Abstract
A 60 year old man with panhypopituitarism due to a large meningioma and prolonged and exaggerated thyroid stimulating hormone (TSH) responses is described. Initial investigations showed a subnormal urinary free cortisol concentration, a low serum cortisol taken at 0900 hours, and a low free T4 concentration. The TSH was towards the upper end of the normal range. Subsequently pituitary function tests showed subnormal production of luteinising hormone in response to luteinising hormone releasing hormone (LHRH) and a short synacthen test with a low 30 minute cortisol value. Long synacthen testing showed a normal response at four days, confirming that the abnormalities were due to a pituitary or hypothalamic cause. A computed tomogram showed a large meningioma compressing the hypothalamus, pituitary, and temporal lobe. TRH testing showed a prolonged and exaggerated response, consistent with tertiary hypothyroidism.
Full text
PDF
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Faglia G., Beck Peccoz P., Ambrosi B., Ferrari C., Neri V. Prolonged and exaggerated elevations in plasma thyrotropin (HTSH) after thyroptropin releasing factor (TRF) in patients with pituitary tumors. J Clin Endocrinol Metab. 1971 Dec;33(6):999–1002. doi: 10.1210/jcem-33-6-999. [DOI] [PubMed] [Google Scholar]
- Faglia G., Beck-Peccoz P., Ferrari C., Ambrosi B., Spada A., Travaglini P., Paracchi S. Plasma thyrotropin response to thyrotropin-releasing hormone in patients with pituitary and hypothalamic disorders. J Clin Endocrinol Metab. 1973 Oct;37(4):595–601. doi: 10.1210/jcem-37-4-595. [DOI] [PubMed] [Google Scholar]
- Faglia G., Bitensky L., Pinchera A., Ferrari C., Paracchi A., Beck-Peccoz P., Ambrosi B., Spada A. Thyrotropin secretion in patients with central hypothyroidism: evidence for reduced biological activity of immunoreactive thyrotropin. J Clin Endocrinol Metab. 1979 Jun;48(6):989–998. doi: 10.1210/jcem-48-6-989. [DOI] [PubMed] [Google Scholar]
- Spitz I. M., Le Roith D., Hirsch H., Carayon P., Pekonen F., Liel Y., Sobel R., Chorer Z., Weintraub B. Increased high-molecular-weight thyrotropin with impaired biologic activity in a euthyroid man. N Engl J Med. 1981 Jan 29;304(5):278–282. doi: 10.1056/NEJM198101293040506. [DOI] [PubMed] [Google Scholar]