{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T14:17:12Z","timestamp":1784557032335,"version":"3.55.0"},"reference-count":14,"publisher":"Bioscientifica","issue":"2","license":[{"start":{"date-parts":[[2024,4,1]],"date-time":"2024-04-01T00:00:00Z","timestamp":1711929600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["edm.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,4,1]]},"abstract":"<jats:sec>\n                    <jats:title>Summary<\/jats:title>\n                    <jats:p>Thyroid-stimulating hormone-secreting pituitary adenomas (TSHomas) are rare, accounting for less than 1% of all pituitary adenomas. We present a case of hyperthyroidism secondary to a likely TSHoma and coexisting functional thyroid adenoma. Laboratory errors and familial abnormalities in thyroid function tests were ruled out, and a diagnosis of the toxic thyroid adenoma was confirmed on a thyroid uptake scan. However, the triiodothyronine suppression test was contraindicated due to the patient\u2019s cardiovascular disease, and the thyrotropin-releasing hormone stimulation test, measurement of glycoprotein hormone alpha-subunit, and genetic testing were unavailable. Magnetic resonance imaging of the brain revealed a suprasellar pituitary macroadenoma measuring 40 mm \u00d7 20.3 mm \u00d7 17 mm. The patient was initiated on carbimazole; however, thyroid stimulating hormone and thyroxine levels remained elevated. The patient declined trans-sphenoidal surgery and was treated with radioactive iodine to manage the toxic thyroid adenoma, leading to reduced thyroxine levels and symptom improvement. Unfortunately, the patient passed away before long-acting somatostatin analogs became available. This case highlights the diagnostic and therapeutic challenges involved in managing thyrotoxicosis with dual etiology.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Learning points<\/jats:title>\n                    <jats:list list-type=\"bullet\">\n                      <jats:list-item>\n                        <jats:p>Hyperthyroidism can have multiple etiologies, which can coexist in the same patient.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>Persistent discordant thyroid function tests warrant further investigation.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>The gold standard for diagnosis of TSHomas remains immunohistochemical analysis of the tumor tissue.<\/jats:p>\n                      <\/jats:list-item>\n                    <\/jats:list>\n                  <\/jats:sec>","DOI":"10.1530\/edm-23-0136","type":"journal-article","created":{"date-parts":[[2024,4,17]],"date-time":"2024-04-17T06:28:41Z","timestamp":1713335321000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-2","source":"Crossref","is-referenced-by-count":1,"title":["A challenging case of a pituitary macroadenoma and toxic thyroid adenoma with inappropriate TSH secretion"],"prefix":"10.1530","volume":"2024","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1428-9493","authenticated-orcid":true,"given":"Michaela Despina","family":"Carides","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand Johannesburg, Johannesburg, Gauteng, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruchika","family":"Mehta","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand Johannesburg, Johannesburg, Gauteng, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaco","family":"Louw","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, University of the Witwatersrand Johannesburg, Johannesburg, Gauteng, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farzahna","family":"Mohamed","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand Johannesburg, Johannesburg, Gauteng, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","reference":[{"key":"bib1","series-title":"European Journal of Endocrinology","first-page":"R65","article-title":"Endocrine Tumours: thyrotropin-secreting pituitary adenoma: a structured review of 535 adult cases","volume":"185","author":"De Herdt","year":"2021","unstructured":"De Herdt CPhilipse E & De Block C. 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