Clinical and morphological characteristics, diagnostic criteria, and outcomes of surgical treatment of TSH-secreting pituitary adenomas

Астафьева, Л. И.; Кадашев, Б А; Shishkina, L V; Kalinin, Pavel; Fomichev, Dmitry; Kutin, Maxim; Aref'eva, I A; Dzeranova, Larisa; Sidneva, Yuliya; Klochkova, I S; Ротин, Д Л

doi:10.17116/neiro201680624-35

Cited by 10 publications

(6 citation statements)

References 35 publications

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“…Mixed TSHomas secreting thyroid-stimulating hormone (TSH) and GH have various clinical manifestations, often presenting with acromegaly and/or thyrotoxicosis and with or without thyroid enlargement. Presently, many studies have reported poor efficacy and prognosis of mixed pituitary TSH/GH adenomas (3,4). In this case report, we retrospectively analyzed the clinical features of a case of pituitary adenoma secreting both GH and TSH simultaneously.…”

Section: Introductionmentioning

confidence: 99%

A rare pituitary tumor associated with hyperthyroidism and acromegaly

Meng

Liu

et al. 2022

Front. Endocrinol.

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BackgroundMixed pituitary TSH/GH adenomas are rare adenomas associated with acromegaly and/or thyrotoxicosis, with or without varying degrees of goiter. In this report, we show a case of pituitary adenoma producing both GH and TSH simultaneously.Case presentationA 27-year-old man was diagnosed with pituitary adenoma based on various symptoms and clinical findings. For further examination and treatment, he was hospitalized in our institution. It was likely that this subject had pituitary adenoma producing both GH and TSH. In brain magnetic resonance imaging, there was a giant tumor in the sellar region. After the diagnosis of mixed pituitary TSH/GH adenoma, he was treated with octreotide, then underwent tumor resection, and then received hydrocortisone acetate and levothyroxine sodium. After then, GH and IGF-1 levels were suppressed and thyroid function was normalized. Postoperative immunohistochemistry reports showed GH (+) but TSH (-), which may be insensitive to the antibody used to detect TSH or combined with other factors.ConclusionsThe diagnosis of mixed pituitary TSH/GH adenoma must be combined with clinical manifestations, immunohistochemical staining and relevant hormone levels, and genetic testing if necessary for comprehensive judgment. For patients with large adenomas, it is recommended to use somatostatin analogs to restore TH levels and control the excessive secretion of GH levels before surgery.

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Section: Introductionmentioning

confidence: 99%

A rare pituitary tumor associated with hyperthyroidism and acromegaly

Meng

Liu

et al. 2022

Front. Endocrinol.

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“…The pituitary gland is an important endocrine organ, and the development of PA is accompanied by endocrine changes, and serum PRL, IGF-1, and GH determinations are the main basis for the diagnosis of pituitary tumors [ 24 ]. Changes in serum TSH, FT-4, and ACTH, which are indicators of pituitary function, can reflect pituitary function [ 25 ]. The results of this study confirmed that CAPTEM regimen significantly enhanced ORR, corrected endocrine disorders, and improved pituitary function in patients, which provide a basis for its application in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Chemotherapy of Capecitabine plus Temozolomide for Refractory Pituitary Adenoma after Tumor Resection and Its Impact on Serum Prolactin, IGF-1, and Growth Hormone

Wang

et al. 2022

Journal of Oncology

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Objective. To investigate the efficiency of capecitabine (CAP) plus temozolomide (TEM) in refractory pituitary adenoma after tumor resection and its impact on serum prolactin (PRL), insulin-like growth factor 1 (IGF-1), and growth hormone (GH) levels. Methods. From January 2017 to January 2020, 80 patients assessed for eligibility receiving transsphenoidal tumor resection for refractory pituitary adenoma in the Department of Neurosurgery of our hospital were recruited. They were randomly distributed at a ratio of 1 : 1 via the random number table method to receive either bromocriptine and TEM (control group) or bromocriptine plus combination chemotherapy of TEM and CAP (study group). The two groups were compared in terms of clinical efficacy and serum levels of PRL, IGF-1, and GH. Results. The objective response rate (ORR) was 87.50% and 67.50% in the study group and the control group, respectively P = 0.032 . Before treatment, two groups had similar levels of PRL, IGF-1, and GH. After treatment, PRL levels in the study group were lower than that in the control group (278.35 ± 39.25 versus 326.35 ± 42.45, P < 0.001 ). Compared with the control group, IGF-1 levels in the study group were also lower (311.78 ± 28.82 versus 364.35 ± 31.35, P < 0.001 ). The study group presented markedly lower levels of thyroid-stimulating hormone (TSH) and higher serum levels of free thyroxine-4 (FT-4) and adrenocorticotropic hormone (ACTH) versus the control group P < 0.05 . The incidence of adverse events was comparable between the study group (30.0%) and the control group (22.5%) P > 0.05 . All eligible patients had similar progression-free survival (PFS) after chemotherapy. Conclusion. For patients with refractory pituitary adenoma, the combination chemotherapy of CAP and TEM significantly improves clinical outcomes and corrects hormonal disturbances, with a good safety profile, but its long-term efficacy requires further investigation.

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“…São medicamentos seguros e que podem ser associados a levotiroxina quando há supressão dos níveis dos hormônios tireoidianos. Em alguns casos, contudo, podem causar colelitíase e hiperglicemia, por isso é preciso que os pacientes sejam monitorados durante todo o tratamento (17,(26)(27)(28)(29) .…”

Section: Tratamentounclassified

“…Como alternativa aos AS, pode ser empregada a bromocriptina, visto que os receptores de dopamina 2 também estão presentes nos tumores. Esse medicamento, não obstante, possui resultados menos impactantes no quadro e as evidências dessa alternativa são ainda escassas (29) .…”

Section: Tratamentounclassified

Adenoma hipofisário secretor de TSH: uma revisão sistemática / TSH-secreting pituitary adenoma: a systematic review

Souza¹,

Morais

Morais³

et al. 2020

Arq Med Hosp Fac Cienc Med Santa Casa São Paulo

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Introdução: Os adenomas hipofisários são tumores caracterizados pela proliferação de células adeno-hipofisárias produtoras de hormônios tróficos. Dentre eles, os adenomas hipofisários produtores de TSH (TSHomas), neoplasias benignas pouco frequentes, que correspondem a menos do que 3% dos adenomas hipofisários. Método: Pesquisamos os termos TSHomas, tireotropinomas e adenomas pituitários secretores de TSH nas bases Pubmed, Lilacs e Scielo. Incluímos artigos publicados entre 2010 e 2020, sendo excluídos relatos de casos, artigos indisponíveis e que não tratavam sobre o tema. Resultados e discussão: Os TSHomas são tumores fibrosos, monoclonais, com incidência entre 0,015 a 0,03 casos/100.000 habitantes, que se manifestam por hipertireoidismo e sintomas causados por efeito de massa. São diagnosticados diante da elevação de TSH juntamente a hormônios tireoidianos, na presença de alterações neurorradiológicas. O tratamento de primeira escolha consiste na neurocirurgia transesfenoidal, sendo os análogos de somatostatina e a radioterapia alternativas para o manejo de pacientes em que a intervenção cirúrgica é desaconselhada. Conclusão: Os TSHomas são raros, contudo, precisam ser investigados diante da secreção inadequada de TSH.Palavras chave: Adenoma, Hormônios tireoidianos, Neoplasias hipofisárias, Síndrome da secreção inadequada de TSH, Hipertireoidismo centralABSTRACTIntroduction: Pituitary adenomas are tumors characterized by the proliferation of adenohypophysis cells that produce trophic hormones. Among them, TSH-producing pituitary adenomas (TSHomas), uncommon benign neoplasms, whichcorrespond to less than 3% of pituitary adenomas. Method: We searched for the terms TSHomas, thyrotropinomas and pituitary adenomas secreting TSH in the Pubmed, Lilacs and Scielo databases. We included articles published between 2010 and 2020, excluding case reports, articles that were unavailable and did not deal with the topic. Results and discussion: TSHomas are fibrous, monoclonal tumors, with an incidence of 0.015 to 0.03 cases / 100,000 inhabitants, which are manifested by hyperthyroidism and symptoms caused by a mass effect. They are diagnosed with elevated TSH along with thyroid hormones, in the presence of neuroradiological changes. The first-choice treatment consists of transsphenoidal neurosurgery, with somatostatin analogs and radiotherapy being alternatives for the management of patients in whom surgical intervention is not recommended. Conclusion: TSHomas are rare, however, they need to be investigated due to inadequate TSH secretion.Keywords: Adenoma, Thyroid hormones, Pituitary neoplasms, Inappropriate TSH secretion syndrome, Central hypothyroidism

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Clinical and morphological characteristics, diagnostic criteria, and outcomes of surgical treatment of TSH-secreting pituitary adenomas

Cited by 10 publications

References 35 publications

A rare pituitary tumor associated with hyperthyroidism and acromegaly

A rare pituitary tumor associated with hyperthyroidism and acromegaly

Chemotherapy of Capecitabine plus Temozolomide for Refractory Pituitary Adenoma after Tumor Resection and Its Impact on Serum Prolactin, IGF-1, and Growth Hormone

Adenoma hipofisário secretor de TSH: uma revisão sistemática / TSH-secreting pituitary adenoma: a systematic review

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