A long‐term follow‐up study of eighteen patients with thyrotrophin‐secreting pituitary adenomas

Varsseveld, N. C. van; Bisschop, Peter H.; Biermasz, Nienke R.; Pereira, Alberto M.; Fliers, Eric; Drent, Madeleine L.

doi:10.1111/cen.12290

Cited by 54 publications

(21 citation statements)

References 37 publications

(95 reference statements)

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“…Although previous studies have shown the surgical outcome to be poor 7,9,23,34,35,38 (Table 5), we were able to achieve complete remission for 76 (84%) of the 90 patients in our study, including all 16 of the patients with microadenomas, 60 (81%) of the 74 with macroadenomas, and 8 (38%) of the 21 with cavernous sinus invasion. The different results may be partially explained by different criteria of remission and the small number of patients who received thyroid-targeted treatments among the studies.…”

Section: Surgical Treatmentcontrasting

confidence: 48%

“…Given the high efficacy of somatostatin analogs (normalization of thyroid hormone levels in 95% and tumor shrinkage in 40% of the patients 4 ), van Varsseveld et al concluded that primary medical therapy may be considered in virtually all patients with TSH adenomas, except in those with optic chiasm compression. 35 However, when we take into account the fact that somatostatin analogs are expensive and treatment must be continued over a long period of time once started, surgery should be the first choice of treatment in patients with TSH-secreting adenomas as in patients with acromegaly or Cushing's disease if we can achieve surgical cure rates in the range of 60%-85%, which is almost similar to those of other types of functioning pituitary adenomas. Our current study can clearly demonstrate that a high surgical cure rate (84%) can be achieved by earlier proper diagnosis of TSH-secreting adenomas and aggressive tumor removal with adequate surgical approaches for various types of tumors.…”

Section: Preoperative Medical Treatmentmentioning

confidence: 99%

“…3,4 Transsphenoidal surgery is the first-line treatment for these tumors. However, most studies, even recent papers describing remission rates of 0% to 55%, 7,9,22,35,38 report poor surgical outcomes due to relatively high frequencies of large adenomas, invasive adenomas, and/or markedly fibrous adenomas, although a steady decrease in the proportion of macroadenomas has been reported. 4,32 Most TSH-secreting pituitary adenomas express a variable number of somatostatin receptors.…”

mentioning

confidence: 99%

“…Fibrosis may worsen surgical results in TSH-secreting adenomas. 4,32,35 For example, Socin et al showed that while 60% of the tumors have a soft consistency that allows them to be gently removed or aspirated, the remaining tumors have fibrotic characteristics and are difficult to excise.…”

mentioning

confidence: 99%

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Clinicopathological characteristics and therapeutic outcomes in thyrotropin-secreting pituitary adenomas: a single-center study of 90 cases

Yamada¹,

Fukuhara²,

Horiguchi³

et al. 2014

JNS

121

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Object The aim of this study was to analyze clinicopathological characteristics and treatment outcomes in a large single-center clinical series of cases of thyrotropin (TSH)–secreting pituitary adenomas. Methods The authors retrospectively reviewed clinical, pathological, and treatment characteristics of 90 consecutive cases of TSH-secreting pituitary adenomas treated with transsphenoidal surgery between December 1991 and May 2013. The patient group included 47 females and 43 males (median age 42 years, range 11–74 years). Results Sixteen tumors (18%) were microadenomas and 74 (82%) were macroadenomas. Microadenomas were significantly more frequent in the more recent half of our case series (12 of 45 cases) (p = 0.0274). Cavernous sinus invasion was confirmed in 21 patients (23%). In 67 cases (74%), the tumors were firm elastic or hard in consistency. Acromegaly and hyperprolactinemia were observed, respectively, in 14 (16%) and 11 (12%) of the 90 cases. Euthyroidism was achieved in 40 (83%) of 48 patients and tumor shrinkage was found in 24 (55%) of 44 patients following preoperative somatostatin analog treatment. Conventional transsphenoidal surgery, extended transsphenoidal surgery, and a simultaneous combined supra- and infrasellar approach were performed in 85, 2, and 3 patients, respectively. Total removal with endocrinological remission was achieved in 76 (84%) of 90 patients, including all 16 (100%) patients with microadenomas, 60 (81%) of the 74 with macroadenomas, and 8 (38%) of the 21 with cavernous sinus invasion. None of these 76 patients experienced tumor recurrence during a median follow-up period of 2.8 years. Stratifying by Knosp grade, total removal with endocrinological remission was achieved in 34 of 36 patients with Knosp Grade 0 tumors, all 24 of those with Grade 1 tumors, 12 of the 14 with Grade 2 tumors, 6 of the 8 with Grade 3 tumors, and none of the 8 with Grade 4 tumors. Cavernous sinus invasion and tumor size were significant independent predictors of surgical outcome. Immunoreactivity for growth hormone, prolactin, or both hormones was present in 32, 9, and 24 patients, respectively. The Ki-67 labeling index was less than 3% in 71 (97%) of 73 tumors for which it was obtained and 3% or more in 2. Postsurgery pituitary dysfunction was found in 15 patients (17%) and delayed hyponatremia was seen in 9. Conclusions TSH-secreting adenomas, particularly those in the microadenoma stage, have increased in frequency over the past 5 years. The high surgical success rate achieved in this series is due to relatively early diagnosis and relatively small tumor size. In addition, the surgical strategies used, such as extracapsular removal of hard or solid adenomas, aggressive resction of tumors with cavernous sinus invasion, or extended transsphenoidal surgery or a simultaneous combined approach for large/giant multilobulated adenomas, also may improve remission rate with a minimal incidence of complications.

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Section: Surgical Treatmentcontrasting

confidence: 48%

Section: Preoperative Medical Treatmentmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Clinicopathological characteristics and therapeutic outcomes in thyrotropin-secreting pituitary adenomas: a single-center study of 90 cases

Yamada¹,

Fukuhara²,

Horiguchi³

et al. 2014

JNS

121

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“…[7][8][9][10] If surgery is contraindicated or if it fails to cure, the European Thyroid Association guidelines strongly recommend treatment with somatostatin analogs (SSA), such as octreotide and lanreotide, which have proved to be highly effective in a series of studies. [9][10][11][12][13][14][15][16][17][18][19] However, there are cases where manifestation of adverse effects, resistance to or escape from the inhibitory effect of SSAs lead to failure of treatment. 15,18,19 In these cases stereotactic irradiation can be employed.…”

Section: Introductionmentioning

confidence: 99%

TSH-secreting pituitary adenomas treated by gamma knife radiosurgery: our case experience and a review of the literature

Mouslech

Somali

Sakali

et al. 2015

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A 43-year-old woman, previously misdiagnosed as having primary hyperthyroidism and treated with antithyroid drugs, presented to us with overt hyperthyroidism, high levels of thyroid hormones and elevated thyroid-stimulating hormone (TSH). Μagnetic resonance imaging (MRI) revealed a pituitary microadenoma extending suprasellarly. the patient responded favorably to initial treatment with somatostatin analogs for 2 years but due to the escape phenomenon, tsH levels escalated and hyperthyroidism relapsed. transsphenoidal adenomectomy was applied but recurrence was again observed due to incomplete tumor removal. Gamma knife radiosurgery was finally employed 5.5 years ago, resulting in complete disease remission without evidence of long-term complications to date. thyrotropin-secreting adenomas (tsHomas) are rare with an estimated prevalence of about one case per million. we retrieved from the literature 14 cases of tsHomas treated by gamma knife radiosurgery and compared the outcomes. our results demonstrate the efficacy and safety of gamma knife radiosurgery for achieving remission in most of the cases, suggesting validation of this technique as an effective treatment option for the management of recurrent tsHomas.

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TSH-Secreting Pituitary Adenomas

Lania

Betella

Milani

2019

Pituitary Disorders of Childhood

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A long‐term follow‐up study of eighteen patients with thyrotrophin‐secreting pituitary adenomas

Cited by 54 publications

References 37 publications

Clinicopathological characteristics and therapeutic outcomes in thyrotropin-secreting pituitary adenomas: a single-center study of 90 cases

Clinicopathological characteristics and therapeutic outcomes in thyrotropin-secreting pituitary adenomas: a single-center study of 90 cases

TSH-secreting pituitary adenomas treated by gamma knife radiosurgery: our case experience and a review of the literature

TSH-Secreting Pituitary Adenomas

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