Thyrotropin-secreting pituitary adenomas (original) (raw)
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Surgical management of thyrotropin-secreting pituitary adenomas
Pituitary, 1999
The reported cases of hyperthyroidism due to a TSH-secreting pituitary adenoma have steadily increased in previous years; however, information about the results and long term outcome after pituitary surgery is scanty. Twenty-four patients with a TSH-secreting adenoma underwent pituitary surgery at our department in the last 15 years. Hypersecretion of other pituitary hormones was diagnosed in 7 patients. Three patients were euthyroid at the time of surgery because of previous ablative thyroid therapies. The success rate of surgery strictly depends on the criteria used. Normalization of elevated FT3 and FT4 levels occurred in 17 of the 21 patients with preoperative hyperthyroidism: however, only those with early postoperative undetectable TSH level (12 cases) had no recurrence of disease during follow-up and no residual tumor tissue on postoperative MRI, whereas recurrence of hyperthyroidism occurred in 3 of the 5 patients without postoperative TSH inhibition. All 3 euthyroid patient...
THYROID STIMULATING HORMONE (TSH) SECRETING PITUITARY ADENOMA: A RARE CAUSE OF THYROTOXICOSIS
Introduction: Thyroid stimulating hormone secreting pituitary adenoma (TSHoma) is a rare cause of thyrotoxicosis, which manifests with features of thyrotoxicosis along with neurological manifestations of pituitary tumour. Biochemically, it is characterized by elevated thyroid hormone (T3 and T4) levels with unsuppressed TSH levels. It accounts for 1-2% of all pituitary adenomas. Mixed TSHomas account for 30% of these cases, among which mixed TSHoma/LH(luteinizing hormone)oma is very rare (<2%). We report a case of mixed TSHoma/LHoma, who was successfully treated with pre-operative Somatostatin analogues followed by Endoscopic Transphenoidal surgery for resection of pituitary adenoma. Case report: A 35 years old, male presented to our hospital in September 2017 with complaints of headache, decreased vision in both eyes, palpitations, excessive sweating, tremors of the hands and increased frequency of loose stools since 8 months. He had bilateral gynaecomastia and decreased libido since 6 months. On evaluation, he was found to have Free T3: 7.5pg/ml (1.45-3.48), Free T4: 2.1ng/dl (0.75-1.85), TSH: 25.31mU/l (0.27-4.2), Prolactin: 31ng/ml (4.1-15.4). MRI Brain showed pituitary macroadenoma of size 2.7?3.4?3.6 cm with suprasellar extension and displacement of optic chaisma laterally. He was treated initially with daily subcutaneous Octreotide for 2 months followed by a single dose of long acting Octreotide LAR. One week after starting Octreotide, his symptoms improved and Free T3 was decreased to 5.42pg/ml, Free T4 to 1.75ng/dl and TSH came down to 16.34mU/l. Then 2 months later, Free T3 was 1.7pg/ml (2.1-4.2), Free T4 was 0.81ng/dl (0.8-2.7), TSH was 0.98mU/l (0.35-4.5). His 8am cortisol was 5.5mcg/dl, LH was 2.61U/l, FSH was 3.63U/l, Testosterone was 1.59ng/ml, IGF-1 was 149ng/ml and Prolactin was 20.2ng/ml. USG neck showed normal sized thyroid gland with a tiny colloid cyst of size 5?3mm in the right lobe of thyroid. Repeat MRI Brain showed pituitary macroadenoma measuring 2.2?2?2.6 cm with suprasellar extension, displacing the optic chaisma superiorly and partial encasement of bilateral cavernous ICA. He was treated with Endoscopic Transphenoidal surgery for resection of pituitary adenoma, along with peri-operative steroid coverage and levothyroxine supplementation. Post-operative period was uneventful, his steroids were tapered and stopped. The histopathology and immunohistochemistry report were s/o TSHoma. He was discharged 1 week later with levothyroxine supplementation. Conclusion:TSHoma should always be considered in patients who present with signs and symptoms of thyrotoxicosis, but with unsuppressed TSH levels in presence of elevated thyroid hormone levels, especially in those who have features of mass effects of pituitary tumour. Its recognition is important avoid unnecessary anti-thyroid drugs and thyroid ablative therapies, which can have a detrimental effect on the pituitary mass.
Thyrotropin-Secreting Pituitary Adenoma: A Case Report
Endocrinologia Japonica, 1992
We report a 44-year-old male with a thyrotropin (TSH)-secreting pituitary adenoma. Basal serum free triiodothyronine (FT3, 12.1pmol/l) and free thyroxine (FT4, 28 pmol/l)were increased with normal basal TSH (3.1mU/l). There was impaired TSH response to thyrotropin releasing hormone (TRH) test. Serum TSH was suppressed to 59% of the basal level after oral administration of 1.4mg 3,3'-5-triiodothyroacetic acid (triac), whereas no suppression was observed after 75 accg daily administration of triiodothyronine (Ti). Serum concentrations of a-subunit of TSH (TSH-cr) and TSH-cr/TSH molar ratio were high, being 1.95ƒÊg/l, and 4.4, respectively. Pituitary CT and MRI scan showed the presence of a macroadenoma in the anterior lobe of the pituitary gland. Histopathology of the excised pituitary confirmed the diagnosis of a TSH-producing adenoma. A positive correlation between TSH and FT3 (r=0.66, P<0.01) or FT4 (r=0.54, P<0.01) was observed in serial sera obtained before and after operation.
Pituitary, 2010
In this report, an extremely rare case of pediatric thyrotropin-secreting pituitary macroadenoma (TSHoma) is described. An 8-year-old boy, complaining of unsteady gait, was suspected of endocrinopathy because of emaciation and muscle weakness of the legs. Endocrinological work-up established a diagnosis of hyperthyroidism due to syndrome of inappropriate secretion of TSH. Magnetic resonance imaging showed a pituitary macroadenoma with suprasellar and sphenoidal extension without cavernous sinus invasion. He underwent an endoscopic endonasal transsphenoidal adenomectory due to the diagnosis of TSHoma. The adenoma was soft and it was totally removed. Histopathological staining confirmed diagnosis of TSHoma. Postoperative evaluation revealed a subnormal level of TSH (from 13-21 to 0.03 micro U/ml), normalization of alpha-subunit (from 10.0 to 0.09 ng/ml), and as a result, hypothyroidism. The boy left the hospital with oral levothyroxine that continued until 12 months of discharge. The present 8-year-old case is the youngest case to the best of our knowledge based on a bibliographical search. Reasons for endocrinological remission following adenomectomy are (1) correct diagnosis without delay: lack of cavernous sinus invasion, (2) soft and non-fibrous adenoma tissue, and (3) endoscopic technique with wide vision and illumination: safe even for a 8-year-old child. Early recognition/detection and pituitary-conserving adenomectomy can cure TSHoma and avoid long-term medical therapy and/or irradiation, which contribute to the best interests of patients with TSHoma.
TSH-secreting pituitary adenomas: follow-up of 11 cases and review of the literature
Pituitary, 2007
Thyrotropin (TSH)-secreting pituitary adenomas account for less than 1% of all pituitary tumors. In the last two decades, their clinical management has changed markedly due to technological advances that made earlier diagnosis possible and the introduction of somatostatin analog therapy. We retrieved the data of 11 patients in Israel diagnosed with TSHsecreting pituitary tumors since 1989. There were six men and five women of mean age 44.8 ± 19.5 years (range 18-80 years). All had elevated thyroxine and triidothyronine levels with nonsuppressed TSH and imaging evidence of a pituitary tumor. In three patients the tumor co-secreted growth hormone. Ten patients had macroadenomas ( ‡10 mm) and one patient had a microadenoma (<10 mm). Nine patients underwent surgery, and all had postoperative evidence of residual tumor. Ten patients received long-term somatostatin analog therapy (9 postoperatively, 1 primarily), which controlled the hyperthyroidism in all of them. In addition, three patients showed tumor shrinkage and seven, stabilization of tumor growth.In conclusion, in patients with TSHsecreting pituitary adenomas, somatostatin therapy appears to be highly effective in treating hyperthyroidism and in halting tumor growth or promoting tumor shrinkage.
European Journal of Endocrinology, 2007
Objective: TSH-secreting pituitary tumors (TSH-omas) are a rare cause of hyperthyroidism and account for !1% of all pituitary adenomas. Failure to recognize the presence of a TSH-oma may result in dramatic consequences such as thyroid ablation that may cause further growth in pituitary tumor. The primary goal of the treatment of TSH-omas is to remove the pituitary tumor. Medical treatment includes dopaminergic agonists or somatostatin analogs. Methods and results: We report five cases of TSH-oma diagnosed between 1997 and 2006 and review the literature. All the patients are females with an age range from 54 to 65 years at diagnosis. Four of the five patients had at least one event of thyroid surgery due to goiter or nodule of unknown dignity. Three of the five patients had a stroke before the diagnosis of TSH-oma, probably due to hypertension, or smoking and contraceptive treatment. One patient with invasive tumor growth received stereotactic radiotherapy (and developed panhypopituitarism after operation), another patient received somatostatin analogs preoperatively and successfully underwent transsphenoidal operation. Three of the five patients received dopaminergic agonists (bromocriptine 5 mg daily or cabergoline 0.5-0.75 mg per week), because they refused surgical therapy or the tumor was stable under dopaminergic therapy. All patients have been followed-up for 2.5-8 years. A normalization of circulating thyroid hormone levels was achieved in all patients. The patient who underwent operation shows no recurrence of the disease. The other patients have a stable pituitary mass without signs of growth. Conclusion: We report the successful long-term treatment of TSH-omas with different therapies.
Journal of neurosurgery, 2014
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. 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). 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 patient...
Acta Endocrinologica-bucharest, 2008
A 63-years old patient with severe thyrotoxicosis with cachexia and high frequency atrial fibrillation showed an inadequate secretion of TSH. A pituitary macroadenoma was revealed by computed tomography. Acute octreotide administration decreased serum TSH from 2.48 mU/mL to 0.06 mU/mL and T3 from 3.1 ng/mL to normal values (0.93 ng/mL) in 3 days; at the same time serum T4 remained unchanged (raised).The response to octreotide supported the diagnosis of TSH-secreting adenoma. T3 suppression test is no longer useful at present for diagnosis.Administration of long-acting somatostatin analogues (lanreotide) together with antithyroid drugs (ATD) was initially necessary. However, after removal of pituitary tumor the clinical symptoms (including atrial fibrillation) disappeared.ATD administration was no longer necessary, nor was octreotide or lanreotide. Immunohistochemistry certified that the pituitary tumor was a pure thyrotropinoma (without plurihormonal expression). Complete cure of severe thyrotoxicosis due to a TSH-secreting pituitary adenoma by pituitary surgery is possible. Thyroidectomy is not indicated.