A CASE OF A TSH AND GH CO-SECRETING PITUITARY MACROADENOMA IN A 56-YEAR-OLD FILIPINO WOMAN

Abstract

CASE
A 56-year-old Filipino female with gradual development of acromegalic features consulted for an enlarging goiter, associated with palpitations, heat intolerance, and weight loss. Thyroid function tests showed persistently elevated FT4, FT3, and TSH levels, despite the use of thioamides. Cranial MRI showed a 2.2 x 2.7 x 2.2 cm complex sellarsuprasellar mass with extension to nearby structures. A hormonal work up confirmed growth hormone secretion, with associated hypocortisolism and hypogonadotropic hypogonadism. Thyroid ultrasound showed multiple nodules suspicious of malignancy. Octreotide-LAR 30 mg was given, rendering the patient euthyroid prior to total thyroidectomy. Histopathology showed multinodular colloid adenomatous goiter. TSH remained elevated despite levothyroxine replacement. She then underwent transsphenoidal excision of the pituitary mass. Postoperatively, levels of TSH and GH decreased significantly, despite the presence of tumor residuals. To our knowledge, this is the first reported case of a co-secreting TSH and GH pituitary macroadenoma in the Philippines. This case highlights the importance of multidisciplinary care in managing plurihormonal pituitary tumors.