Thyrotropin-Secreting Pituitary Adenoma in an Adolescent Boy: Challenges in Management

Abstract

Thyrotropinomas tend to be aggressive, invasive tumors that are difficult to resect because of their marked fibrosis and their proximity to vital structures such as the optic chiasm. The latter characteristic also limits the use of radiation therapy. In the few cases reported of children younger than 18 years whose thyrotropinomas were treated surgically, the results were disappointing. We present here the case of a 16-year-old boy with a thyrotropin-secreting pituitary macroadenoma who underwent partial resection via a transsphenoidal approach and was left with significant residual tumor and continued hyperthyroidism. He subsequently received 4 years of long-acting release somatostatin therapy, during which he has remained euthyroid without requiring antithyroid medication. To our knowledge, this is thus far the longest duration of somatostatin therapy in the pediatric age group. This regimen also achieved a decrease in compression of the optic nerve and prevented further tumor growth. We review here the current literature on somatostatin analog treatment including molecular mechanisms and promising new treatment modalities, such as the heterodimerization of dopamine and somatostatin receptors. We conclude that this has been a useful adjuvant treatment for our adolescent patient.

Paediatric Pituitary Adenomas: A Decade of Change

“…These account for 0.5-2.8% of PPAs [2,56]. Typical presentation includes symptoms of hyperthyroidism, goitre and neurological signs due to mass effect, as almost 90% of the cases are macroadenomas.…”

TSH-secreting pituitary adenomas treated by gamma knife radiosurgery: our case experience and a review of the literature

“…[7][8][9][10] If surgery is contraindicated or if it fails to cure, the European Thyroid Association guidelines strongly recommend treatment with somatostatin analogs (SSA), such as octreotide and lanreotide, which have proved to be highly effective in a series of studies. [9][10][11][12][13][14][15][16][17][18][19] However, there are cases where manifestation of adverse effects, resistance to or escape from the inhibitory effect of SSAs lead to failure of treatment. 15,18,19 In these cases stereotactic irradiation can be employed.…”

Clinical and Therapeutic Characteristics of Pituitary TSH-Secreting Adenoma in Adolescent-Onset Patients: Six Case Studies and Literature Review

“…For intractable cases, combination medical therapy such as SSAs combined with dopamine analogs and (or) antithyroid drugs may work well. There is a need to be cautious while using antithyroid drugs alone preoperatively because it may increase TSH levels through feedback regulation ( 19 ).…”