Surgical treatment and outcome of TSH-producing pituitary adenomas

Rotermund, Roman; Riedel, Nina; Burkhardt, Till; Matschke, Jakob; Schmidt, Nils-Ole; Aberle, Jens; Flitsch, Jörg

doi:10.1007/s00701-017-3105-4

Cited by 18 publications

(7 citation statements)

References 12 publications

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“…Some authors have recently suggested that SSA may play a role in the treatment of TSHoma as primary therapy reducing the risk of post-operative hypopituitarism (24). In 4 case series including 131 patients, 21 subjects (16%) developed hypopituitarism between 4 months and 15 years after surgery (26,27,28,29). During a mean follow-up time of 12 (7-15) months, seven out of the eight analysed case reports treated with SSA in monotherapy had normalization of TSH secretion.…”

Section: Diagnosismentioning

confidence: 99%

ENDOCRINE TUMOURS: Thyrotropin-secreting pituitary adenoma: a structured review of 535 adult cases

Herdt

Philipse

Block

2021

European Journal of Endocrinology

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Background and Aims: Thyrotropin-stimulating pituitary adenoma (TSHoma) are a rare entity, occurring in 1 per million people. We performed a systematic review of 535 adult cases summarizing the clinical, biochemical, hormonal and radiological characteristics of TSHoma. Furthermore, we discuss the current guidelines for diagnosis and treatment. Methods A structured research was conducted using Pubmed with the following MeSH terms: “thyrotropin secreting pituitary adenoma” OR “TSHoma” OR “thyrotropinoma”. Results Our analysis included 535 cases originating from 18 case series, 5 cohort studies and 91 case reports. Mean age at diagnosis was 46 years. At presentation 75% had symptoms of hyperthyroidism, 55.5% presented with a goitre and 24.9% had visual field defects. Median TSH at diagnosis was 5.16 (3.20-7.43) mU/L with a mean fT4 of 41.5±15.3 pmol/L. The majority (76.9%) of the TSHoma were macroadenoma. Plurihormonality was seen in 37.4% of the adenoma with a higher incidence in macroadenoma. Surgical resection of the adenoma was performed in 87.7% patients of which 33.5% had residual pituitary adenoma. Postoperative treatment with a somatostatin analogue led to a stable disease in 81.3% of the cases with residual tumour. We noticed a significant correlation between the diameter of the adenoma and residual pituitary adenoma (r=0.490, p<0.001). However, in patients pre-operatively treated with somatostatin analogue this correlation was absent. Conclusion TSHoma are a rare cause of hyperthyroidism and are frequently misdiagnosed. Based on our structured analysis of case series, cohort studies and case reports, we conclude that the majority of TSHoma are macroadenoma being diagnosed in the 5-6th decade of life and presenting with symptoms of hyperthyroidism. Plurihormonalitiy is observed in one third of TSHoma. Treatment consists of neurosurgical resection and SSA in case of surgical failure.

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Section: Diagnosismentioning

confidence: 99%

ENDOCRINE TUMOURS: Thyrotropin-secreting pituitary adenoma: a structured review of 535 adult cases

Herdt

Philipse

Block

2021

European Journal of Endocrinology

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“…[18] The rate of postoperative biochemical remission is 70% to 90%. [7,18,19] In the past, a diagnosis of TSHoma was often delayed, resulting in an invasive macroadenoma, which complicates the surgical procedure. The preoperative MRI findings in our patient showed a microadenoma without mass effect in the sellar region, suggesting an early diagnosis in this case, significantly reducing the difficulty of the operation.…”

Section: Discussionmentioning

confidence: 99%

Successful management of octreotide-insensitive thyrotropin-secreting pituitary adenoma with bromocriptine and surgery

Yang¹,

Wu²,

Wang³

et al. 2017

Medicine

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“…Recently, a relatively good outcome of the surgical removal of TSH-PA has been reported. Yamada et al 20) reported a remission rate of 84% for surgery for TSH-PA, whereas Rotermund et al 16) also reported a remission rate of surgery alone for TSH-PA of 91.7% in their case series. In our series, the remission rate of TSH-PA after surgical treatment alone was 92.3%.…”

Section: Discussionmentioning

confidence: 93%

Thyroid-Stimulating Hormone-Secreting Pituitary Adenomas : Single Institutional Experience of 14 Consecutive Cases

Byun

Kim

et al. 2020

J Korean Neurosurg Soc

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Objective : Thyroid-stimulating hormone (TSH)-secreting pituitary adenoma (PA) is an extremely rare functioning form of PA that accounts for 0.7-2% of all such cases. The previously reported outcomes of the surgical removal of TSH-PA are poor. Owing to its extremely low incidence, most available reports on TSH-PA are case reports or small case series. Thus, we investigated the clinical and endocrinological outcomes of surgically treated TSH-PA through our institutional series. Methods : We retrospectively reviewed 14 consecutive cases of surgically treated TSH-PA, focusing on the clinical, radiological, surgical, and endocrinological data. Results : There were seven male (50%) and seven female (50%) patients. The mean age was 42.5 years (range, 19-63). The mean tumor size was 16.6 mm (range, 4-30). Optic chiasm compression was noted in six patients (42.9%), and no patient showed cavernous sinus invasion. Thirteen of 14 patients (92.8%) underwent transnasal transsphenoidal approach (TSA), and one patient underwent TSA followed by transcranial approach for residual tumor removal. Thirteen of 14 patients (92.8%) showed endocrinological remission; all patients who experienced remission showed subnormal levels of TSH (<0.4 μU/mL) on postoperative day 2. Recurrence occurred in two patients (14.2%). One patient underwent subsequent revision transnasal TSA for recurrent tumor removal, and the other patient underwent gamma knife radiosurgery for recurrence. Conclusion : Surgical treatment showed excellent surgical outcomes. The TSH level in the immediate postoperative period may be a predictor for endocrinological remission. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Surgical treatment and outcome of TSH-producing pituitary adenomas

Abstract: We argue that transsphenoidal surgery for TSHoma should be considered as the treatment of choice as remission following surgery is highly probable and postoperative hypopituitarism is very unlikely if patients are referred to centers with high pituitary surgery case loads.

Cited by 18 publications

References 12 publications

ENDOCRINE TUMOURS: Thyrotropin-secreting pituitary adenoma: a structured review of 535 adult cases

ENDOCRINE TUMOURS: Thyrotropin-secreting pituitary adenoma: a structured review of 535 adult cases

Successful management of octreotide-insensitive thyrotropin-secreting pituitary adenoma with bromocriptine and surgery

Thyroid-Stimulating Hormone-Secreting Pituitary Adenomas : Single Institutional Experience of 14 Consecutive Cases

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