Journal Article

Pituitary Gangliocytoma Producing TSH and TRH: A Review of “Gangliocytomas of the Sellar Region”

Fujimori, Kana, Sugita, Yasuo, Komaki, Satoru, Sakata, Kiyohiko, Ashida, Kenji, Furuta, Takuya, Nomura, Masatoshi, Morioka, Motohiro

2020

Overview

Abstract Purpose Pituitary gangliocytomas (GCs) are rare neuronal tumors that present with endocrinological disorders, such as acromegaly, amenorrhea-galactorrhea syndrome, and Cushing’s disease. Most pituitary GCs coexist with pituitary adenomas pathologically and are diagnosed as mixed gangliocytoma-adenomas. Herein, we report a case of 45-year-old man who presented with the syndrome of inappropriate secretion of thyroid-stimulating hormone (SITSH) and discuss the pathogenesis of pituitary GCs. Methods Pituitary magnetic resonance imaging showed an 8-mm homogeneous and poorly enhanced mass inside the pituitary gland. Endoscopic transsphenoidal surgery was performed under a preoperative diagnosis of thyrotroph adenoma. However, the tumor was finally diagnosed as gangliocytoma without an adenomatous component. The tumor was further analyzed via immunohistochemistry and electron microscopy. Additionally, we searched MEDLINE and PubMed for previously published cases of isolated pituitary GCs and analyzed the reported clinicopathological findings. Results The patient showed complete clinical and endocrinological recovery after an operation. The tumor was positive for thyrotropin (TSH), TSH-releasing hormone (TRH), Pit-1, GATA-2, and most neuronal markers. Electron microscopy demonstrated the presence of intracytoplasmic secretory granules and neuronal processes. Co-secreting hypothalamic and pituitary hormone inside the tumor indicated autocrine/paracrine endocrinological stimulation. Conclusion Herein, we report a case of SITSH caused by an isolated pituitary gangliocytoma, expressing both TSH and TRH, which, to our best knowledge, is the first reported case of such a condition. The multidirectional differentiation and multihormonal endocrine characteristics of these tumors indicate that they are a member of neuroendocrine neoplasms, further supporting that they are derived from neural crest cells.

• Publisher: Oxford University Press,Copyright Oxford University Press
• Subject: Acromegaly / Adenoma / Adenoma - diagnosis / Adrenocorticotropic hormone / Amenorrhea / Autocrine signalling / Case reports / Case studies / Cushing syndrome / Cushing's disease / Development and progression / Diagnosis / Diagnosis, Differential / Electron microscopy / Endoscopy / Ganglioneuroma - blood / Ganglioneuroma - diagnosis / Ganglioneuroma - pathology / Ganglioneuroma - surgery / GATA-2 protein / Health aspects / Humans / Hypothalamus / Immunohistochemistry / Magnetic Resonance Imaging / Male / Microscopy / Middle Aged / Mini-Reviews / Nervous system diseases / Neural crest / Neuroendocrine tumors / Paracrine signalling / Pit1 protein / Pituitary / Pituitary Gland - diagnostic imaging / Pituitary Gland - pathology / Pituitary Gland - surgery / Pituitary gland tumors / Pituitary hormones / Pituitary Neoplasms - blood / Pituitary Neoplasms - diagnosis / Pituitary Neoplasms - pathology / Pituitary Neoplasms - surgery / Secretory vesicles / Surgery / Thyroid / Thyroid Hormones - blood / Thyroid-stimulating hormone / Thyrotropin / Thyrotropin - analysis / Thyrotropin - metabolism / Thyrotropin releasing factor / Thyrotropin-releasing hormone / Thyrotropin-Releasing Hormone - analysis / Thyrotropin-Releasing Hormone - metabolism / Tumors