ESPE Abstracts (2014) 82 P-D-2-1-519

ESPE2014 Poster Category 2 Pituitary (10 abstracts)

Hyperthyroidism Due to TSH Secreting Pituitary Adenoma in a 7-Year-Old Boy

Saygin Abali , Zeynep Atay , Belma Haliloglu , Tulay Guran , Abdullah Bereket & Serap Turan

Pediatric Endocrinology, Marmara University, Istanbul, Turkey

Background: Pituitary adenomas in childhood are 2–6% 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 (0.93–1.7) and a fT3: 7.5 pg/ml (1.8–4.6). 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 (0–0.8) 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.

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