatively and replacement thyroxine was commenced. Histopathology showed a double lesion with predominant pituitary transcription factor-1 positive, steroidogenic factor negative plurihormonal adenoma and co-existent mixed thyroid-stimulating hormone, growth hormone, lactotroph and follicle-stimulating hormone staining with a Ki-67 of 1%. This case demonstrates a conservative approach to thyrotropinoma in pregnancy with a successful outcome. This highlights the need to consider the timing of intervention with careful consideration of risks to mother and fetus. |
| first_indexed | 2024-04-12T18:12:44Z |
| format | Article |
| id | doaj.art-2d2b0c31bac54d1aab9f5256a1c2a20f |
| institution | Directory Open Access Journal |
| issn | 2052-0573 |
| language | English |
| last_indexed | 2024-04-12T18:12:44Z |
| publishDate | 2022-09-01 |
| publisher | Bioscientifica |
| record_format | Article |
| series | Endocrinology, Diabetes & Metabolism Case Reports |
| spelling | doaj.art-2d2b0c31bac54d1aab9f5256a1c2a20f2022-12-22T03:21:44ZengBioscientificaEndocrinology, Diabetes & Metabolism Case Reports2052-05732022-09-01111610.1530/EDM-21-0194Thyrotropinoma with silent somatotroph and lactotroph adenoma during pregnancyYu-Fang Wu0Hui Yi Ng1Divya Namboodiri2David Lewis3Andrew Davidson4Bernard Champion5Veronica Preda6Department of Clinical Medicine, EndocrinologyDepartment of Clinical Medicine, EndocrinologyDepartment of Clinical Medicine, EndocrinologyDepartment of Clinical Medicine, EndocrinologyDepartment of Clinical Medicine, Neurosurgery, Macquarie University, Sydney, New South Wales, Australia; Department of Neurosurgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Peter McCallum Cancer Centre, Department of Oncology, Melbourne, Victoria, Australia Department of Clinical Medicine, Endocrinology; School of Medicine, University of Notre Dame, Sydney, New South Wales, AustraliaDepartment of Clinical Medicine, EndocrinologyThyrotropinomas are an uncommon cause of hyperthyroidism and are exceedingly rarely identified during pregnancy, with limited evidence to guide management. Most commonly they present as macroadenomas and may cause symptoms of mass effect including headache, visual field defects and hypopituitarism. We present a case of a 35-year-old woman investigated for headaches in whom a 13 mm thyrotropinoma was found. In the lead-up to planned trans-sphenoidal surgery (TSS), she spontaneously conceived and surgery was deferred, as was pharmacotherapy, at her request. The patient was closely monitored through her pregnancy by a multi-disciplinary team and delivered without complication. Pituitary surgery was performed 6 months post-partum. Isolated secondary hypothyroidism was diagnosed postoperatively and replacement thyroxine was commenced. Histopathology showed a double lesion with predominant pituitary transcription factor-1 positive, steroidogenic factor negative plurihormonal adenoma and co-existent mixed thyroid-stimulating hormone, growth hormone, lactotroph and follicle-stimulating hormone staining with a Ki-67 of 1%. This case demonstrates a conservative approach to thyrotropinoma in pregnancy with a successful outcome. This highlights the need to consider the timing of intervention with careful consideration of risks to mother and fetus.https://edm.bioscientifica.com/view/journals/edm/2022/1/EDM21-0194.xml |
| spellingShingle | Yu-Fang Wu Hui Yi Ng Divya Namboodiri David Lewis Andrew Davidson Bernard Champion Veronica Preda Thyrotropinoma with silent somatotroph and lactotroph adenoma during pregnancy Endocrinology, Diabetes & Metabolism Case Reports |
| title | Thyrotropinoma with silent somatotroph and lactotroph adenoma during pregnancy |
| title_full | Thyrotropinoma with silent somatotroph and lactotroph adenoma during pregnancy |
| title_fullStr | Thyrotropinoma with silent somatotroph and lactotroph adenoma during pregnancy |
| title_full_unstemmed | Thyrotropinoma with silent somatotroph and lactotroph adenoma during pregnancy |
| title_short | Thyrotropinoma with silent somatotroph and lactotroph adenoma during pregnancy |
| title_sort | thyrotropinoma with silent somatotroph and lactotroph adenoma during pregnancy |
| url | https://edm.bioscientifica.com/view/journals/edm/2022/1/EDM21-0194.xml |
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