PMC4718236_01
Chest-computed tomography. Pericardial and pleural effusions marked by arrows.
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F1
A chest computed tomography confirmed the diagnosis (Figure 1).
TSHoma pre- and postoperatively and 1 year after long acting octreotide treatment initiation marked by arrows: (A, B) pituitary MRI preoperatively; (C) pituitary MRI postoperatively before long acting octreotide treatment initiation; and (D) Pituitary MRI 1 year after long acting octreotide treatment initiation. MRI = magnetic resonance imaging.
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F2
Magnetic resonance imaging revealed a pituitary macroadenoma (21 x 20 mm) with invasion of the right cavernous sinus (Figure 2). After surgery, due to incomplete resection (Figure 2) and persistent:although mild:elevation of a-glycoprotein subunit, an octreoscan was performed. One year after OCT LAR treatment there was a significant shrinkage in tumor size (Figure 2), no recurrence of pericardial or pleural effusions and an improvement in bone mineral density measurement (DEXA L1-L4: T-score = -1, 5, Z-score = -1).
Positive immunostaining for TSH pituitary secreting adenoma (x100). TSH = thyrotropin.
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F3
Uptake of indium-111-DTPA-octreotide postoperatively.
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F4
As octreoscan was positive (Figure 4), treatment with long acting octreotide (OCT LAR) was initiated, to which the patient had a rapid antisecretory response.