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Hyperthyroidism due to a Thyrotropin-Secreting Pituitary AdenomaStudies of Thyrotropin and Subunit Secretion
LTC Charles E. Smith, MC;
LTC Robert C. Smallridge, MC;
COL Richard C. Dimond, MC;
COL Leonard Wartofsky, MC
Arch Intern Med. 1982;142(9):1709-1711.
Abstract
• A 58-year-old man had symptoms of hyperthyroidism and congestive heart failure. While hyperthyroid, his serum thyrotropin (TSH) level was inappropriately elevated at 6.1 µU/mL. The molar ratio of alpha subunit to TSH was 2.5, suggesting the presence of a TSH-secreting pituitary tumor. Further evaluation disclosed an enlarged sella turcica with posterior erosion, and an intrasellar mass was visualized on computed tomographic scan. Neither serum TSH nor alpha subunit levels became elevated after administration of thyrotropin-releasing hormone, nor were they suppressed by a dopamine infusion. Serum TSH but not alpha subunit levels rose during antithyroid drug therapy. Estrogens produced a partial reduction in serum alpha subunit concentration (presumably reflecting the nontumorous gonadotroph contribution to circulating alpha subunit). Dexamethasone completely suppressed serum TSH level but had no effect on the alpha subunit level, suggesting a differential feedback of glucocorticoids on TSH and alpha secretion. The patient was treated with pituitary irradiation rather than surgery because of his underlying heart disease.
(Arch Intern Med 1982;142:1709-1711)
Author Affiliations
USA; USA; USA; USA
From the Division of Medicine, Walter Reed Army Institute of Research (Drs Smallridge and Dimond), and the Endocrine Metabolic Service, Walter Reed Army Medical Center (Drs Smith and Wartofsky), Washington, DC.
Footnotes
Accepted for publication March 10, 1982.
The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or reflecting the views of the Department of the Army or the Department of Defense.
Reprint requests to Division of Medicine, Walter Reed Army Institute of Research, Washington, DC 20012 (Dr Smallridge).
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ABSTRACT
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