Title:Plurihormonal (TSH-GH-prolactin Secreting) PIT-1-Positive pituitary
Macroadenoma/Pituitary Neuroendocrine Tumor (PitNET) Associated with
Graves’ Disease: A Case Report
Volume: 23
Issue: 12
Author(s): Cesare Morgante*, Federica Guaraldi, Sofia Asioli, Diego Mazzatenta, Giampaolo Papi and Alfredo Pontecorvi
Affiliation:
- Division of Endocrinology, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
Keywords:
Plurihormonal Pit-1-positive-Pituitary Adenoma, TSH-secreting adenoma, GH-secreting adenoma, prolactinoma, Pituitary Neuroendocrine Tumor (PitNET), Graves’ disease.
Abstract:
Background: Differential diagnosis of primary and secondary hyperthyroidism can be
challenging. Moreover, although extremely rare, the two conditions can coexist.
Case Presentation: A 58-year-old woman presented with symptoms of thyrotoxicosis, gradual
changes in face shape, headache and progressive enlargement of hands and feet in the last year.
When she was 46 years old, she was diagnosed with Graves’ disease, and treated with 4-year methimazole
therapy. Since 2016, a progressive increase of free-T4 and free-T3 with normal-TSH
and positive TrAb was noticed.
Results: At biochemical examination, fT3 was 5.3pg/ml (n. v. 2.5 - 3.9 pg/ml), fT4 was 20.6 pg/ml
(n.v 6-12 pg/ml), IGF1 was 698 ng/ml (57 – 240 ng/ml*), GH (basally and after OGTT), and
prolactin were significantly increased; while TSH was 1.8 (n.v. 0.35-4.0 mcUI/ml). A pituitary
MRI demonstrated a large sellar tumor with suprasellar extension. The patient underwent endoscopic
transsphenoidal surgery. Histological examination revealed a plurihormonal (GH-PRLTSH-
secreting) PIT-1-positive pituitary adenoma/pituitary neuroendocrine tumor (PitNET). At 3-
month follow-up, the pituitary function was normal, and no residual tumor was detected at the
MRI.
Conclusion: We report a rare case of Graves’ disease coexisting with a plurihormonal PIT-1-positive
pituitary adenoma/PitNET.
