{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T03:54:38Z","timestamp":1792814078140,"version":"4.5.0"},"reference-count":13,"publisher":"Bioscientifica","content-domain":{"domain":["edm.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2017,7,7]]},"abstract":"A 19-year-old woman with a history of isosexual precocious puberty and bilateral oophorectomy at age 10 years because of giant ovarian cysts, presents with headaches and mild symptoms and signs of hyperthyroidism. Hormonal evaluation revealed elevated FSH and LH levels in the postmenopausal range and free hyperthyroxinemia with an inappropriately normal TSH. Pituitary MRI showed a 2-cm macroadenoma with suprasellar extension. She underwent successful surgical resection of the pituitary tumor, which proved to be composed of two distinct populations of cells, each of them strongly immunoreactive for FSH and TSH, respectively. This mixed adenoma resulted in two different hormonal hypersecretion syndromes: the first one during childhood and consisting of central precocious puberty and ovarian hyperstimulation due to the excessive secretion of biologically active FSH and which was not investigated in detail and 10 years later, central hyperthyroidism due to inappropriate secretion of biologically active TSH. Although infrequent, two cases of isosexual central precocious puberty in girls due to biologically active FSH secreted by a pituitary adenoma have been previously reported in the literature. However, this is the first reported case of a mixed adenoma capable of secreting both, biologically active FSH and TSH.<\/jats:p>\n \n Learning points:<\/jats:title>\n \n \n Although functioning gonadotrophinomas are infrequent, they should be included in the differential diagnosis of isosexual central precocious puberty.<\/jats:p>\n <\/jats:list-item>\n \n Some functioning gonadotrophinomas are mixed adenomas, secreting other biologically active hormones besides FSH, such as TSH.<\/jats:p>\n <\/jats:list-item>\n \n Early recognition and appropriate treatment of these tumors by transsphenoidal surgery is crucial in order to avoid unnecessary therapeutic interventions that may irreversibly compromise gonadal function.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:sec>","DOI":"10.1530\/edm-17-0057","type":"journal-article","created":{"date-parts":[[2017,7,7]],"date-time":"2017-07-07T07:36:41Z","timestamp":1499413001000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-2","source":"Crossref","is-referenced-by-count":11,"title":["An FSH and TSH pituitary adenoma, presenting with precocious puberty and central hyperthyroidism"],"prefix":"10.1530","volume":"2017","author":[{"given":"Guadalupe","family":"Vargas","sequence":"first","affiliation":[{"name":"1Endocrinology Service and Experimental Endocrinology Unit, Hospital de Especialidades, Centro M\u00e9dico Nacional Siglo XXI, IMSS, Mexico City Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lourdes-Josefina","family":"Balcazar-Hernandez","sequence":"additional","affiliation":[{"name":"1Endocrinology Service and Experimental Endocrinology Unit, Hospital de Especialidades, Centro M\u00e9dico Nacional Siglo XXI, IMSS, Mexico City Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Virgilio","family":"Melgar","sequence":"additional","affiliation":[{"name":"2Neurological Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roser-Montserrat","family":"Magri\u00f1a-Mercado","sequence":"additional","affiliation":[{"name":"1Endocrinology Service and Experimental Endocrinology Unit, Hospital de Especialidades, Centro M\u00e9dico Nacional Siglo XXI, IMSS, Mexico City Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Baldomero","family":"Gonzalez","sequence":"additional","affiliation":[{"name":"1Endocrinology Service and Experimental Endocrinology Unit, Hospital de Especialidades, Centro M\u00e9dico Nacional Siglo XXI, IMSS, Mexico City Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier","family":"Baquera","sequence":"additional","affiliation":[{"name":"3Pathology Department, American British Cowdray Hospital, Mexico City Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mois\u00e9s","family":"Mercado","sequence":"additional","affiliation":[{"name":"1Endocrinology Service and Experimental Endocrinology Unit, Hospital de Especialidades, Centro M\u00e9dico Nacional Siglo XXI, IMSS, Mexico City Mexico"},{"name":"2Neurological Center"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","reference":[{"key":"key20170711160339641_bib1","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/j.ecl.2007.10.011","article-title":"Nonfunctioning pituitary tumors and pituitary incidentalomas","volume":"37","author":"Molitch","year":"2008","journal-title":"Endocrinology and Metabolism Clinics of North America"},{"key":"key20170711160339641_bib2","doi-asserted-by":"crossref","first-page":"756069","DOI":"10.1155\/2015\/756069","article-title":"Clinical characteristics and treatment outcome of 485 patients with nonfunctioning pituitary macroadenomas","volume":"2015","author":"Vargas","year":"2015","journal-title":"International Journal of Endocrinology"},{"key":"key20170711160339641_bib3","doi-asserted-by":"crossref","first-page":"4423","DOI":"10.1210\/jc.2014-2362","article-title":"Functioning gonadotroph adenomas","volume":"99","author":"Ntali","year":"2014","journal-title":"Journal of Clinical Endocrinology and Metabolism"},{"key":"key20170711160339641_bib4","first-page":"591","article-title":"Gonadotroph adenoma in a premenopausal woman secreting follicle-stimulating hormone and causing ovarian hyperstimulation","volume":"80","author":"Djerassi","year":"1995","journal-title":"Journal of Clinical Endocrinology and Metabolism"},{"key":"key20170711160339641_bib5","doi-asserted-by":"crossref","first-page":"2366","DOI":"10.1056\/NEJMcp0800459","article-title":"Clinical practice. 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