Immediate postoperative measurement of thyroid-stimulating hormone as an early predictor of remission in thyroid-stimulating hormone–secreting pituitary adenomas

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Thyroid-stimulating hormone (TSH)–secreting pituitary adenoma (TSHoma) is a rare type of pituitary adenoma; thus, little is known about TSHomas. The purpose of this study was to analyze clinical characteristics and therapeutic outcomes of TSHomas based on a single-center experience. The authors also searched for reliable preoperative and early postoperative factors that could predict long-term endocrinological remission.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>The clinical, radiological, and pathological characteristics and surgical and endocrinological outcomes of 31 consecutive cases of TSHomas that were surgically treated between 2005 and 2017 were reviewed retrospectively. Preoperative factors were evaluated for their ability to predict long-term remission by comparing remission and nonremission groups. TSH and free thyroxine levels were measured at 2, 6, 12, 18, and 24 hours after surgery to determine whether they could predict long-term remission.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Gross-total removal of tumor was achieved in 28 patients (90.3%), and 26 patients (83.9%) achieved endocrinological remission by surgery alone based on long-term endocrinological follow-up (median 50 months, range 32–81 months). The majority of the tumors were solid (21/31, 67.7%), and en bloc resection was possible in 16 patients (51.6%). Larger tumor size and tumor invasion into cavernous sinus and sphenoid sinus were strong predictors of lower rates of endocrinological remission. Immediate postoperative TSH level at 12 hours after surgery was the strongest predictor, with a 0.62 μIU/mL cutoff. Postoperative complications included CSF rhinorrhea in one patient and epistaxis in another patient, who underwent additional surgical treatment for the complications.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>Tumor size and extent are major prognostic factors for both extent of resection and endocrinological remission. The consistency of TSHomas was more likely to be solid, which makes extracapsular dissection more feasible. Long-term remission of TSHomas could be predicted even during the early postoperative period.</jats:p></jats:sec>

Influence of gender and sexual hormones on outcomes after pituitary surgery: a systematic review and meta-analysis

“…1 , the PubMed/Medline search provided 3238 articles to which none were added through other sources. After duplicate removal ( n = 35), 3203 records were screened and 294 were assessed for eligibility through full-text screening, concluding 40 studies included in qualitative synthesis, all of which were also eligible for quantitative meta-analysis [ 2 , 6 – 10 , 12 , 14 , 17 , 21 , 27 , 29 , 31 , 34 , 40 , 42 , 47 , 48 , 51 – 53 , 55 , 57 – 59 , 67 , 68 , 75 , 78 , 79 , 81 , 83 , 86 , 89 , 91 – 96 ].

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“…The details of the 40 included studies are summarized in Table 1 . We identified 31 studies reporting postoperative biochemical remission [ 2 , 6 , 8 , 10 , 12 , 14 , 21 , 29 , 31 , 34 , 40 , 42 , 47 , 48 , 51 – 53 , 55 , 57 – 59 , 67 , 68 , 75 , 78 , 79 , 81 , 86 , 89 , 92 , 94 ], eight reporting rate of GTR [ 7 , 17 , 27 , 68 , 75 , 91 , 94 , 95 ], five reporting incidence of postoperative diabetes insipidus (DI) [ 7 , 21 , 58 , 83 , 93 ], four reporting preoperative levels of prolactin [ 21 , 67 , 94 , 96 ], one study reporting rate of postoperative hyperprolactinemia [ 94 ], one study reporting both postoperative adrenocorticotropic hormone (ACTH) and thyroid-stimulating hormone (TSH) deficiency [ 9 ], one study reporting postoperative panhypopituitarism [ 83 ], and one study reporting any endocrinological deficit [ 55 ], while each of those endpoints was stratified by gender. No studies were found that reported preoperative levels of testosterone or estrogen, postoperative follicle-stimulating hormone (FSH), luteinizing hormone (LH) deficiency, growth hormone (GH) deficiency, or postoperative rate of syndrome of inappropriate antidiuretic hormone secretion (SIADH) by gender.…”

Role of Immediate Postoperative Prolactin Measurement in Female Prolactinoma Patients: Predicting Long-Term Remission After Complete Tumor Removal

“…Since normal lactotrophs are suppressed by prolonged negative feedback, prolactin levels should decrease to a subnormal level in cases of radical tumor removal [ 22 ]. We previously demonstrated that immediate postoperative measurement of hypersecreting hormones reliably predicts long-term remission in acromegaly and thyroid-stimulating hormone-secreting pituitary adenoma models [ 23 24 ]. We hypothesized that this predictive modeling system may also be useful for patients with surgically treated prolactinoma.…”

Effect of pituitary adenoma consistency on surgical outcomes in patients undergoing endonasal endoscopic transsphenoidal surgery

“…If only major complications were considered, interventions on brous adenomas seem to have a more signi cant number of complications according to the univariate model (Table 4), despite having passed the learning curve. This may be mainly due to the fact that surgical removal in these tumors is more complex, requiring greater glandular manipulation[6] and, in many cases, an extracapsular dissection [31].…”