Abstract
Increased bone turnover and other less frequent comorbidities of hyperthyroidism, such as heart failure, have only rarely been reported in association with central hyperthyroidism due to a thyrotropin (TSH)-secreting pituitary adenoma (TSHoma). Treatment is highly empirical and relies on eliminating the tumor and the hyperthyroid state.We report here an unusual case of a 39-year-old man who was initially admitted for management of pleuritic chest pain and fever of unknown origin. Diagnostic work up confirmed pericarditis and pleural effusion both refractory to treatment. The patient had a previous history of persistently elevated levels of alkaline phosphatase (ALP), indicative of increased bone turnover. He had also initially been treated with thyroxine supplementation due to elevated TSH levels. During the diagnostic process a TSHoma was revealed. Thyroxine was discontinued, and resection of the pituitary tumor followed by treatment with a somatostatin analog led to complete recession of the effusions, normalization of ALP, and shrinkage of pituitary tumor.Accelerated bone metabolism and pericardial and pleural effusions attributed to a TSHoma may resolve after successful treatment of the tumor. The unexpected clinical course...Continue Reading
References
May 1, 1977·Calcified Tissue Research·L MosekildeM S Christensen
May 1, 1994·The Journal of Clinical Investigation·K KaralisG Tolis
Mar 17, 2000·The Journal of Clinical Endocrinology and Metabolism·H Pantazi, P D Papapetrou
Mar 16, 2001·Endocrine Practice : Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists·H Colakovski, D L Lorber
Jul 5, 2002·Thyroid : Official Journal of the American Thyroid Association·Peter Vestergaard, Leif Mosekilde
Sep 11, 2003·American Journal of Physiology. Endocrinology and Metabolism·Fatima R S FreitasCecilia H A Gouveia
Dec 10, 2003·Medicine·Pierre-Yves LevyDidier Raoult
Jan 27, 2005·Clinical Endocrinology·Deborah MannavolaPaolo Beck-Peccoz
Apr 26, 2006·The American Journal of Emergency Medicine·Min-Shan TsaiChien-Hua Huang
Dec 7, 2006·Journal of Leukocyte Biology·Chiara ArmaniDavide Cervia
Mar 10, 2007·Pituitary·Rosane Ness-AbramofIlan Shimon
May 1, 2009·International Journal of Cardiology·Annalisa LamariSalvatore Patanè
Dec 1, 2009·Best Practice & Research. Clinical Endocrinology & Metabolism·Paolo Beck-PeccozIrene Campi
Apr 7, 2010·Proceedings of the National Academy of Sciences of the United States of America·J H Duncan BassettGraham R Williams
Apr 21, 2011·Arthritis and Rheumatism·Anne-Katja ImhofStefan Schulz
Sep 6, 2012·Thyroid : Official Journal of the American Thyroid Association·Sarah RabbiosiGiovanna Weber
Jul 4, 2013·Military Medicine·Peter S AirelAlfred F Shwayhat
Nov 5, 2013·Journal of the Formosan Medical Association = Taiwan Yi Zhi·Yu-Hsi KaoTien-Shang Huang
May 2, 2014·European Thyroid Journal·P Beck-PeccozJ-L Wemeau
Citations
Mar 7, 2017·Clinical Nuclear Medicine·Mathieu GauthéFrançoise Montravers
Sep 12, 2018·Journal of the Endocrine Society·Stefano FraraAndrea Giustina
Apr 24, 2018·Endocrine Reviews·Gherardo MazziottiAndrea Giustina
Feb 20, 2021·Hormones : International Journal of Endocrinology and Metabolism·Flaminia CarroneGherardo Mazziotti