[Endocrine abnormalities in a XXXX with @entity4225 - case 8/2014].

@entity1 @entity4225 @entity353 @entity9808 @entity1955 @entity1378 @entity148 @entity17685 @entity5651 @entity977 @entity1943 @entity1954
HISTORY AND ADMISSION FINDINGS: We report on a 44-year-old @entity1 who was treated for @entity4225 in the Department of Psychiatry. In addition, symptoms of @entity1378 ( @entity148 , @entity353 , hyperdefecation) were noticeable. @entity9808 ( @entity9808 ) was marginally elevated, free @entity1954 (T3) and free @entity1955 (T4) were clearly elevated. Hence, the @entity1 was transferred to the Department of Endocrinology. INVESTIGATIONS: Thyroid ultrasound revealed a @entity5651 with a total volume of 24,8 ml. Antibody screening did not show elevated titers. The @entity17685 (TRH) test depicted a blunted @entity9808 response. Serum levels of free glycoprotein hormone alpha-subunit, prolactin and insulin-like growth factor 1 were increased. DIAGNOSIS, TREATMENT AND COURSE: In cranial magnetic resonance imaging (MRI), a hypointense lesion on the left side of the anterior pituitary gland was detected indicating a thyrotropin-secreting microadenoma with concomitant secretion of prolactin and possible secretion of @entity1 growth hormone (HGH). A thyreostatic therapy was initiated aiming at euthyreosis. For symptom control, betablockers were administered. Subsequently, the @entity1 underwent an uncomplicated transsphenoidal resection. Histological examination confirmed the diagnosis of a @entity977 with expression of @entity9808 , prolactin and HGH. As expected, thyroid hormones declined afterwards. CONCLUSIONS: TSHoma is rare. Diagnosis is confirmed by endocrinological testing and cranial imaging. Therapeutic options comprise transsphenoidal adenomectomy, drug therapy ( @entity1943 analogues, dopaminergic agonists) and irradiation. Resistance to thyroid hormones should be included in the differential diagnosis.
