Coexistence of Nonfunctioning Pituitary Adenoma and Graves’ Disease: A Diagnostic Challenge
https://doi.org/10.15605/jafes.041.S1
- Author:
Alexander Kam
1
;
Dinda Aprilia
1
;
Eva Decroli
1
;
Syafril Syahbuddin
1
;
Yanne Pradwi Efendi
1
;
Athari Fadhila Namanda Putri
1
Author Information
1. Metabolic Endocrinology and Diabetes Division, Internal Medicine Department, Medical Faculty, Universitas Andalas;Metabolic Endocrinology and Diabetes Division, Internal Medicine Department, M. Djamil General Hospital
- Publication Type:Journal Article
- MeSH:
Pituitary Neoplasms;
Graves Disease
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):98-
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Nonfunctioning pituitary adenomas (NFPA) may cause
central hypothyroidism due to pituitary compression, often
presenting with low thyroid-stimulating hormone (TSH).
However, suppressed TSH in this setting should not automatically be attributed to pituitary dysfunction, as primary
hyperthyroidism—such as Graves’ disease—may rarely
coexist. Distinguishing between these disorders is essential
to avoid misdiagnosis and inappropriate management.
Case:A 42-year-old female presented with intermittent headache, visual field impairment, palpitations, fine tremors,
and weight loss. Physical examination revealed visual field
deficits and no goiter.
Laboratory evaluation showed cortisol level of 1 µg/dL
(normal: 3.7–19.4 µg/dL), luteinizing hormone 1.62 mU/L
(normal: 2.4–12.6 mU/L), follicle-stimulating hormone 5.01
mU/L (normal: 3.5–12.5 mU/L), free thyroxine 4 28.32 pmol/L
(normal: 12–22 pmol/L), TSH 0.02 µIU/mL (normal: 0.27–4.2
µIU/mL), and prolactin 70.84 ng/mL. Thyrotropin receptor
antibody (TRAb) was 3.53 IU/L, confirming Graves’ disease.
Contrast-enhanced brain magnetic resonance imaging
demonstrated a pituitary macroadenoma (2.13 × 2.28 × 3.05
cm) with optic chiasm compression. The patient was diagnosed with NFPA, Graves’ disease,
secondary adrenal insufficiency, possible hypogonadotropic
hypogonadism, and hyperprolactinemia likely due to the
stalk effect.
Preoperative management included hydrocortisone replacement and antithyroid therapy. The patient subsequently
underwent transsphenoidal surgery with appropriate
perioperative care. Postoperatively, no new pituitary
hormone deficiencies were observed. She was maintained
on thiamazole 10 mg daily with clinical improvement and
remains under regular follow-up.
Conclusion:This case highlights a rare but clinically important coexistence of NFPA and Graves’ disease. Suppressed TSH in
patients with pituitary adenoma should not be assumed to
reflect pituitary dysfunction without thorough evaluation.
Comprehensive thyroid assessment is crucial to ensure
accurate diagnosis and appropriate management.
- Full text:2026080416172857299EP_A141.pdf
