Thyrotropin-Secreting Pituitary Adenomas: Outcome of Pituitary Surgery and Irradiation

Malchiodi, Elena; Profka, Eriselda; Ferrante, E.; Sala, Elisa; Verrua, Elisa; Campi, Irene; Lania, Andrea; Arosio, Maura; Locatelli, Marco; Mortini, Pietro; Losa, Marco; Motti, Enrico; Beck‐Peccoz, Paolo; Spada, Anna; Mantovani, Giovanna

doi:10.1210/jc.2013-4376

Cited by 81 publications

(41 citation statements)

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“…SRLs are used for the treatment of TSH-oma [2, 41, 42]. In our study, presurgical medical treatment with SRLs, but not that with methimazole, was associated with a lower prevalence of VFs.…”

Section: Discussionmentioning

confidence: 48%

“…Accordingly, vertebral morphometry should be performed both at baseline and during follow-up in patients with TSH-oma. Finally, a relevant number of patients with TSH-oma are not cured by neurosurgery with a consequent relapse of hyperthyroidism [2, 42, 55–57]. Based on the preliminary results of our study, SRL treatment may be proposed in all those patients with active disease in place of methimazole for these apparent favorable effects on skeletal health.…”

Section: Discussionmentioning

confidence: 95%

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High Prevalence of Radiological Vertebral Fractures in Patients With TSH-Secreting Pituitary Adenoma

Frara

Losa

Doga

et al. 2018

Journal of the Endocrine Society

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BackgroundBone loss and high risk of fractures have been reported in patients with primary hyperthyroidism, whereas data on skeletal health in TSH-secreting adenoma (TSH-oma) are scant, and the risk of fractures in this specific clinical context has not been investigated so far. In this cross-sectional study, we aimed at evaluating for the first time, to our knowledge, the prevalence and determinants of radiological vertebral fractures (VFs) in patients with TSH-oma.MethodsTwenty-two patients (10 males, 12 females; median age 47 years) with TSH-oma and 44 patients (20 males, 24 females; median age 49 years) with nonfunctioning pituitary adenoma (NFPA) were retrospectively evaluated for thoracic VFs using a morphometric approach on lateral chest X-ray routinely performed in the presurgical diagnostic workup.ResultsThe prevalence of VFs was significantly higher in TSH-oma vs NFPA (59.1% vs 22.7%; P = 0.003), the difference being still significant (odds ratio, 10.5; P = 0.005) after correction for the size of pituitary adenomas and biochemical parameters. In TSH-oma, the prevalence of VFs was significantly associated with older age (P = 0.007) and higher serum free T4 values (P = 0.02). In 20 patients, data on presurgical medical therapies of TSH-oma were available. All patients not treated with somatostatin receptor ligands were fractured compared with 25% of those who were treated with these drugs (P = 0.001). No significant (P = 0.25) association between VFs and treatment with methimazole was found.ConclusionsThis study provides the first evidence, to our knowledge, that patients with TSH-oma may develop VFs in close relationship with severity of hyperthyroidism.

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Section: Discussionmentioning

confidence: 48%

Section: Discussionmentioning

confidence: 95%

High Prevalence of Radiological Vertebral Fractures in Patients With TSH-Secreting Pituitary Adenoma

Frara

Losa

Doga

et al. 2018

Journal of the Endocrine Society

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“…При подтвержденном диагнозе ТТГ-секретирующей опухоли гипофиза предпочтительным методом лечения является удаление тиреотропиномы, позволяющее добиться гормональной ремиссии в 75-84% случаев [4,19,20]. Однако радикальное удаление макротиреотропином достаточно часто сопряжено с техническими трудностями, связанными с фиброзом, инвазией опухоли в кавернозные синусы, внутреннюю сонную артерию или хиазму.…”

Section: Discussionunclassified

TSH-secreting pituitary adenoma: late diagnosis and effectiveness of therapy

Петрик¹,

Космачева²,

Polyakova³

et al. 2017

Probl. Endokrinol. (Mosk.)

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1 ФГБОУ ВО «Кубанский государственный медицинский университет», Краснодар, Россия; 2 ГБУЗ НИИ «Краевая клиническая больница №1 им. проф. С.В. Очаповского», Краснодар, Россия; 3 ФБГУ «Эндокринологический научный центр» Минздрава России, Москва, Россия Современные лечебно-диагностические алгоритмы позволяют своевременно выявить нарушения функции щитовидной железы, назначить адекватное лечение. Между тем в процессе интерпретации тиреоидного статуса необходимо учитывать крайне редкую, но реально существующую возможность развития тиреотоксикоза центрального генеза, диагностика которого, как показывает общемировая практика, затруднена. Представлен клинический случай ТТГ-продуцирующей аденомы гипофиза у женщины 47 лет, длительное время получающей тиреостатики по поводу тиреотоксикоза. Пациентке был установлен диагноз болезнь Грейвса, однако истинной причиной тиреотоксикоза являлась тиреотропинома. Основные лабораторные проявления тиреотоксикоза центрального генеза заключались в сочетании эпизодов нормального или повышенного уровня ТТГ с высокой или нормальной концентрацией свободного Т4. При МРТ выявлена макроаденома гипофиза. Наличие клинических проявлений тиреотоксикоза позволило исключить синдром резистентности к тиреоидным гормонам. Пробное лечение октреотидом купировало клинические и лабораторные проявления тиреотоксикоза, что обусловило выбор консервативного метода в качестве первой линии терапии. Обсуждаются особенности клинико-лабораторных проявлений, а также принципы дифференциальной диагностики и современных методов лечения ТТГ-продуцирующих аденом гипофиза. Ключевые слова: клинический случай, тиреотоксикоз, ттг продуцирующая аденома гипофиза, тиреотропинома.The modern therapeutic and diagnostic algorithms allow timely detection of pituitary disorder to prescribe adequate treatment. Meanwhile, when interpreting the thyroid status, physicians need to take into account the extremely rare but the actually existing possibility of central thyrotoxicosis. The worldwide practice shows that diagnosis of this condition is rather challenging. We report a clinical case of a TSH-secreting pituitary adenoma in a 47-year-old female who received a long-term thyrostatic therapy for thyrotoxicosis. The patient was diagnosed with Graves' disease; however, thyrotoxicosis was actually caused by TSH-oma.The key laboratory signs of central thyrotoxicosis included the combination of episodes of normal or elevated TSH level with the high or normal free T4 level. MRI showed a pituitary macroadenoma. The clinical manifestations of thyrotoxicosis made it possible to rule out the thyroid hormone resistance syndrome. The attempted therapy with octreotide eliminated the clinical and laboratory signs of thyrotoxicosis, so the conservative method was selected as first-line therapy. The features of clinical and laboratory signs, as well as the principles of differential diagnosis and modern methods for treating TSH-secreting pituitary adenomas are discussed.

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“…100 Conventional radiotherapy or radiosurgery are other options when there is incomplete cure with surgery. 101 Antithyroid drugs are avoided given the expected tumor growth if the residual feedback inhibition from thyroid hormones on the tumor is eliminated.…”

Section: Amiodarone-induced Thyroid Dysfunctionmentioning

confidence: 99%

Thyrotoxicosis: Diagnosis and Management

Sharma

Stan

2019

Mayo Clinic Proceedings

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Thyrotoxicosis is the clinical manifestation of excess thyroid hormone action at the tissue level due to inappropriately high circulating thyroid hormone concentrations. Hyperthyroidism, a subset of thyrotoxicosis, refers specifically to excess thyroid hormone synthesis and secretion by the thyroid gland. We performed a review of the literature on these topics utilizing published data in PubMed and MEDLINE. In this review, we discuss the more common etiologies of thyrotoxicosis, focusing on the current approach to diagnosis and management, new trends in those directions, and potential upcoming changes in the field.

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Thyrotropin-Secreting Pituitary Adenomas: Outcome of Pituitary Surgery and Irradiation

Cited by 81 publications

References 15 publications

High Prevalence of Radiological Vertebral Fractures in Patients With TSH-Secreting Pituitary Adenoma

High Prevalence of Radiological Vertebral Fractures in Patients With TSH-Secreting Pituitary Adenoma

TSH-secreting pituitary adenoma: late diagnosis and effectiveness of therapy

Thyrotoxicosis: Diagnosis and Management

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