Short-term preoperative octreotide treatment for TSH-secreting pituitary adenoma

Fukuhara, Noriaki; Horiguchi, Kentaro; Nishioka, Hiroshi; Suzuki, Hisanori; Takeshita, Akira; Takeuchi, Yasuhiro; Inoshita, Naoko; Yamada, Shozo

doi:10.1507/endocrj.ej14-0118

Cited by 39 publications

(29 citation statements)

References 13 publications

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“…While TSH levels show a prompt response within few hours of octreotide injection, however, normalization of T3 (from 9-4 pg/mL) within 4 days of initiation of octreotide in our patient is surprising. Fukuhara et al noticed that the median time to normalization of TFT was 20 days in patients who were given preoperative octreotide therapy for control of TFT prior to surgery (14). However, in their series, the time to normalization of TFT ranged from 5-30 days indicating possibly differing octreotide responsiveness and metabolism of T3 and T4 in patients with TSH secreting tumors.…”

Section: Discussionmentioning

confidence: 94%

Thyroiditis Developing Post Initiation of Octreotide in a Case of TSH Secreting Tumor

et al. 2020

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Thyroiditis developing post pituitary surgery in a case of TSH secreting tumor has been reported, albeit rarely. A 46 year old female was treated as a case of hypothyroidism for almost five years, however, TSH levels remained unsuppressed in spite of increasing thyroxine doses. A cyclic pattern of TSH with T3 secretion was observed after stopping thyroxine, though T4 levels were normal. T3 suppression test revealed a non suppressed TSH and MRI sella revealed a pituitary mass with Grade 1 cavernous sinus invasion. With a diagnosis of TSH secreting tumor, the patient was initiated on octreotide therapy. TFT normalized within 4 days of initiation of octreotide, tumor size reduced by about 30% within 2 months of therapy and goiter size reduced to almost half with octreotide therapy. Anti TPO levels which were initially negative became positive within a month of octreotide therapy and FNAC thyroid revealed thyroiditis. To the best of our knowledge, this is the second case report of development of thyroiditis after octreotide therapy. The immunomodulatory role of TSH and somatostatin may have a role in the development of thyroiditis in this case.

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Section: Discussionmentioning

confidence: 94%

Thyroiditis Developing Post Initiation of Octreotide in a Case of TSH Secreting Tumor

et al. 2020

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“…The inhibitory effect of octreotide and the lack of an effect of a dopamine agonist on TSH levels are typical characteristics of a TSH-producing tumor. Octreotide LAR has been shown to be a useful and safe therapeutic treatment for TSH-producing adenomas after incomplete surgery [17,18] and was therefore determined to be the most appropriate treatment for the residual tumor in this case. Conversely, in Case 2 with a TSH-producing adenoma, serum TSH levels were increased by the administration of GHRP-2.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of growth hormone-releasing peptide-2 for diagnosis of thyrotropin-producing pituitary adenomas

et al. 2018

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Thyrotropin (TSH)-producing adenomas are a rare cause of hyperthyroidism and are a type of functional pituitary adenoma. The diagnosis of TSH-producing adenoma is a challenging problem in clinical endocrinology. Since growth hormone-releasing peptide-2 (GHRP-2) fails to induce TSH secretion in normal subjects, the effect of GHRP-2 on TSH levels was therefore examined in patients with TSH-producing adenomas. A total of 5 patients (4 women and 1 man) referred to our departments for further evaluation of pituitary hormones were followed-up using the GHRP-2, TSH-releasing hormone (TRH), octreotide, and bromocriptine tests to examine and evaluate TSH secretory dynamics in TSH-producing adenomas. Of 5 patients, 2 (40%) showed such a significant response, defined as a >50% increase in serum TSH level above baseline in the GHRP-2 test. Additionally, 1 patient showed a 48% increase in serum TSH level. In 1 patient whose adenoma was completely removed, basal serum concentrations of TSH were sufficiently suppressed after the operation, and serum TSH levels failed to increase in response to GHRP-2 administration. In 4 patients (80%), a poor response of serum TSH levels was observed in the TRH test. In 2 out of 5 patients (40%), serum TSH levels were significantly decreased following octreotide administration. No patient demonstrated a significant response to the bromocriptine test. In addition to TRH test, the GHRP-2 test as a potential diagnostic tool for TSH-producing pituitary adenomas.

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“…In addition, pasireotide induces rapid SSTR2 recycling to the plasma membrane after endocytosis, reducing the desensitization effect (17). Preclinical and clinical studies demonstrated the efficacy of long-acting SSA in the treatment of PT, particularly GH (18) and TSH-secreting tumours (19). Moreover, international multi-centre studies demonstrated the efficacy of pasireotide in the medical management of Cushing's disease (20,21) and GH-secreting PTs (22).…”

Section: Somatostatin and Drs In Ptsmentioning

confidence: 99%

Is receptor profiling useful for predicting pituitary therapy?

Marazuela

Ramos-Leví

Souza

et al. 2018

European Journal of Endocrinology

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Medical treatment of pituitary tumours may present important challenges in the presence of resistance to first line therapy. In this setting, the availability of specific markers of responsiveness/resistance could be helpful to provide tailored patients' treatment. Pituitary receptor profiling has emerged as a potentially useful tool for predicting the response to specific pituitary-directed medical therapy, mainly somatostatin analogues and dopamine agonists. However, its utility is not always straightforward. In fact, agonist-receptor coupling to the consequent biological response is complex and sometimes jeopardizes the understanding of the molecular basis of pharmacological resistance. Defective expression of pituitary receptors, genetic alterations, truncated variants, impaired signal transduction or involvement of other proteins, such as cytoskeleton proteins or the Aryl hydrocarbon receptor interacting protein amongst others, have been linked to differential tumour phenotype or treatment responsiveness with conflicting results, keeping the debate on the utility of pituitary receptor profiling open. Why does this occur? How can we overcome the difficulties? Is there a true role for pituitary receptor profiling in the near future? All authors of this debate article agree on the need of prospective studies using standardized methods in order to assess the efficacy of receptor profiling as a reliable clinical predictive factor.

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Short-term preoperative octreotide treatment for TSH-secreting pituitary adenoma

Cited by 39 publications

References 13 publications

Thyroiditis Developing Post Initiation of Octreotide in a Case of TSH Secreting Tumor

Thyroiditis Developing Post Initiation of Octreotide in a Case of TSH Secreting Tumor

Evaluation of growth hormone-releasing peptide-2 for diagnosis of thyrotropin-producing pituitary adenomas

Is receptor profiling useful for predicting pituitary therapy?

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