Combination of transsphenoidal endoscopic surgery and presurgical somatostatin analogs in thyrotropin (TSH)-secreting pituitary adenomas: Treatment outcome and long-term remission at a single pituitary center

Abstract

BackgroundThyrotropin (TSH)-secreting pituitary adenomas (TSHomas) account for an extremely rare group of pituitary adenomas. Few studies examined the sensitivity and efficacy of presurgical somatostatin analogs (SSAs) and described the long-term remission under such treatment modality. The aim of the present study was to assess the efficacy of presurgical SSA treatment and long-term remission after surgery.MethodsA retrospective cohort of 65 TSHoma patients who received endoscopic transsphenoidal pituitary surgery between 2011 and 2020 in a single pituitary center in China was established. Data were analyzed for sex differences and different types of SSA and ultimately to explore the hormonal cutoff for remission prediction.ResultsTSHomas had a predominant female preference in this cohort (43 women vs. 22 men). Baseline FT3 was higher in men [7.543 ± 2.407 vs. 5.58 (4.99, 6.58), p = 0.019], which was consistent with its longer diagnosis time and larger tumor volume. The median medication time for hormonal control was 2. 5 days for short-acting SSA and 4. 0 weeks for long-term SSA. Patients with long-acting SSA had a shrinking maximum tumor diameter at a median of 1.0 (−1.6, 4.925) mm. Only 10 patients (15.38%) were not in complete remission among whom 8 patients were not en-bloc resected and 2 patients had tumor recurrence after 81.6 and 10. 7 months of complete removal. Postsurgical thyroid hormones (within 1 week) of TSH <0.094 μIU/ml were identified as the cutoff for remission using the ROC curve.ConclusionsThe combination of endoscopic transsphenoidal surgery and presurgical SSA TSHomas provided a higher long-term remission for TSHomas.

Characteristics and response cutoff of octreotide suppression test in thyrotrophin (TSH)‐secreting pituitary adenomas

“…27 Our recent study also reported the TSHoma patients with long-term use of Octreotide LAR with hormonal control, but it had limited power for tumour shrinkage. 28 In our clinical experience, long-term SSA was not advised for preoperative therapy because it might harden the tumour texture, and it would be a surgical obstacle if the tumour texture was too fibrotic.…”

Clinical characteristics and outcomes of patients with TSH-secreting pituitary adenoma and Graves’ disease - a case report and systematic review

“…TSHoma, on the other hand, is managed primarily with surgical removal of pituitary adenoma. Pre-operative management of these patients is vital as perioperative uncontrolled hyperthyroidism can lead to atrial fibrillation [ 32 ]. Pre-operative somatostatin analogues can lead to up to 73% reduction in TSH levels prior to surgery [ 33 ].…”

Clinical features and therapeutic outcomes of GH/TSH cosecreting pituitary adenomas: experience of a single pituitary center

“…Among 65 patients diagnosed with TSH-producing pituitary adenomas who were admitted to Peking Union Medical College Hospital during 2011 and 2020, 23 patients (35.4%) were immunostained negative for TSH, and they achieved thyroid hormone plunge after surgery and remission, suggesting that a considerable fraction of TSH-producing PAs might be negative TSH staining ( 34 ). The immunohistochemical staining of TSH in two-thirds of mixed PAs was negative, and there are multiple possible reasons.…”

“…Thus, we speculate that these cells are immature with a lower degree of differentiation and less specialized production of GH than the adenoma cells in GHPAs, leading to lower GH and IGF-1 at baseline in the mixed PA group than in the GHPA controls. Among 65 patients diagnosed with TSH-producing pituitary adenomas who were admitted to Peking Union Medical College Hospital during 2011 and 2020, 23 patients (35.4%) were immunostained negative for TSH, and they achieved thyroid hormone plunge after surgery and remission, suggesting that a considerable fraction of TSH-producing PAs might be negative TSH staining (34). The immunohistochemical staining of TSH in two-thirds of mixed PAs was negative, and there are multiple possible reasons.…”