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Comprehensive evaluation of thyrotropinomas: single-center 20-year experience

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Abstract

Purpose

To present a single-center 20-year experience with operated thyrotropinomas, including prevalence, clinical, biochemical and histological characteristics, and postoperative outcomes.

Methods

Retrospective series of histopathologically-proven thyrotropinomas (1993–2013), divided in two groups: A (active, central hyperthyroidism) and B (silent, no hyperthyroidism).

Results

Of 1628 operated pituitary adenomas, 20 were β-TSH-positive (1.2 %). In increments of 5 years, proportion of thyrotropinomas was 1, 1, 0.04 and 1.77 % respectively. Median follow-up was 10.4 months (1.2–150). Group A: 6 patients (5 men), age 41 ± 12 years presented with hyperthyroidism (3), pituitary incidentaloma (2) and acromegaly (1). Tumor diameter was 2.1 ± 1.2 cm, FT4 2.68 ± 2.73 ng/dL; TSH 6.50 ± 3.68 µIU/mL. Glycoprotein alpha subunit (GSU) was uniformly elevated. Two patients had biochemical evidence of acromegaly. Tumors were plurihormonal (5 GH-positive); none atypical. Postoperative euthyroidism was achieved in 4 of 6 patients (66 %). Group B: 14 patients (7 men), age 47 ± 14 years presented with acromegaly (6), mass effect (4), incidentaloma (3) and galactorrhea (1). Tumor diameter was 2.0 ± 1.0 cm. Free T4 (1.00 ± 0.24 ng/dL) and TSH (2.02 ± 1.65 mIU/L) were lower than in group A (p < 0.01). GSU was elevated in all tested cases. Nine patients had biochemical evidence of acromegaly. Tumors were plurihormonal (12 GH-positive); none atypical. Gross total resection was achieved in 12 of 14 (86 %), and 1 (7 %) recurred.

Conclusion

In our series, more thyrotropinomas were operated in recent years. These tumors were often plurihormonal with heterogenous clinical presentation and frequent GH co-secretion. Surgical outcomes were good but long-term follow up is necessary.

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Acknowledgments

Emilee Wehunt, research coordinator.

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Authors and Affiliations

  1. Division of Endocrinology and Metabolism, Department of Medicine and Neurosurgery, Emory Pituitary Center, Emory University School of Medicine, 1365 B Clifton Rd., NE, B6209, Atlanta, GA, 30322, USA

    Alice Azzalin, Tina Constantin, Nelson M. Oyesiku & Adriana G. Ioachimescu

  2. Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA

    Christina L. Appin, Matthew J. Schniederjan & James C. Ritchie

  3. Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA

    Nelson M. Oyesiku & Adriana G. Ioachimescu

  4. Department of Pathology, Children’s Healthcare of Atlanta, Atlanta, GA, USA

    Matthew J. Schniederjan

  5. Baptist Health South Florida, Miami, FL, USA

    Emir Veledar

Authors
  1. Alice Azzalin
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  2. Christina L. Appin
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  3. Matthew J. Schniederjan
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  4. Tina Constantin
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  5. James C. Ritchie
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  6. Emir Veledar
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  7. Nelson M. Oyesiku
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  8. Adriana G. Ioachimescu
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Correspondence to Adriana G. Ioachimescu.

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Azzalin, A., Appin, C.L., Schniederjan, M.J. et al. Comprehensive evaluation of thyrotropinomas: single-center 20-year experience. Pituitary 19, 183–193 (2016). https://doi.org/10.1007/s11102-015-0697-7

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  • DOI: https://doi.org/10.1007/s11102-015-0697-7

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