Thyroid-Stimulating Hormone-Secreting Pituitary Adenomas : Single Institutional Experience of 14 Consecutive Cases

Abstract

Objective : Thyroid-stimulating hormone (TSH)-secreting pituitary adenoma (PA) is an extremely rare functioning form of PA that accounts for 0.7-2% of all such cases. The previously reported outcomes of the surgical removal of TSH-PA are poor. Owing to its extremely low incidence, most available reports on TSH-PA are case reports or small case series. Thus, we investigated the clinical and endocrinological outcomes of surgically treated TSH-PA through our institutional series. Methods : We retrospectively reviewed 14 consecutive cases of surgically treated TSH-PA, focusing on the clinical, radiological, surgical, and endocrinological data. Results : There were seven male (50%) and seven female (50%) patients. The mean age was 42.5 years (range, 19-63). The mean tumor size was 16.6 mm (range, 4-30). Optic chiasm compression was noted in six patients (42.9%), and no patient showed cavernous sinus invasion. Thirteen of 14 patients (92.8%) underwent transnasal transsphenoidal approach (TSA), and one patient underwent TSA followed by transcranial approach for residual tumor removal. Thirteen of 14 patients (92.8%) showed endocrinological remission; all patients who experienced remission showed subnormal levels of TSH (<0.4 μU/mL) on postoperative day 2. Recurrence occurred in two patients (14.2%). One patient underwent subsequent revision transnasal TSA for recurrent tumor removal, and the other patient underwent gamma knife radiosurgery for recurrence. Conclusion : Surgical treatment showed excellent surgical outcomes. The TSH level in the immediate postoperative period may be a predictor for endocrinological remission. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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

“…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 ]. Post-operative remission has been noted in up to 70% of cases [ 34 ].…”

Clinical Characteristics, Diagnosis, and Treatment of Thyroid Stimulating Hormone-Secreting Pituitary Neuroendocrine Tumor (TSH PitNET): A Single-Center Experience

“…Kim et al [20] reported the remission rate as 84%, and similarly Yamada et al [8] reported as 84.4%. In a study by Byun et al [21], the remission rate was reported as 93%, but it's worth noting that only postoperative achievement of a euthyroid state was considered in defining remission. On the other hand, similarly to our study, Azzalin et al [16] reported 66%, and Cossu et al [9] reported pooled remission rate as 66% and 76% after adjuvant radiotherapy and medical therapy respectively, in their systematic review and meta-analysis on TSH PitNET.…”

Thyrotropinoma - the case report about one of the rarest type of pituitary adenomas

“…Transsphenoidal tumour resection is recommended as the treatment of choice (12) . Joonho Byun et al reported that in 13 of 14 cases of surgical treatment of TSH -oma showed excellent surgical outcomes (19) . In our case, surgical treatment was performed after 4 injections of octreotide analogue with successful TSH normalisation.…”