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Thyrotropin-secreting pituitary adenomas: a systematic review and meta-analysis of postoperative outcomes and management

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Abstract

Purpose

TSH-secreting pituitary adenomas are rare pituitary tumors. An efficient treatment is essential to limit the mortality and morbidity in untreated patients. The aim of this study is to summarize the evidence about the postoperative outcomes and management of this rare pathology.

Methods

A systematic search and meta-analysis of surgical series was performed.

Results

Our analysis included 23 articles (536 patients). No sex difference was observed and mean age at diagnosis was 45 years. Hyperthyroidism was reportedly clinical in 67% and biochemical in 90% of patients. Co-secretion of other pituitary hormones was present in 42% of cases. Macroadenomas were found in 79% of patients, showing in 44% and 30% of cases respectively extrasellar extension and cavernous sinus invasion. The pooled rate of postoperative biochemical remission was 69.7% and a gross total resection (GTR) was observed in 54% of patients. The extent of resection was significantly increased in microadenomas (p < 0.001) and cavernous sinus invasion was predictive of lower GTR rate (p < 0.001). A biochemical remission was achieved in 66% of patients after adjuvant radiation therapy and in 76% after adjuvant medical treatment. The combination of both allowed remission in 67% of cases. At final follow-up the overall biochemical remission rate was significantly improved (85.8%) when compared to the postoperative biochemical remission (p < 0.001).

Conclusion

When compared to the early postoperative period, at last follow-up biochemical remission was significantly greater (p < 0.001). GTR was achieved in half of patients; the size of tumor and cavernous sinus invasion determined the extent of resection.

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Authors and Affiliations

  1. Department of Neurosurgery, University Hospital of Lausanne, Lausanne, Switzerland

    Giulia Cossu, Roy Thomas Daniel & Mahmoud Messerer

  2. Center for Biomedical Imaging, EPFL, Lausanne, Switzerland

    Katarzyna Pierzchala

  3. Skull Base Surgery Unit, Department of Neurosurgery B, Pierre Wertheimer Neurological and Neurosurgical Hospital, Hospices Civils de Lyon, Lyon, France

    Moncef Berhouma

  4. Department of Endocrinology, University Hospital of Lausanne, Lausanne, Switzerland

    Nelly Pitteloud & Faiza Lamine

  5. Department of Endocrinology, University Hospital of Naples, Naples, Italy

    Annamaria Colao

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  1. Giulia Cossu
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  2. Roy Thomas Daniel
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  3. Katarzyna Pierzchala
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  4. Moncef Berhouma
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  8. Mahmoud Messerer
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Correspondence to Giulia Cossu.

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The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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Cossu, G., Daniel, R.T., Pierzchala, K. et al. Thyrotropin-secreting pituitary adenomas: a systematic review and meta-analysis of postoperative outcomes and management. Pituitary 22, 79–88 (2019). https://doi.org/10.1007/s11102-018-0921-3

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