papillary carcinoma and lymph node metastases. She was reoperated in 1972
because two radioactive sites were seen in the neck on
I scanning, but no
recurrent disease was found at surgery. During examination at Tripler Army
Medical Center in April 1976, a routine skull x-ray showed erosion of the
anterior floor of the sella turcica and a mass extending into the sphenoid
~
sinus.
There were no related symptoms and no visual field loss,
and menses
were normal. Thyroid hormone treatment had been discontinued for radioiodine
testing, and the serum thyroid stimulating hormone (TSH) was elevated (Table
3A). Serum follicle-stimulating hormone (FSH) and luteinizing hormone (LH)
were high and growth hormone (GH) was normal.
Table 3.
A.
Endocrine function tests on pituitary tumor case:
(normal values in parentheses).
April 1976
Serum
TSH
FSH
LH
GH
Ty
T3
B.
May
Serum
1976
FSH
LH
PRL
116
59
4
0.3
w/ml
(<5)
mIU/ml (20-30)
mIU/ml (<20)
ng/ml
ug/dl
(0.2-5)
(5-10)
16 ng/dl (60-160)
31.2
27.8
18.2
17.6
9.1
mIU/ml (follicular 9-27, midcycle 7-41)
mIU/ml (luteal 5-15, postmenopausal 35-217)
mIU/ml (follicular 6-27, midcycle 45-154)
mIU/ml (luteal 5-17, postmenopausal 39-96)
ng/ml (16.2 + <2)
AM cortisol
8.0
44
58
10
Ty,
9.4 g/dl (4.6-10.7)
17-OH corticoids
17-ketosteroids
1.6, 2.2, 1.2, 1.5 mg/24 hr (2.0-6.0)
4.0, 5.0, 2.0, 4.0 mg/24 hr (9.0-22.0)
estradiol
Urine
9.8
hormone levels
FT,
T3
11
2.7
149
ng/ml
pg/ml
pg/ml
we/dl
g/dl
ng/dl
ng/di
(follicular 10-100, midcycle 170-770)
(luteal 190-340, postmenopausal <10-140)
(6-26)
(1.0-2.3)
(110-230)
She was admitted to the Clinical Center of the National Institutes of
Health on 18 May 1976 for further study. Laboratory tests showed normal
electrolytes, and the results of endocrine function tests (Table 3B) were
within normal limits except for a slight decrease in the 24-hr urinary 17hydroxycorticoids and 17-ketosteroids. Skull x rays and sella tomograms
revealed an asymmetric erosion in the anterior floor of the sella with extension of a soft tissue mass into the sphenoid sinus. Computerized tomography
showed no supracellular extension.
Visual fields were normal.
- 50 -