Surgical treatment of thyrotropin-secreting pituitary adenomas

View More View Less
  • 1 Clinical Neurosurgery Section, Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, and Molecular, Cellular, and Nutritional Endocrinology Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

✓ Thyrotropin-secreting pituitary adenomas have been diagnosed more frequently as radiographic techniques and biochemical assays have improved; however, they remain uncommon and are unfamiliar to most neurosurgeons. This report concerns eight patients with hyperthyroidism, inappropriately elevated levels of serum thyrotropin and α-subunit, and radiographic evidence of pituitary tumor. All underwent surgery and had pathological confirmation of a thyrotropin-secreting adenoma, and most had been subjected to prior ablation of the thyroid gland. Only one tumor was a microadenoma; the others ranged in size from 1.4 to 12 cm, and invasion of parasellar structures was common. Thyrotropin, triiodothyronine, thyroxine, and α-subunit were measured preoperatively and at intervals postoperatively. Coexistent hormonal abnormalities (which occurred in all patients) included acromegaly and hyperprolactinemia and were also monitored. All four patients who had tumors less than 2 cm in diameter remain alive. Complete extirpation of tumor in these patients produced rapid correction of all hormonal abnormalities and resolution of clinical hyperthyroidism. The other four patients had larger invasive tumors: two died soon after surgery, one died of disseminated tumor 8 years after presentation, and one remains alive with residual tumor.

Tumors secreting thyroid-stimulating hormone are less easily cured by surgery than are other types of pituitary adenoma because of the large size and invasive features that many attain during the delay to diagnosis; medical therapy can subdue the tumor but not cure it. The experience with these patients establishes the importance of early diagnosis and surgical excision for successful treatment, and demonstrates the utility of modern diagnostic techniques for finding these lesions. As occurs in Nelson's syndrome after adrenalectomy for Cushing's disease, ablation of the target organ may allow the tumor to convert to a more clinically malignant form which is resistant to cure.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Address reprint requests to: Edward H. Oldfield, M.D., Room 5D37, Building 10, Clinical Neurosurgery Section, Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland 20892.
  • 1.

    Anniko M, , Tribukait B, & Werner S, et al: TSH-secreting pituitary tumor. Arch Otorhinolaryngol 238:135142, 1983 Anniko M, Tribukait B, Werner S, et al: TSH-secreting pituitary tumor. Arch Otorhinolaryngol 238:135–142, 1983

    • Search Google Scholar
    • Export Citation
  • 2.

    Balsam A, & Oppenheimer JH: Pituitary tumor with primary hypothyroidism. NY State J Med 75:17371741, 1975 Balsam A, Oppenheimer JH: Pituitary tumor with primary hypothyroidism. NY State J Med 75:1737–1741, 1975

    • Search Google Scholar
    • Export Citation
  • 3.

    Beck-Peccoz P, , Piscitelli G, & Amr S, et al: Endocrine, biochemical, and morphological studies of a pituitary adenoma secreting growth hormone, thyrotropin (TSH), and α-subunit: evidence for secretion of TSH with increased bioactivity. J Clin Endocrinol Metab 62:704711, 1986 Beck-Peccoz P, Piscitelli G, Amr S, et al: Endocrine, biochemical, and morphological studies of a pituitary adenoma secreting growth hormone, thyrotropin (TSH), and α-subunit: evidence for secretion of TSH with increased bioactivity. J Clin Endocrinol Metab 62:704–711, 1986

    • Search Google Scholar
    • Export Citation
  • 4.

    Beckers A, , Hennen G, & Reznik M, et al: Les adenomes hypophysaires a TSH. Rev Med Liege 43:396402, 1988 Beckers A, Hennen G, Reznik M, et al: Les adenomes hypophysaires a TSH. Rev Med Liege 43:396–402, 1988

    • Search Google Scholar
    • Export Citation
  • 5.

    Black PM, , Hsu DW, & Klibanski A, et al: Hormone production in clinically nonfunctioning pituitary adenomas. J Neurosurg 66:244250, 1987 Black PM, Hsu DW, Klibanski A, et al: Hormone production in clinically nonfunctioning pituitary adenomas. J Neurosurg 66:244–250, 1987

    • Search Google Scholar
    • Export Citation
  • 6.

    Comi RJ, , Gesundheit N, & Murray L, et al: Response of thyrotropin-secreting pituitary adenomas to a long-acting somatostatin analogue. N Engl J Med 317:1217, 1987 Comi RJ, Gesundheit N, Murray L, et al: Response of thyrotropin-secreting pituitary adenomas to a long-acting somatostatin analogue. N Engl J Med 317:12–17, 1987

    • Search Google Scholar
    • Export Citation
  • 7.

    Dickstein G, & Barzilai D: Hypothyroidism secondary to biologically inactive thyroid-stimulating hormone secretion by a pituitary chromophobe adenoma. Arch Intern Med 142:15441545, 1982 Dickstein G, Barzilai D: Hypothyroidism secondary to biologically inactive thyroid-stimulating hormone secretion by a pituitary chromophobe adenoma. Arch Intern Med 142:1544–1545, 1982

    • Search Google Scholar
    • Export Citation
  • 8.

    Faglia G, , Beck-Peccoz P, & Piscitelli G, et al: Inappropriate secretion of thyrotropin by the pituitary. Hormone Res 26:7999, 1987 Faglia G, Beck-Peccoz P, Piscitelli G, et al: Inappropriate secretion of thyrotropin by the pituitary. Hormone Res 26:79–99, 1987

    • Search Google Scholar
    • Export Citation
  • 9.

    Fatourechi V, , Gharib H, & Scheithauer BW, et al: Pituitary thyrotropic adenoma associated with congenital hypothyroidism. Report of two cases. Am J Med 76:725728, 1984 Fatourechi V, Gharib H, Scheithauer BW, et al: Pituitary thyrotropic adenoma associated with congenital hypothyroidism. Report of two cases. Am J Med 76:725–728, 1984

    • Search Google Scholar
    • Export Citation
  • 10.

    Furth J, & Clifton KH: Experimental pituitary tumors, in Harris GW, & Donovan BT (eds): The Pituitary Gland. Berkeley: University of California Press, 1966, Vol 2, pp 460497 Furth J, Clifton KH: Experimental pituitary tumors, in Harris GW, Donovan BT (eds): The Pituitary Gland. Berkeley: University of California Press, 1966, Vol 2, pp 460–497

    • Search Google Scholar
    • Export Citation
  • 11.

    Furth J, , Moy P, & Hershman JM, et al: Thyrotropic tumor syndrome. A multiglandular disease induced by sustained deficiency of thyroid hormones. Arch Pathol 96:217226, 1973 Furth J, Moy P, Hershman JM, et al: Thyrotropic tumor syndrome. A multiglandular disease induced by sustained deficiency of thyroid hormones. Arch Pathol 96:217–226, 1973

    • Search Google Scholar
    • Export Citation
  • 12.

    Gesundheit N, , Petrick PA, & Nissim M, et al: Of thyrotropin-secreting pituitary adenomas: clinical and biochemical heterogeneity. Ann Intern Med 111:827835, 1989 Gesundheit N, Petrick PA, Nissim M, et al: Of thyrotropin-secreting pituitary adenomas: clinical and biochemical heterogeneity. Ann Intern Med 111:827–835, 1989

    • Search Google Scholar
    • Export Citation
  • 13.

    Girod C, , Trouillas J, & Claustrat B: The human thyrotropic adenoma: pathologic diagnosis in five cases and critical review of the literature. Semin Diagn Pathol 3:5868, 1986 Girod C, Trouillas J, Claustrat B: The human thyrotropic adenoma: pathologic diagnosis in five cases and critical review of the literature. Semin Diagn Pathol 3:58–68, 1986

    • Search Google Scholar
    • Export Citation
  • 14.

    Grisoli F, , Leclercq T, & Winteler JP, et al: Thyroid-stimulating hormone pituitary adenomas and hyperthyroidism. Surg Neurol 25:361368, 1986 Grisoli F, Leclercq T, Winteler JP, et al: Thyroid-stimulating hormone pituitary adenomas and hyperthyroidism. Surg Neurol 25:361–368, 1986

    • Search Google Scholar
    • Export Citation
  • 15.

    Gup RS, , Sheeler LR, & Maeder MC, et al: Pituitary enlargement and primary hypothyroidism: a report of two cases with sharply contrasting outcomes. Neurosurgery 11:792794, 1982 Gup RS, Sheeler LR, Maeder MC, et al: Pituitary enlargement and primary hypothyroidism: a report of two cases with sharply contrasting outcomes. Neurosurgery 11:792–794, 1982

    • Search Google Scholar
    • Export Citation
  • 16.

    Halberg FE, & Sheline GE: Radiotherapy of pituitary tumors. Endocrinol Metab Clin North Am 16:667684, 1987 Halberg FE, Sheline GE: Radiotherapy of pituitary tumors. Endocrinol Metab Clin North Am 16:667–684, 1987

    • Search Google Scholar
    • Export Citation
  • 17.

    Halmi NS, & Gude WD: The morphogenesis of pituitary tumors induced by radiothyroidectomy in the mouse and the effects of their transplantation on the pituitary body of the host. Am J Pathol 30:403419, 1954 Halmi NS, Gude WD: The morphogenesis of pituitary tumors induced by radiothyroidectomy in the mouse and the effects of their transplantation on the pituitary body of the host. Am J Pathol 30:403–419, 1954

    • Search Google Scholar
    • Export Citation
  • 18.

    Heshmati HM, , Turpin G, & Kujas M, et al: The immunocytochemical heterogeneity of silent pituitary adenomas. Acta Endocrinol 118:533537, 1988 Heshmati HM, Turpin G, Kujas M, et al: The immunocytochemical heterogeneity of silent pituitary adenomas. Acta Endocrinol 118:533–537, 1988

    • Search Google Scholar
    • Export Citation
  • 19.

    Hill SA, , Falko JM, & Wilson CB, et al: Thyrotrophin-producing pituitary adenomas. J Neurosurg 57:515519, 1982 Hill SA, Falko JM, Wilson CB, et al: Thyrotrophin-producing pituitary adenomas. J Neurosurg 57:515–519, 1982

    • Search Google Scholar
    • Export Citation
  • 20.

    Horn K, , Erhardt F, & Fahlbusch R, et al: Recurrent goiter, hyperthyroidism, galactorrhea, and amenorrhea due to a thyrotropin and prolactin-producing pituitary tumor. J Clin Endocrinol Metab 43:137143, 1976 Horn K, Erhardt F, Fahlbusch R, et al: Recurrent goiter, hyperthyroidism, galactorrhea, and amenorrhea due to a thyrotropin and prolactin-producing pituitary tumor. J Clin Endocrinol Metab 43:137–143, 1976

    • Search Google Scholar
    • Export Citation
  • 21.

    Jackson JA, , Smigiel M, & Greene JF Jr: Hyperthyroidism due to a thyrotropin-secreting pituitary tumor. Henry Ford Hosp Med J 35:198200, 1987 Jackson JA, Smigiel M, Greene JF Jr: Hyperthyroidism due to a thyrotropin-secreting pituitary tumor. Henry Ford Hosp Med J 35:198–200, 1987

    • Search Google Scholar
    • Export Citation
  • 22.

    Katz MS, , Gregerman RI, & Horvath E, et al: Thyrotroph cell adenoma of the human pituitary gland associated with primary hypothyroidism: clinical and morphological features. Acta Endocrinol 95:4148, 1980 Katz MS, Gregerman RI, Horvath E, et al: Thyrotroph cell adenoma of the human pituitary gland associated with primary hypothyroidism: clinical and morphological features. Acta Endocrinol 95:41–48, 1980

    • Search Google Scholar
    • Export Citation
  • 23.

    Kellett HA, , Wyllie AH, & Dale BAB, et al: Hyperthyroidism due to a thyrotrophin-secreting microadenoma. Clin Endocrinol 19:5765, 1983 Kellett HA, Wyllie AH, Dale BAB, et al: Hyperthyroidism due to a thyrotrophin-secreting microadenoma. Clin Endocrinol 19:57–65, 1983

    • Search Google Scholar
    • Export Citation
  • 24.

    Koide Y, , Kugai N, & Kimura S, et al: A case of pituitary adenoma with possible simultaneous secretion of thyrotropin and follicle-stimulating hormone. J Clin Endocrinol Metab 54:397403, 1982 Koide Y, Kugai N, Kimura S, et al: A case of pituitary adenoma with possible simultaneous secretion of thyrotropin and follicle-stimulating hormone. J Clin Endocrinol Metab 54:397–403, 1982

    • Search Google Scholar
    • Export Citation
  • 25.

    Kourides IA, , Ridgway EC, & Weintraub BD, et al: Thyrotropin-induced hyperthyroidism: use of alpha and beta subunit levels to identify patients with pituitary tumors. J Clin Endocrinol Metab 45:534543, 1977 Kourides IA, Ridgway EC, Weintraub BD, et al: Thyrotropin-induced hyperthyroidism: use of alpha and beta subunit levels to identify patients with pituitary tumors. J Clin Endocrinol Metab 45:534–543, 1977

    • Search Google Scholar
    • Export Citation
  • 26.

    Kurisaka M, , Takei Y, , Tindall GT: [A recurrent case of TSH-PRL secreting microadenoma following hypothyroidism.]No Shinkei Geka 14:15691575, 1986 Kurisaka M, Takei Y, Tindall GT: [A recurrent case of TSH-PRL secreting microadenoma following hypothyroidism.] No Shinkei Geka 14:1569–1575, 1986 (Jpn) (Jpn)

    • Search Google Scholar
    • Export Citation
  • 27.

    Leong AS, , Chawla JC, & Teh EC: Pituitary thyrotropic tumour secondary to long-standing primary hypothyroidism. Pathol Eur 11:4955, 1976 Leong AS, Chawla JC, Teh EC: Pituitary thyrotropic tumour secondary to long-standing primary hypothyroidism. Pathol Eur 11:49–55, 1976

    • Search Google Scholar
    • Export Citation
  • 28.

    Mashiter K, , van Noorden S, & Fahlbusch R, et al: Hyperthyroidism due to a TSH secreting pituitary adenoma: case report, treatment and evidence for adenoma TSH by morphological and cell culture studies. Clin Endocrinol 18:472483, 1983 Mashiter K, van Noorden S, Fahlbusch R, et al: Hyperthyroidism due to a TSH secreting pituitary adenoma: case report, treatment and evidence for adenoma TSH by morphological and cell culture studies. Clin Endocrinol 18:472–483, 1983

    • Search Google Scholar
    • Export Citation
  • 29.

    Nelson DH, , Meakin JW, & Thorn GW: ACTH-producing pituitary tumors following adrenalectomy for Cushing's syndrome. Ann Intern Med 52:560569, 1960 Nelson DH, Meakin JW, Thorn GW: ACTH-producing pituitary tumors following adrenalectomy for Cushing's syndrome. Ann Intern Med 52:560–569, 1960

    • Search Google Scholar
    • Export Citation
  • 30.

    Pioro EP, , Scheithauer BW, & Laws ER Jr, et al: Combined thyrotroph and lactotroph cell hyperplasia simulating prolactin-secreting pituitary adenoma in long-standing primary hypothyroidism. Surg Neurol 29:218226, 1988 Pioro EP, Scheithauer BW, Laws ER Jr, et al: Combined thyrotroph and lactotroph cell hyperplasia simulating prolactin-secreting pituitary adenoma in long-standing primary hypothyroidism. Surg Neurol 29:218–226, 1988

    • Search Google Scholar
    • Export Citation
  • 31.

    Pita JC Jr, , Shafey S, & Pina R: Diminution of large pituitary tumor after replacement therapy for primary hypothyroidism. Neurology 29:11691172, 1979 Pita JC Jr, Shafey S, Pina R: Diminution of large pituitary tumor after replacement therapy for primary hypothyroidism. Neurology 29:1169–1172, 1979

    • Search Google Scholar
    • Export Citation
  • 32.

    Saeger W, & Lüdecke DK: Pituitary adenomas with hyper-function of TSH. Frequency, histological classification, immunohistochemistry and ultrastructure. Virchows Arch 394:255267, 1982 Saeger W, Lüdecke DK: Pituitary adenomas with hyper-function of TSH. Frequency, histological classification, immunohistochemistry and ultrastructure. Virchows Arch 394:255–267, 1982

    • Search Google Scholar
    • Export Citation
  • 33.

    Samaan NA, , Osborne BM, & Mackay B, et al: Endocrine and morphologic studies of pituitary adenomas secondary to primary hypothyroidism. J Clin Endocrinol Metab 45:903911, 1977 Samaan NA, Osborne BM, Mackay B, et al: Endocrine and morphologic studies of pituitary adenomas secondary to primary hypothyroidism. J Clin Endocrinol Metab 45:903–911, 1977

    • Search Google Scholar
    • Export Citation
  • 34.

    Scanlon MF, , Howells S, & Peters JR, et al: Hyperprolactinaemia, amenorrhoea and galactorrhoea due to a pituitary thyrotroph adenoma. Clin Endocrinol 23:3542, 1985 Scanlon MF, Howells S, Peters JR, et al: Hyperprolactinaemia, amenorrhoea and galactorrhoea due to a pituitary thyrotroph adenoma. Clin Endocrinol 23:35–42, 1985

    • Search Google Scholar
    • Export Citation
  • 35.

    Scheithauer BW, , Horvath E, & Kovacs K, et al: Plurihormonal pituitary adenomas. Semin Diagn Pathol 3:6982, 1986 Scheithauer BW, Horvath E, Kovacs K, et al: Plurihormonal pituitary adenomas. Semin Diagn Pathol 3:69–82, 1986

    • Search Google Scholar
    • Export Citation
  • 36.

    Scheithauer BW, , Kovacs K, & Randall RV, et al: Pituitary gland in hypothyroidism: histologic and immunocytologic study. Arch Pathol Lab Med 109:499504, 1985 Scheithauer BW, Kovacs K, Randall RV, et al: Pituitary gland in hypothyroidism: histologic and immunocytologic study. Arch Pathol Lab Med 109:499–504, 1985

    • Search Google Scholar
    • Export Citation
  • 37.

    Smallridge RC: Thyrotropin-secreting pituitary tumors. Endocrinol Metab Clin North Am 16:765792, 1987 Smallridge RC: Thyrotropin-secreting pituitary tumors. Endocrinol Metab Clin North Am 16:765–792, 1987

    • Search Google Scholar
    • Export Citation
  • 38.

    Stockigt JR, , Essex WB, & West RH, et al: Visual failure during replacement therapy in primary hypothyroidism with pituitary enlargement. J Clin Endocrinol Metab 43:10941100, 1976 Stockigt JR, Essex WB, West RH, et al: Visual failure during replacement therapy in primary hypothyroidism with pituitary enlargement. J Clin Endocrinol Metab 43:1094–1100, 1976

    • Search Google Scholar
    • Export Citation
  • 39.

    Tucker HSG, , Grubb SR, & Wigand JP, et al: Transsphenoidal removal of pituitary tumors: experience with 167 patients. Va Med 109:164170, 1982 Tucker HSG, Grubb SR, Wigand JP, et al: Transsphenoidal removal of pituitary tumors: experience with 167 patients. Va Med 109:164–170, 1982

    • Search Google Scholar
    • Export Citation
  • 40.

    Wajchenberg BL, , Tsanaclis AMC, & Marino R Jr: TSH-containing pituitary adenoma associated with primary hypothyroidism manifested by amenorrhoea and galactorrhoea. Acta Endocrinol 106:6166, 1984 Wajchenberg BL, Tsanaclis AMC, Marino R Jr: TSH-containing pituitary adenoma associated with primary hypothyroidism manifested by amenorrhoea and galactorrhoea. Acta Endocrinol 106:61–66, 1984

    • Search Google Scholar
    • Export Citation
  • 41.

    Warnet A, , Timsit J, & Chanson P, et al: The effect of somatostatin analogue on chiasmal dysfunction from pituitary macroadenomas. J Neurosurg 71:687690, 1989 Warnet A, Timsit J, Chanson P, et al: The effect of somatostatin analogue on chiasmal dysfunction from pituitary macroadenomas. J Neurosurg 71:687–690, 1989

    • Search Google Scholar
    • Export Citation
  • 42.

    Weintraub BD, , Gershengorn MC, & Kourides IA, et al: Inappropriate secretion of thyroid-stimulating hormone. Ann Intern Med 95:339351, 1981 Weintraub BD, Gershengorn MC, Kourides IA, et al: Inappropriate secretion of thyroid-stimulating hormone. Ann Intern Med 95:339–351, 1981

    • Search Google Scholar
    • Export Citation
  • 43.

    Wémeau JL, , Dewailly D, & Leroy R, et al: Long-term treatment with the somatostatin analog SMS 201–995 in a patient with a thyrotropin- and growth hormone-secreting pituitary adenoma. J Clin Endocrinol Metab 66:636639, 1988 Wémeau JL, Dewailly D, Leroy R, et al: Long-term treatment with the somatostatin analog SMS 201–995 in a patient with a thyrotropin- and growth hormone-secreting pituitary adenoma. J Clin Endocrinol Metab 66:636–639, 1988

    • Search Google Scholar
    • Export Citation
  • 44.

    Wilson CB: A decade of pituitary microsurgery. The Herbert Olivecrona Lecture. J Neurosurg 61:814833, 1984 Wilson CB: A decade of pituitary microsurgery. The Herbert Olivecrona Lecture. J Neurosurg 61:814–833, 1984

    • Search Google Scholar
    • Export Citation
  • 45.

    Yamada T, , Tsukui T, & Ikejiri K, et al: Volume of sella turcica in normal subjects and in patients with primary hypothyroidism and hyperthyroidism. J Clin Endocrinol Metab 42:817822, 1976 Yamada T, Tsukui T, Ikejiri K, et al: Volume of sella turcica in normal subjects and in patients with primary hypothyroidism and hyperthyroidism. J Clin Endocrinol Metab 42:817–822, 1976

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 588 151 7
Full Text Views 225 6 0
PDF Downloads 80 5 1
EPUB Downloads 0 0 0