Thyrotropin-secreting pituitary adenomas induce left atrial enlargement with subclinical atrial fibrillation: an echocardiographic study

Yoshiki, Kenji; Sasagawa, Yasuo; Shimojima, Masaya; Takeshita, Yumie; Takata, Sho; Hayashi, Yasuhiko; Takamura, Toshinari; Tachibana, Osamu; Nakada, Mitsutoshi

doi:10.1007/s11102-021-01154-3

Cited by 4 publications

(3 citation statements)

References 45 publications

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“…Recently, a meta-analysis revealed that atrial fibrillation or heart failure happened in 11.1% of 535 adult TSH-oma cases ( 22 ). Another research found that TSH-oma can significantly induce left atrial enlargement and subclinical atrial fibrillation since excess thyroid hormones can increase the arrhythmogenic activity of the pulmonary veins, and increase the hemodynamic load ( 23 ). Thus, the potential cardiovascular complications caused by the TSH-oma may be more common than reported and should be taken seriously.…”

Section: Discussionmentioning

confidence: 99%

Clinical and Therapeutic Characteristics of Pituitary TSH-Secreting Adenoma in Adolescent-Onset Patients: Six Case Studies and Literature Review

et al. 2021

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BackgroundThyrotropin-secreting adenoma (TSH-oma) is a very rare kind of functional pituitary adenoma, especially that which occurs in adolescents. However, its potential clinical and therapeutic characteristics are still unknown.ObjectivesThe study was aimed to summarize the clinical and therapeutic characteristics of patients with adolescent-onset TSH-oma.MethodsWe retrospectively analyzed six (4.1%) adolescent-onset TSH-oma cases from 148 patients who were diagnosed with TSH-oma at our hospital between January 2012 and October 2020. A literature review was performed on the PubMed online database, and 14 adolescent-onset TSH-oma cases were retrieved. Then, the characteristics of clinical manifestations, treatment outcomes, and follow-ups were analyzed and compared to the adult TSH-oma patients.ResultsAltogether, 20 adolescent-onset cases were included in this study having mean onset age of 13.4 ± 3.3 years. Males were found to be slightly predominant (M: F = 1.5:1) in our study. The median baseline levels of TSH, FT3, and FT4 in adolescent-onset cases were found to be 6.30 [interquartile range (IQR) 9.82] µIU/ml, 9.18 (IQR 11.61) pg/ml, and 3.22 (IQR 1.90) ng/dl, respectively, which were all significantly higher than the adult patients of our hospital. Also, the adolescent-onset cases showed more large tumor ratio (36.8% vs. 9.3%, p = 0.007) compared to the adult patients. Compared to the patients of all ages in the literature, the biochemical remission rate of SSAs (57.1%) and remission rate of TSS (38.9%) were found to be considerably lower in adolescent-onset patients, while the recurrence rate (44.4%) was found to be considerably higher.ConclusionsAdolescent-onset TSH-oma patients showed higher TSH and thyroid hormone levels, more large tumors, and worse treatment outcomes than adult cases. Hence, early diagnosis, multidisciplinary therapy, and close follow-up should be highlighted to improve the prognosis.

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Section: Discussionmentioning

confidence: 99%

Clinical and Therapeutic Characteristics of Pituitary TSH-Secreting Adenoma in Adolescent-Onset Patients: Six Case Studies and Literature Review

et al. 2021

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“…However, not infrequently, despite surgery and SRL therapy, disease control remains suboptimal ( 402 ). Patients may experience cardiac complications such as atrial fibrillation ( 403 ), increasing the risk of stroke ( 350 ). In a retrospective case series, more than half of patients showed morphometrical vertebral fractures associated with age and serum free T4, but not with TSH levels ( 404 ).…”

Section: Long-term Comorbidities and Mortality Outcomesmentioning

confidence: 99%

Clinical Biology of the Pituitary Adenoma

et al. 2022

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All endocrine glands are susceptible to neoplastic growth, yet the health consequences of these neoplasms differ between endocrine tissues. Pituitary neoplasms are highly prevalent and overwhelmingly benign, exhibiting a spectrum of diverse behaviors and impact on health. To understand the clinical biology of these common yet often innocuous neoplasms, we review pituitary physiology, and adenoma epidemiology, pathophysiology, behavior, and clinical consequences. The anterior pituitary develops in response to a range of complex brain signals integrating with intrinsic ectodermal cell transcriptional events that together determine gland growth, cell type differentiation, and hormonal production, in turn maintaining optimal endocrine health. Pituitary adenomas occur in ten percent of the population; however, the overwhelming majority remain harmless during life. Triggered by somatic or germline mutations, disease-causing adenomas manifest pathogenic mechanisms that disrupt intra-pituitary signaling to promote benign cell proliferation associated with chromosomal instability. Cellular senescence acts as a mechanistic buffer protecting against malignant transformation, an extremely rare event. It is estimated that fewer than one thousandth of all pituitary adenomas cause clinically significant disease. Adenomas variably and adversely affect morbidity and mortality depending on cell type, hormone secretory activity, and growth behavior. For most clinically apparent adenomas, multimodal therapy controlling hormone secretion and adenoma growth lead to improved quality of life and normalized mortality. The clinical biology of pituitary adenomas and particularly their benign nature stands in marked contrast to other tumors of the endocrine system such as thyroid and neuroendocrine tumors.

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“…Atrial fibrillation is the most common cardiac arrhythmia in our setting (1,2). Thyroid disorders and, in particular, hyperthyroidism are a recognized risk factor for atrial arrhythmias (2)(3)(4)(5), which have to be considered among other conditions that pose a risk for developing atrial fibrillation (smoking, diabetes mellitus, hypertension, coronary heart disease, heart failure, left atrial enlargement, or obesity) (6).…”

Section: Introductionmentioning

confidence: 99%

An elevated parametric thyroid feedback quantile-based index is associated with atrial fibrillation

et al. 2023

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IntroductionAtrial fibrillation is associated with hyperthyroidism. Within the euthyroid range, it is also associated with high thyroxine (fT4), but not with thyrotropin (TSH). We aim to describe differences in thyroid regulation, measured by the Parametric Thyroid Feedback Quantile-Based Index (PTFQI), between patients with atrial fibrillation and the general population.Materials and methodsThyroid parameters (PTFQI, TSH, and fT4) of a sample of 84 euthyroid subjects with atrial fibrillation (cases) were compared to a reference sample of euthyroid healthcare patients (controls). We calculated age and sex adjusted ORs for atrial fibrillation across tertiles of these parameters. Also, within cases, we studied thyroid parameters association with clinical characteristics of the atrial fibrillation.ResultsAfter adjusting for age and sex, fT4 and PTFQI were higher in subjects with atrial fibrillation when compared to the general sample (p<0.01 and p=0.01, respectively). Atrial fibrillation ORs of the third versus the first PTFQI tertile was 1.88(95%CI 1.07,3.42), and there was a gradient across tertiles (p trend=0.02). Among atrial fibrillation patients, we observed that higher PTFQI was associated with sleep apnea/hypopnea syndrome (OSAS) (p=0.03), higher fT4 was associated with the presence of an arrhythmogenic trigger (p=0.02) and with heart failure (p<0.01), and higher TSH was also associated with OSAS (p<0.01).ConclusionsEuthyroid subjects with atrial fibrillation have an elevation of the pituitary TSH-inhibition threshold, measured by PTFQI, with respect to the general population. Within atrial fibrillation patients, high PTFQI was associated with OSAS, and high fT4 with heart failure. These results hint of the existence of a relationship between thyroid regulation and atrial fibrillation.

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Thyrotropin-secreting pituitary adenomas induce left atrial enlargement with subclinical atrial fibrillation: an echocardiographic study

Cited by 4 publications

References 45 publications

Clinical and Therapeutic Characteristics of Pituitary TSH-Secreting Adenoma in Adolescent-Onset Patients: Six Case Studies and Literature Review

Clinical and Therapeutic Characteristics of Pituitary TSH-Secreting Adenoma in Adolescent-Onset Patients: Six Case Studies and Literature Review

Clinical Biology of the Pituitary Adenoma

An elevated parametric thyroid feedback quantile-based index is associated with atrial fibrillation

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