case_images: PMC4718236_01
case_images: Chest-computed tomography. Pericardial and pleural effusions marked by arrows.
case_images: medi-95-e2358-g002.jpg
case_images: PMC4718236_01_medi-95-e2358-g002.jpg
case_images: F1
case_images: A chest computed tomography confirmed the diagnosis (Figure 1).
case_images: TSHoma pre- and postoperatively and 1 year after long acting octreotide treatment initiation marked by arrows: (A, B) pituitary MRI preoperatively; (C) pituitary MRI postoperatively before long acting octreotide treatment initiation; and (D) Pituitary MRI 1 year after long acting octreotide treatment initiation. MRI = magnetic resonance imaging.
case_images: medi-95-e2358-g005.jpg
case_images: PMC4718236_01_medi-95-e2358-g005.jpg
case_images: F2
case_images: Magnetic resonance imaging revealed a pituitary macroadenoma (21 x 20 mm) with invasion of the right cavernous sinus (Figure 2). After surgery, due to incomplete resection (Figure 2) and persistent:although mild:elevation of a-glycoprotein subunit, an octreoscan was performed. One year after OCT LAR treatment there was a significant shrinkage in tumor size (Figure 2), no recurrence of pericardial or pleural effusions and an improvement in bone mineral density measurement (DEXA L1-L4: T-score = -1, 5, Z-score = -1).
case_images: Positive immunostaining for TSH pituitary secreting adenoma (x100). TSH = thyrotropin.
case_images: medi-95-e2358-g006.jpg
case_images: PMC4718236_01_medi-95-e2358-g006.jpg
case_images: F3
case_images: Uptake of indium-111-DTPA-octreotide postoperatively.
case_images: medi-95-e2358-g007.jpg
case_images: PMC4718236_01_medi-95-e2358-g007.jpg
case_images: F4
case_images: As octreoscan was positive (Figure 4), treatment with long acting octreotide (OCT LAR) was initiated, to which the patient had a rapid antisecretory response.