Diagnosis and treatment of TSH-secreting adenomas: review of a longtime experience in a reference center

Abstract

In spite of its relatively straightforward diagnosis, which includes clinical/subclinical hyperthyroidism with or without goiter, increased free thyroxine and nonsuppressed TSH levels, and pituitary mass, the diagnosis of TSH-secreting and cosecreting adenomas was frequently unrecognized and thus much delayed. Serum alpha-subunit levels were high in nearly all patients with TSH-secreting adenomas and useful in excluding other conditions in the differential diagnosis. Proper indication and interpretation of simple laboratory tests should be emphasized in medical education to improve diagnostic accuracy.

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.…”

“…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]. …”

Refractory Transposing Hyperthyroid Disorder Inducing Tsh-secreting Pituitary Adenoma: A Case Report and Literature Review

“…Asymptomatic cases as well as diffuse anterior neck swelling with no exophthalmia forms of this disorder has also been reported (2,5). Acromegaly and/or hyperprolactinemia as a result of co-secretion of growth hormone (GH) and/ or prolactin (PRL), correspondingly has also been associated with TSH-sPAs (2,3). This presentation is often evident when endocrine workout uncovers elevated levels of free thyroxine (FT4) with normal or high levels TSH, which juxtaposes with the suppressed TSH levels usually seen in other kinds of thyrotoxicosis (2,(4)(5)(6).…”

“…TSH-sPAs manifesting with hyperthyroidism may appear as clinically insignificant to very grave thyrotoxicosis. Asymptomatic cases as well as diffuse anterior neck swelling with no exophthalmia forms of this disorder has also been reported (2,5). Acromegaly and/or hyperprolactinemia as a result of co-secretion of growth hormone (GH) and/ or prolactin (PRL), correspondingly has also been associated with TSH-sPAs (2,3).…”

“…TSH-secreting pituitary adenomas (TSH-sPAs) or thyrotropinomas, are very rare forms of pituitary adenomas (PAs), accounting for about 0.9-1.5% of all pituitary tumors reported in literature (1)(2)(3)(4). TSH-sPAs manifesting with hyperthyroidism may appear as clinically insignificant to very grave thyrotoxicosis.…”