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Pituitary

, Volume 22, Issue 1, pp 79–88 | Cite as

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

  • Giulia CossuEmail author
  • Roy Thomas Daniel
  • Katarzyna Pierzchala
  • Moncef Berhouma
  • Nelly Pitteloud
  • Faiza Lamine
  • Annamaria Colao
  • Mahmoud Messerer
Article

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.

Keywords

Endoscopy Pituitary adenoma SITSH Thyrotropin secreting adenoma Transsphenoidal TSH-secreting adenoma 

Notes

Compliance with ethical standards

Conflict of interest

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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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of NeurosurgeryUniversity Hospital of LausanneLausanneSwitzerland
  2. 2.Center for Biomedical ImagingEPFLLausanneSwitzerland
  3. 3.Skull Base Surgery Unit, Department of Neurosurgery B, Pierre Wertheimer Neurological and Neurosurgical HospitalHospices Civils de LyonLyonFrance
  4. 4.Department of EndocrinologyUniversity Hospital of LausanneLausanneSwitzerland
  5. 5.Department of EndocrinologyUniversity Hospital of NaplesNaplesItaly

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