Abstract
Purpose
This study aims to analyze the clinicopathological features, diagnostic steps, and therapeutic results of TSHomas and to reveal the effective factors on remission.
Methods
The clinical, radiological, and pathological features and surgical and endocrinological results of 41 TSHoma cases followed between 2005 and 2022 were retrospectively analyzed. The factors affecting the surgical cure were investigated by comparing the groups with and without remission.
Results
A total of 41 patients (23 male,18 female) were included in the study and the mean age was 42 (31.5–49). Palpitation and headache were the most common complaints. The time from the onset of symptoms to diagnosis was 8 (3–20) months. There were 8 patients with a preoperative clinical and biochemical diagnosis of TSH + GH co-secretion. In the TRH stimulation test, a blunted TSH response was obtained in 18 patients (90.0%). Complete suppression could not be obtained in any of the patients who underwent the T3 suppression test. The median maximum tumor diameter was 19.0 mm (6.8–41). There was microadenoma in 4 (9.8%) patients and macroadenoma in 37 patients (92.8%). Remission was achieved in 31 (75.6%) of 40 patients who underwent endoscopic transsphenoidal surgery (eTSS). The Ki-67 labeling index was 2% (1.00–4.00) in the entire patient group. Preoperative use of antithyroid drugs appears to be significantly associated with surgical cure.
Conclusion
Diagnosis of TSHoma is still full of challenges and dynamic tests remain important. Recognition and good management of inappropriate TSH secretion states affect subsequent surgical outcomes.
Similar content being viewed by others
Data availability
The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.
References
A. Tjörnstrand, K. Gunnarsson, M. Evert, E. Holmberg, O. Ragnarsson, T. Rosén et al. The incidence rate of pituitary adenomas in western Sweden for the period 2001–2011. Eur. J. Endocrinol. 171, 519–526 (2014). https://doi.org/10.1530/EJE-14-0144
L. Önnestam, K. Berinder, P. Burman, P. Dahlqvist, B.E. Engström, J. Wahlberg et al. National incidence and prevalence of TSH-secreting pituitary adenomas in Sweden. J. Clin. Endocrinol. Metab. 98, 626–635 (2013). https://doi.org/10.1210/JC.2012-3362
G. Cossu, R.T. Daniel, K. Pierzchala, M. Berhouma, N. Pitteloud, F. Lamine 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/FIGURES/6
Luo P., Zhang L., Yang L., An Z., Tan H. (2020). Progress in the pathogenesis, diagnosis, and treatment of TSH-secreting pituitary neuroendocrine tumor. Front. Endocrinol. (Lausanne). 11 https://doi.org/10.3389/FENDO.2020.580264.
P. Beck-Peccoz, C. Giavoli, A. Lania, A 2019 update on TSH-secreting pituitary adenomas. J. Endocrinol. Invest. 42, 1401–1406 (2019). https://doi.org/10.1007/S40618-019-01066-X/TABLES/2
S. Yamada, N. Fukuhara, K. Horiguchi, M. Yamaguchi-Okada, H. Nishioka, A. Takeshita et al. Clinicopathological characteristics and therapeutic outcomes in thyrotropin-secreting pituitary adenomas: a single-center study of 90 cases: clinical article. J. Neurosurg. 121, 1462–1473 (2014). https://doi.org/10.3171/2014.7.JNS1471
N.C. Van Varsseveld, P.H.L.T. Bisschop, N.R. Biermasz, A.M. Pereira, E. Fliers, M.L. Drent, A long-term follow-up study of eighteen patients with thyrotrophin-secreting pituitary adenomas. Clin. Endocrinol. 80, 395–402 (2014). https://doi.org/10.1111/CEN.12290
H.E. Sen, E.C. Ceylan, S. Atayev, M. Sozen, B.Y. Bayrak, B. Cetinarslan et al. The endoscopic endonasal transsphenoidal approach for thyrotropin-secreting pituitary adenomas: single-center experience and clinical outcomes of 49 patients. World Neurosurg. 167, e1275–e1283 (2022)
A. Tjörnstrand, H.F. Nyström, DIAGNOSIS OF ENDOCRINE DISEASE: Diagnostic approach to TSH-producing pituitary adenoma. Eur. J .Endocrinol. 177, R183–R197 (2017). https://doi.org/10.1530/EJE-16-1029
P. Beck-Peccoz, F. Brucker-Davis, L. Persani, R.C. Smallridge, B.D. Weintraub, Thyrotropin-secreting pituitary tumors. Endocr. Rev. 17, 610–638 (1996). https://doi.org/10.1210/EDRV-17-6-610
V. Socin, P. Chanson, B. Delemer, A. Tabarin, V. Rohmer, J. Mockel et al. The changing spectrum of TSH-secreting pituitary adenomas: diagnosis and management in 43 patients. Eur. J. Endocrinol. 148, 433–442 (2023). www.eje.org. Accessed 25 Jan 2023
L. Katznelson, E.R. Laws, S. Melmed, M.E. Molitch, M.H. Murad, A. Utz et al. Acromegaly: an endocrine society clinical practice guideline. J. Clin. Endocrinol. Metab. 99, 3933–3951 (2014). https://doi.org/10.1210/JC.2014-2700
E. Knosp, E. Steiner, K. Kitz, C. Matula, Pituitary adenomas with invasion of the cavernous sinus space: a magnetic resonance imaging classification compared with surgical findings. Neurosurgery 33, 610–617 (1993). https://doi.org/10.1227/00006123-199310000-00008. discussion 617
F. Gatto, L.F. Grasso, E. Nazzari, T. Cuny, P. Anania, C. Di Somma et al. Clinical outcome and evidence of high rate post-surgical anterior hypopituitarism in a cohort of TSH-secreting adenoma patients: might somatostatin analogs have a role as first-line therapy? Pituitary. 18, 583–591 (2015). https://doi.org/10.1007/S11102-014-0611-8/TABLES/2
O.M. Căpraru, C. Gaillard, A. Vasiljevic, H. Lasolle, F. Borson-Chazot, V. Raverot et al. Diagnosis, pathology, and management of TSH-secreting pituitary tumors.a single-center retrospective study of 20 patients from 1981 to 2014. Ann. Endocrinol. (Paris). 80, 216–224 (2019)
P. Beck Peccoz, R. Roncoroni, S. Mariotti, G. Medri, C. Marcocci, G. Brabant et al. Sex hormone-binding globulin measurement in patients with inappropriate secretion of thyrotropin (IST): Evidence against selective pituitary thyroid hormone resistance in nonneoplastic IST. J. Clin. Endocrinol. Metab. 71, 19–25 (1990)
N. Sanno, A. Teramoto, R.Y. Osamura, Long-term surgical outcome in 16 patients with thyrotropin pituitary adenoma. J. Neurosurg. 93, 194–200 (2000)
S.H. Kim, C.R. Ku, M. Na, J. Yoo, W. Kim, I.H. Jung et al. Immediate postoperative measurement of thyroid-stimulating hormone as an early predictor of remission in thyroid-stimulating hormone–secreting pituitary adenomas. J. Neurosurg. 1 (aop), 1–7 (2020). https://doi.org/10.3171/2020.1.JNS192787
E. Malchiodi, E. Profka, E. Ferrante, E. Sala, E. Verrua, I. Campi et al. Thyrotropin-secreting pituitary adenomas: outcome of pituitary surgery and irradiation. J. Clin. Endocrinol. Metab. 99, 2069–2076 (2014). https://doi.org/10.1210/JC.2013-4376
Funding
This project was supported by Kocaeli University Scientific Research Projects Coordination Unit with project number 2756.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare no competing interests.
Ethics approval and consent to participate
This study was approved by Kocaeli University Non-Interventional Clinical Research Ethics Committee with project number 2021/271.
Additional information
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Sözen, M., Bayrak, B.Y., Selek, A. et al. A reference center study in thyrotropin-secreting pituitary adenomas: clinicopathological, therapeutic and long-term follow-up outcomes. Endocrine 82, 622–630 (2023). https://doi.org/10.1007/s12020-023-03480-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12020-023-03480-x