{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T14:22:47Z","timestamp":1781360567760,"version":"3.54.1"},"reference-count":8,"publisher":"BMJ","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Clin Pathol"],"published-print":{"date-parts":[[1991,6]]},"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.1136\/jcp.44.6.522","type":"journal-article","created":{"date-parts":[[2007,6,9]],"date-time":"2007-06-09T00:50:46Z","timestamp":1181350246000},"page":"522-523","source":"Crossref","is-referenced-by-count":3,"title":["Exaggerated and prolonged thyrotrophin releasing hormone (TRH) test responses in tertiary hypothyroidism."],"prefix":"10.1136","volume":"44","author":[{"given":"G H","family":"Mills","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R D","family":"Ellis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P R","family":"Beck","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[1991,6,1]]},"reference":[{"key":"ref_1","first-page":"391","article-title":"Thyrotropin response to thyrotropin releasing hormone. Fundamentals of clinical endocrinology","author":"In, Eastham R.D.","year":"1989","unstructured":"Eastham RD. In: Hall R, Besser GM, eds. In: Thyrotropin response to thyrotropin releasing hormone. Fundamentals of clinical endocrinology 4th ed. Edinburgh: Churchill Livingstone, 1989, 391-3.","edition":"4th ed"},{"key":"ref_2","article-title":"In: Prolactin response to TRM. Biochemical values in clinical medicine","author":"Eastham, R.D.","year":"1985","unstructured":"Eastham RD. In: Prolactin response to TRM. Biochemical values in clinical medicine. 7th ed. Bristol: PG Wright, 1985:393.","edition":"7th ed"},{"key":"ref_3","first-page":"172","article-title":"In: Disorders of gonadal function in the male. Biochemical investigations in endocrinology","author":"Ismail, A.A.A.","year":"1981","unstructured":"Ismail AAA. In: Disorders of gonadal function in the male. Biochemical investigations in endocrinology. London: Academic Press, 1981:172-4."},{"key":"ref_4","first-page":"171","article-title":"In: Adrenal vortex. Fundamentals of clinical endocrinology","author":"Drury, P.L.; Besser, G.M.","year":"1989","unstructured":"Drury PL, Besser GM. In: Adrenal vortex. Fundamentals of clinical endocrinology 4th ed. Edinburgh: Churchill Livingstone, 1989:171-2.","edition":"4th ed"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"999","DOI":"10.1210\/jcem-33-6-999","article-title":"Prolonged and exaggerated elevations in plasma thyrotrophin (HTSH) after thyrotrophin releasing factor (TRF) in patients with pituitary tumours","volume":"33","author":"Faglia, G.; Beck-Peccoz, P.; Ambrosi, B.; Ferrari, G.; Neri, V.","year":"1971","unstructured":"Faglia G, Beck-Peccoz P, Ambrosi B, Ferrari G, Neri V. Prolonged and exaggerated elevations in plasma thyrotrophin (HTSH) after thyrotrophin releasing factor (TRF) in patients with pituitary tumours. J Clin Endocrinol Metab 1971;33:999-1002.","journal-title":"J Clin Endocrinol Metab"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1210\/jcem-37-4-595","article-title":"Plasma thyrotropin response to thyrotropin-releasing hormone in patients with pituitary and hypothalamic disorders","volume":"37","author":"Faglia, G.; Beck-Peccoz, P.; Ferrari, C.","year":"1973","unstructured":"Faglia G, Beck-Peccoz P, Ferrari C, et al. Plasma thyrotropin response to thyrotropin-releasing hormone in patients with pituitary and hypothalamic disorders. J Clin Endocrinol Metab 1973;37:595-601.","journal-title":"J Clin Endocrinol Metab"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"989","DOI":"10.1210\/jcem-48-6-989","article-title":"Thyrotrophin secretion in patients with central hypothyroidism: evidence for reduced biological activity of immunoreactive thyrotrophin","volume":"48","author":"Faglia, G.; Bitensky, L.; Pinchera, A.","year":"1979","unstructured":"Faglia G, Bitensky L, Pinchera A, et al. Thyrotrophin secretion in patients with central hypothyroidism: evidence for reduced biological activity of immunoreactive thyrotrophin. J Clin Endocrinol Metab 1979; 48:989-98.","journal-title":"J Clin Endocrinol Metab"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1056\/NEJM198101293040506","article-title":"High molecular weight human TSH with impaired biological activity","volume":"304","author":"Spitz, I.M.; Leroith, D.L.; Hirsch, H.","year":"1981","unstructured":"Spitz IM, Leroith DL, Hirsch H, et al. High molecular weight human TSH with impaired biological activity. N Engl J Med 1981;304:278-82.","journal-title":"N Engl J Med"}],"container-title":["Journal of Clinical Pathology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/jcp.44.6.522","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T17:17:43Z","timestamp":1763745463000},"score":1,"resource":{"primary":{"URL":"https:\/\/jcp.bmj.com\/lookup\/doi\/10.1136\/jcp.44.6.522"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1991,6]]},"references-count":8,"journal-issue":{"issue":"6","published-online":{"date-parts":[[1991,6,1]]},"published-print":{"date-parts":[[1991,6]]}},"alternative-id":["10.1136\/jcp.44.6.522"],"URL":"https:\/\/doi.org\/10.1136\/jcp.44.6.522","relation":{},"ISSN":["0021-9746","1472-4146"],"issn-type":[{"value":"0021-9746","type":"print"},{"value":"1472-4146","type":"electronic"}],"subject":[],"published":{"date-parts":[[1991,6]]}}}