CASE REPORT article
Front. Endocrinol.
Sec. Neuroendocrine Science
Lugol's Solution for Preoperative Management of a TSH/GH-Secreting Pituitary Adenoma with Suboptimal Response to Octreotide: A Case Report
Provisionally accepted
- 1Department of Endocrinology, First Affiliated Hospital (Southwest Hospital) of Army Medical University, Chongqing, China
- 2Department of Pathology, First Affiliated Hospital (Southwest Hospital) of Army Medical University, Chongqing, China
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Background Thyroid-stimulating hormone pituitary adenomas (TSHomas) are a rare cause of central hyperthyroidism, characterized by characterized by abnormally high TSH levels, and typically respond to somatostatin analogue (SSA). We report a young patient with SSA-insensitive TSHoma where Lugol's solution facilitated surgical preparation. Case presentation A 28-year-old male patient presented with a 1.5-year history of headache and visual loss. Thyroid function revealed elevated levels of free triiodothyronine (FT3) 45.87 pmol/L, free thyroxine (FT4) exceeding 100 pmol/L, and non-suppressed TSH 6.66 mIU/L. Magnetic resonance imaging (MRI) suggested a large pituitary adenoma (19 × 25 × 23 mm). Initial long-acting octreotide treatment was ineffective in controlling hyperthyroidism and was discontinued after five months. Approximately one year after the initial presentation, reassessment showed persistently elevated thyroid hormone levels. A TSH suppression test indicated octreotide sensitivity at 55%. An oral glucose tolerance test (OGTT) suggested concomitant growth hormone (GH) excess. Preoperatively, treatment with short-acting octreotide, methimazole, and Lugol's solution effectively controlled thyroid hormone levels. The patient subsequently underwent transnasal adenomectomy. Histopathology confirmed a PIT-1 positive pituitary adenoma, with TSH, GH, and prolactin (PRL) positivity. At the 3-month follow-up, thyroid hormone, GH, and insulin-like growth factor-1 (IGF-1) levels had normalized. Conclusions This case highlights Lugol's solution as a rescue therapy for SSA-insensitive TSH/GH co-secreting pituitary adenomas. Despite SSTR2/5 positivity, suboptimal response to octreotide suggests tumor heterogeneity or downstream signaling defects. Preoperative Lugol's solution should be considered when SSAs and methimazole fail.
Keywords: Acromegaly, central hyperthyroidism, Lugol's solution, Octreotide, Plurihormonal pituitary adenoma, somatostatin analogs, TSH-secreting adenoma
Received: 04 Sep 2025; Accepted: 12 Dec 2025.
Copyright: © 2025 Lei, Leng, Wu, Xie, Long and Chen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Liu Chen
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.