A case of thyrotropin-secreting pituitary macroadenoma.

We present a 49 year old male patient with thyroid stimulating hormone (TSH) producing pituitary macroadenoma. He had been mistakenly diagnosed and treated as Graves' disease for 1 year. Serum TSH level was inappropriately elevated in the presence of high serum total and free thyroid hormone concentrations. Thyrotropin releasing hormone stimulation showed blunt response of TSH but good response for prolactin. The alpha-subunit level and alpha-subunit to TSH molar ratio were measured and found to be high before surgery. The sex hormone-binding globulin level was also high. MRI demonstrated a pituitary macroadenoma. Insulin tolerance test and GnRH revealed normal response. The patient was given a high dose of PTU combined with lugol's solution for controlling hyperthyroidism preoperatively. Transfrontal surgery was performed and the tumor was partially removed. The diagnosis was confirmed by tissue pathology and immunohistochemistry staining of the tumor. The immunohistochemistry staining was performed and found that tumor cells were strongly reactive to TSH with a relatively mild degree for follicular stimulating hormone and leutinizing hormone. The tumor cells were not stained for prolactin, growth hormone and ACTH. Supervoltage irradiation by 60Co was delivered to the pituitary area because of persistence of hyperthyroidism. While waiting for the remote effect of radiotherapy, the patient was given an antithyroid drug to control hyperthyroidism.

Serum copper and zinc levels in Thai patients with various diseases.

This study was conducted to evaluate the possible alteration of serum Cu and Zn levels in 118 medical inpatients (53 women and 65 men) in Ramathibodi Hospital. Patients were classified according to their main clinical diseases: pulmonary (n = 12), renal (14), infectious (30), malignant (9), cardiovascular (22), GI & hepatic (13) and hematological (18) diseases. Significantly increased serum Cu concentrations were found in patients with pulmonary, malignant, cardiovascular and infectious diseases; moreover, 75, 75, 50 and 37 per cent of these diseases, respectively, had serum levels greater than the normal mean + 2SD (23.6 mumol/L). Besides, 5 per cent of patients (3 in renal, 1 in infectious and 2 in GI & hepatic diseases) had low serum Cu levels suggestive of Cu depletion. By contrast, significantly decreased serum Zn concentrations were found in patients with GI & hepatic, infectious, renal, cardiovascular and malignant diseases. Serum Zn levels below the normal mean - 2SD (8.1 mumol/L) were presented in 46, 37, 29, 23 and 22 per cent of cases, respectively. It was found that serum Cu/Zn ratio in our patients not only with cancer but also with other diseases were statistically significant from the normal group. Hence, the use of serum Cu/Zn ratios as markers for the diagnosis of cancer or for staging tumors must be interpreted cautiously.