An FSH and TSH pituitary adenoma, presenting with precocious puberty and central hyperthyroidism

[摘要] A 19-year-old woman with a history of isosexual precocious puberty and bilateral oophorectomy at age 10 years becauseof giant ovarian cysts, presents with headaches and mild symptoms and signs of hyperthyroidism. Hormonal evaluationrevealed elevated FSH and LH levels in the postmenopausal range and free hyperthyroxinemia with an inappropriatelynormal TSH. Pituitary MRI showed a 2-cm macroadenoma with suprasellar extension. She underwent successful surgicalresection of the pituitary tumor, which proved to be composed of two distinct populations of cells, each of them stronglyimmunoreactive for FSH and TSH, respectively. This mixed adenoma resulted in two different hormonal hypersecretionsyndromes: the first one during childhood and consisting of central precocious puberty and ovarian hyperstimulation dueto the excessive secretion of biologically active FSH and which was not investigated in detail and 10 years later, centralhyperthyroidism due to inappropriate secretion of biologically active TSH. Although infrequent, two cases of isosexualcentral precocious puberty in girls due to biologically active FSH secreted by a pituitary adenoma have been previouslyreported in the literature. However, this is the first reported case of a mixed adenoma capable of secreting both,biologically active FSH and TSH.

[学科分类] 血液学