DIAGNOSIS OF ENDOCRINE DISEASE: Diagnostic approach to TSH-producing pituitary adenoma

Abstract

Thyrotropin (TSH)-secreting adenomas (TSHomas) are the rarest form of pituitary adenomas, and most endocrinologists will see few cases in a lifetime, if any. In most cases, the diagnostic approach is complicated and cases may be referred after being presented as a syndrome of inappropriate TSH secretion or as a pituitary mass. This review aims to cover the past, present and possible future diagnostic approaches to TSHomas, including different clinical presentations, laboratory assessment and imaging advances. The differential diagnoses will be discussed, as well as possible coexisting disorders. By evaluating the existing reports and reviews describing this rare condition, this review aims to present a clinically practical suggestion on the diagnosic workup for TSHomas, Major advances and scientific breakthroughs in the imaging area in recent years, facilitating diagnosis of TSHomas, support the belief that future progress within the imaging field will play an important role in providing methods for a more efficient diagnosis of this rare condition.

High Prevalence of Radiological Vertebral Fractures in Patients With TSH-Secreting Pituitary Adenoma

“…Diagnosis of TSH-oma is often delayed [4, 5] and patients are potentially predisposed to develop chronic complications of thyroid hormones excess, especially when their occurrence is early, as it seems for skeletal fragility. Based on the results of our study, the morphometric evaluation of VFs should be performed in all patients at diagnosis of TSH-oma, possibly accompanied by a measurement of BMD by dual energy X-ray absorptiometry (DXA) to have a comprehensive evaluation of skeletal health.…”

“…The inappropriate hypersecretion of TSH causes secondary hyperthyroidism, in which signs and symptoms are generally milder than those occurring in primary hyperthyroidism [4]. However, the diagnosis of disease is often delayed [4, 5] and patients with TSH-oma may be predisposed to develop chronic complications of thyroid hormone excess, such as cardiovascular events and skeletal fragility, as commonly observed in patients with primary hyperthyroidism [6, 7].…”

Tirotropintermelő hypophysisadenoma

“…A férfi/nő arány közel azonos [3]. A TSH-termelő tumor csaknem mindig benignus, az esetek döntő többségében (70-80%) macroadenomáról van szó [4]. Korábban a betegséget gyakran a hypophysistumor okozta kompressziós tünetek hátterében fedezték fel.…”

Thyrotoxicosis: Diagnosis and Management

“…94 This diagnosis should also be considered in patients with presumed primary hypothyroidism in whom TSH does not normalize with LT 4 therapy. 95 Pituitary imaging with magnetic resonance is the next step, and the most common presentation of a TSHproducing adenoma is a macroadenoma. Cavernous sinus invasion is present in 23% of these lesions.…”