Thyroid-stimulating hormone pituitary adenomas

Restricted access

Object

Thyroid-stimulating hormone (TSH)–secreting pituitary adenomas are rare, representing < 2% of all pituitary adenomas.

Methods

The authors conducted a retrospective analysis of patients with TSH-secreting or clinically silent TSH-immunostaining pituitary tumors among all pituitary adenomas followed at their institution between 1987 and 2003. Patient records, including clinical, imaging, and pathological and surgical characteristics were reviewed. Twenty-one patients (6 women and 15 men; mean age 46 years, range 26–73 years) were identified. Of these, 10 patients had a history of clinical hyperthyroidism, of whom 7 had undergone ablative thyroid procedures (thyroid surgery/131I ablation) prior to the diagnosis of pituitary adenoma. Ten patients had elevated TSH preoperatively. Seven patients presented with headache, and 8 presented with visual field defects. All patients underwent imaging, of which 19 were available for imaging review. Sixteen patients had macroadenomas.

Results

Of the 21 patients, 18 underwent transsphenoidal surgery at the authors' institution, 2 patients underwent transsphenoidal surgery at another facility, and 1 was treated medically. Patients with TSH-secreting tumors were defined as in remission after surgery if they had no residual adenoma on imaging and had biochemical evidence of hypo-or euthyroidism. Patients with TSH-immunostaining tumors were considered in remission if they had no residual tumor. Of these 18 patients, 9 (50%) were in remission following surgery. Seven patients had residual tumor; 2 of these patients underwent further transsphenoidal resection, 1 underwent a craniotomy, and 4 underwent postoperative radiation therapy (2 conventional radiation therapy, 1 Gamma Knife surgery, and 1 had both types of radiation treatment). Two patients had persistently elevated TSH levels despite the lack of evidence of residual tumor. On pathological analysis and immunostaining of the surgical specimen, 17 patients had samples that stained positively for TSH, 8 for α-subunit, 10 for growth hormone, 7 for prolactin, 2 for adrenocorticotrophic hormone, and 1 for follicle-stimulating hormone/luteinizing hormone. Eleven patients (61%) ultimately required thyroid hormone replacement therapy, and 5 (24%) required additional pituitary hormone replacement. Of these, 2 patients required treatment for new anterior pituitary dysfunction as a complication of surgery, and 2 patients with preoperative partial anterior pituitary dysfunction developed complete panhypopituitarism. One patient had transient diabetes insipidus. The remainder had no change in pituitary function from their preoperative state.

Conclusions

Thyroid-stimulating hormone–secreting pituitary lesions are often delayed in diagnosis, are frequently macroadenomas and plurihormonal in terms of their pathological characteristics, have a heterogeneous clinical picture, and are difficult to treat. An experienced team approach will optimize results in the management of these uncommon lesions.

Abbreviations used in this paper: ACTH = adrenocorticotrophic hormone; FSH = follicle-stimulating hormone; GH = growth hormone; LH = luteinizing hormone; PRL = prolactin; TRH = thyrotropin-releasing hormone; TSH = thyroid-stimulating hormone.

Article Information

Address correspondence to: Michelle J. Clarke, M.D., Department of Neurosurgery, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55906. email: Clarke.michelle@mayo.edu.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Flow diagram of imaging and biochemical outcomes following surgery in 14 patients with TSH-secreting adenomas. N = number of patients; OSH = outside hospital; RT = radiotherapy.

  • View in gallery

    Magnetic resonance images of a TSH-secreting pituitary adenoma obtained preoperatively (left) and postoperatively (right) following transsphenoidal resection.

References

  • 1

    Beck-Peccoz PBrucker-Davis FPersani LSmallridge RCWeintraub BD: Thyrotropin-secreting pituitary tumors. Endocr Rev 17:6106381996

  • 2

    Beck-Peccoz PPersani L: Medical management of thyrotropin-secreting pituitary adenomas. Pituitary 5:83882002

  • 3

    Bertholon-Grégoire MTrouillas JGuigard MPLoras BTour-niaire J: Mono- and plurihormonal thyrotropic pituitary adenomas: pathological, hormonal and clinical studies in 12 patients. Eur J Endocrinol 140:5195271999

  • 4

    Brucker-Davis FOldfield EHSkarulis MCDoppman JLWeintraub BD: Thyrotropin-secreting pituitary tumors: diagnostic criteria, thyroid hormone sensitivity, and treatment outcome in 25 patients followed at the National Institutes of Health. J Clin Endocrinol Metab 84:4764861999

  • 5

    Dhillon KSCohan PKelly DFDarwin CHIyer KVChopra IJ: Treatment of hyperthyroidism associated with thyrotropin-secreting pituitary adenomas with iopanoic acid. J Clin Endocrinol Metab 89:7087112004

  • 6

    Laws ERVance MLJane JA: TSH adenomas. Pituitary 9:3133152006

  • 7

    Ness-Abramof RIshay AHarel GSylvetsky NBaron EGreen-man Y: TSH-secreting pituitary adenomas: follow-up of 11 cases and review of the literature. Pituitary 10:3073102007

  • 8

    Orrego JJBarkan AL: Pituitary disorders: drug treatment options. Drugs 59:931062000

  • 9

    Sanno NTeramoto AOsamura RY: Long-term surgical outcome in 16 patients with thyrotropin pituitary adenoma. J Neurosurg 93:1942002000

  • 10

    Sanno NTeramoto AOsamura RY: Thyrotropin-secreting pituitary adenomas. Clinical and biological heterogeneity and current treatment. J Neurooncol 54:1791862001

  • 11

    Sanno NTeramoto AOsamura RYHorvath EKovacs KLloyd RV: Pathology of pituitary tumors. Neurosurg Clin N Am 14:25392003

  • 12

    Sarlis NJGourgiotis LKoch CASkarulis MCBrucker-Davis FOldfield EH: MR Imaging features of thyrotropin-secreting pituitary adenomas at initial presentation. AJR Am J Roentgenol 181:5775822003

  • 13

    Socin HVChanson PDelemer BTabarin ARohmer VMockel J: The changing spectrum of TSH-secreting pituitary adenomas: diagnosis and management in 43 patients. Eur J Endocrinol 148:4334422003

  • 14

    Teramoto ASanno NTahara SOsamura YR: Pathological studies of thyrotropin-secreting pituitary adenoma: plurihormonality and medical treatment. Acta Neuropathol 108:1471532004

  • 15

    Wu YYChang HYLin JDChen KWHuang YYJung SM: Clinical characteristics of patients with thyrotropin-secreting pituitary adenoma. J Formos Med Assoc 102:1641712003

TrendMD

Cited By

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 173 173 20
Full Text Views 234 234 2
PDF Downloads 107 107 1
EPUB Downloads 0 0 0

PubMed

Google Scholar