A case report of pituitary multi-hormone adenoma：a single center study

Abstract:

Objective To strengthen the understanding of pituitary adenoma that produces growth hormone（GH） and thyroidstimulatinghormone（TSH）. And more，to prevent misdiagnosis，missed diagnosis and delayed diagnosis，and to explore its treatment.Methods The clinical manifestations，hormone biochemical examination，imaging examination，treatment and prognosis of 5 patients with pituitary GH+TSH adenoma diagnosed in West China Hospital were analyzed retrospectively.Results ①5 cases of GH+TSH tumors accounted for 2.9%（4 /172） of pituitary tumors diagnosed at the same time in west china hospital. Pathological findings of 2 patients showed that TSH，GH and PRL were all positive，and pathological findings of 3 patients showed that TSH and GH were all positive. ②MRI scan of sellar region showed that 5 cases were large adenomas（diameter > 1cm） and no small adenomas. ③Before operation，the baseline level of GH in 4 patients（cases 2，3，4 and 5） increased significantly（random value > 2.5ng/mL），of which 2 patients were not inhibited by high glucose，and 2 patients were not subjected to high glucose inhibition experiment； Case 1 has been repeatedly treated in the past，and now GH has completely biochemical remission. Four patients（cases 1，2，4 and 5） had elevated 5）FT4 and TSH was not inhibited，among which 2 patients had thyrotoxicosis. The level of gonadal axis decreased in 2 patients. Among the 5 patients，4 cases underwent space-occupying resection in the sellar region through nasal endoscope，and most of their GH，TSH and FT4 decreased significantly after operation（2 cases recovered to the normal range，while the GH level in another case decreased，but not completely relieved，and the TSH and FT4 levels returned to normal，while the GH，TSH and FT4 in the other case did not change significantly）. The remaining case 1 was treated with gamma knife first，then with drug，and the GH level was relieved after the third recurrence was treated with surgery，but TSH and FT4 were still not relieved. The results of postoperative sex hormones suggest that the gonadal function of 2 patients with hypogonadism did not return to normal immediately. The function of pituitary-adrenal axis was normal in 5 patients before and after operation.Conclusion The clinical incidence of pituitary GH+TSH mixed tumor is low，the onset is insidious，and it is often misdiagnosed because of thyrotoxicosis，which is easy to miss the best treatment opportunity. Surgery is still the first-line treatment for this disease.