Thyrotropin-secreting pituitary macroadenoma presented with pulmonary embolism

Abstract

Although studies have indicated that hyperthyroidism is associated with pulmonary embolism, an association with thyroid stimulating hormone-producing pituitary adenoma (TSHoma) and pulmonary embolism has not been reported so far. A 43 year-old man hospitalized in the pulmonary diseases department with the diagnosis of pulmonary embolism. Thyroid function tests revealed increased thyroid hormone concentrations in the presence of inappropriately elevated serum TSH levels. Pituitary magnetic resonance imaging showed a 15 mm macroadenoma. Serum concentrations of the alpha-subunit of TSH (αTSH) and the αTSH/TSH molar ratio were 2.7 IU/L and 2.7, respectively. He underwent transsphenoidal adenomectomy with the diagnosis of TSHoma. Histopathological staining confirmed the diagnosis of TSHoma. We report an unusual case of pulmonary embolism accompanying TSHoma. TSHoma, like other causes of hyperthyroidism, may be associated with pulmonary embolism. 

Keywords

• Hypercoagulability
• Hyperthyroidism
• Pulmonary embolism
• Pituitary adenom

References

1. Erem, C., 2001. Thyroid disorders and hypercoagulability. Semin. Thromb. Hemost. 37, 17-26. doi:10.1055/s-0030-1270067.
2. Erem, C., Ersoz, H.O., Karti, S.S., Ukinç, K., Hacihasanoglu, A., Deger, O., Telatar, M., 2002. Blood coagulation and fibrinolysis in patients with 57 Kılıç Kan et al.
3. hyperthyroidism. J. Endocrinol. Invest. 25, 345-350.
4. Franchini, M., Lippi, G., Targher, G., 2011. Hyperthyroidism and venous thrombosis: A casual or causal association? A systematic literature review. Clin. Appl. Thromb. Hemost. 17, 387-392. doi:10.1177/1076029610364521.
5. Hofbauer, L.C., Heufelder, A.E., 1997. Coagulation disorders in thyroid diseases. Eur. J. Endocrinol. 136, 1-7. doi:10.1530/eje.0.1360001.
6. Lin, H.C., Yang, L.Y., Kang, J.H., 2010. Increased risk of pulmonary embolism among patients with hyperthyroidism: A 5-year follow-up study. J. Thromb. Haemost. 8, 2176-2181. doi:10.1111/j.1538-7836.2010.03993.x.
7. Lippi, G., Franchini, M., Targher, G., Montagnana, M., Salvagno, G.L., Guidi, G.C., Favaloro, E.J., 2009. Hyperthyroidism is associated with shortened APTT and increased fibrinogen values in a general population of unselected outpatients. J. Thromb. Thrombolysis. 28, 362-365. doi:10.1007/s11239-008-0269-z.
8. Paolo, B., Persani, L., Mannavola, D., Campi, I., 2009. TSH-secreting adenomas. Best. Pract. Res. Clin. Endocrin. Metab. 23, 597-606.

9. Socin, H.V., Chanson, P., Delemer, B., Tabarin, A., Rohmer, V., Mockel, J., Stevenaert A, Beckers, A., 2003. The changing spectrum of TSH- secreting pituitary adenomas: diagnosis and management in 43 patients. Eur. J. Endocrinol. 148, 433-442. doi:10.1530/eje.0.1480433.
10. Squizzato, A., Romualdi, E., Büller, H.R,, Gerdes, V.E., 2007. Clinical review: Thyroid dysfunction and effects on coagulation and fibrinolysis: A systematic review. J. Clin. Endocrinol. Metab. 92, 2415-2420. doi:http://dx.doi.org/10.1210/jc.2007-0199.