Background: Pituitary adenomas in childhood are 26% of all surgically treated pituitary adenomas at all ages. It has been estimated that TSH secretion is rare (<1% of all pituitary adenomas). Therefore, TSH secreting adenoma is very rare in childhood. Here we present the youngest patient with TSH secreting adenoma.
Case: A 7-year-old boy was referred to our clinic with thyroid dysfunction by the psychiatry clinic, during his evaluation of hyperactivity and nervousness. He had mild headache for 2 years. On presentation to our clinic, his BMI was >95p, blood pressure and heart rate were 130/80 mmHg and 110 beats/m respectively. There was no thyroid enlargement. tremor or ophthalmopathy. His serum TSH level was 11 mIU/ml with a fT4:2.1 ng/dl (0.931.7) and a fT3: 7.5 pg/ml (1.84.6). Thyroid functions of the parents were normal. On TRH test, fairly normal response with a TSH peak of 47.9 μIU/ml was observed. The α-glycoprotein hormone subunit level was 8.8 IU/l (00.8) and suggestive for TSH secreting adenoma, and, pituitary MRI revealed a 17 mm adenoma infiltrating right cavernous sinus. His prolactin level was 25 ng/ml. There were no other pituitary hormone deficiencies or hypersecretions including GH and ACTH. Transsphenoidal adenoma resection was performed and histopathology showed pituitary adenoma with prolactin, GH, and TSH staining.
Conclusion: Although it is a rare condition for pediatric age, TSH secreting adenoma should be excluded in children having high or normal TSH level with high serum T4 and T3 levels.
18 Sep 2014 - 20 Sep 2014