Skip to main content
SpringerLink
Log in

Gamma knife radiosurgery is effective in patients with thyrotropin-secreting pituitary adenomas

  • Original Article
  • Published:
Journal of Endocrinological Investigation Aims and scope Submit manuscript

Abstract

Purpose

Thyrotropin (TSH)-secreting pituitary adenoma (TSHoma) is a rare cause of TSH-dependent hyperthyroidism. The first therapeutic option is surgery. Medical treatment with somatostatin analogs is also effective. To obviate the need for lifelong drug therapy, gamma knife radiosurgery (GKRS) might be considered in selected patients. We report the largest series of patients with TSHoma treated by GKRS at a single center.

Methods

This study was a retrospective analysis of 18 consecutive patients with TSHoma treated by GKRS between 1994 and 2022. Normalization of hyperthyroidism, when present at the time of surgery, and control of tumor growth were the main outcomes of the study.

Results

The median follow-up after GKRS treatment was 114 months (IQR, 57–213 months; range 17–285 months). No patients had growth of the residual tumor after GKRS. Remission of hyperthyroidism occurred in 9 of the 11 (81.8%) patients who were hyperthyroid before GKRS. The probability of hyperthyroidism remission three years after GKRS was 59.1% (95% CI 27.9–90.3%). No major side effects occurred after GKRS. One patient out of the 15 patients (6.7%) with normal baseline adrenal function and follow-up longer than 3 years developed new onset hypoadrenalism, while hypogonadism did not occur in the 13 patients with baseline normal function.

Conclusion

Our study shows that GKRS is an effective and safe adjuvant treatment for selected patients with residual or recurring TSHoma. The option of GKRS as an alternative treatment to lifelong medical treatment with somatostatin analogs should be thoroughly discussed with the patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1 
Fig. 2

Similar content being viewed by others

References

  1. Beck-Peccoz P, Brucker-Davis F, Persani L, Smallridge RC, Weintraub BD (1995) Thyrotropin-secreting pituitary tumors. Endocr Rev 17(6):610–638. https://doi.org/10.1210/edrv-17-6-610

    Article  Google Scholar 

  2. Amlashi FG, Tritos NA (2016) Thyrotropin-secreting pituitary adenomas: epidemiology, diagnosis, and management. Endocrine 52(3):427–440. https://doi.org/10.1007/s12020-016-0863-3

    Article  CAS  PubMed  Google Scholar 

  3. Tjörnstrand A, Nyström HF (2017) Diagnosis of endocrine disease: diagnostic approach to TSH-producing pituitary adenoma. Eur J Endocrinol 177(4):R183–R197. https://doi.org/10.1530/EJE-16-1029

    Article  PubMed  Google Scholar 

  4. Beck-Peccoz P, Lania A, Beckers A, Chatterjee K, Wemeau JL (2013) European thyroid association guidelines for the diagnosis and treatment of thyrotropin-secreting pituitary tumors. Eur Thyroid J 2(2):76–82. https://doi.org/10.1159/000351007

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Losa M, Giovanelli M, Persani L, Mortini P, Faglia G, Beck-Peccoz P (1996) Criteria of cure and follow-up of central hyperthyroidism due to thyrotropin-secreting pituitary adenomas. J Clin Endocrinol Metab 81(8):3086–3090. https://doi.org/10.1210/jcem.81.8.8768879

    Article  Google Scholar 

  6. Brucker-Davis F, Oldfield EH, Skarulis MC, Doppman JL, Weintraub BD (1999) Thyrotropin secreting pituitary tumors: diagnostic criteria, thyroid hormone sensitivity, and treatment outcome in 25 patients followed at the National Institutes of Health. J Clin EndocrinolMetab 84(2):476–486. https://doi.org/10.1210/jcem.84.2.5505

    Article  CAS  Google Scholar 

  7. Socin HV, Chanson P, Delemer B, Tabarin A, Rohmer V, Mockel J, Stevenaert A, Beckers A (2003) The changing spectrum of TSH-secreting pituitary adenomas: diagnosis and management in 43 patients. Eur J Endocrinol 148(4):433–442. https://doi.org/10.1530/eje.0.1480433

    Article  CAS  PubMed  Google Scholar 

  8. Ónnestam L, Berinder K, Burman P, Dahlqvist P, Engström BE, Wahlberg J, Nyström HF (2013) National incidence and prevalence of TSH secreting pituitary adenomas in Sweden. J Clin Endocrinol Metab 98(2):626–635. https://doi.org/10.1210/jc.2012-3362

    Article  CAS  PubMed  Google Scholar 

  9. Malchiodi E, Profka E, Ferrante E, Sala E, Verrua E, Campi I, Lania AG, Arosio M, Locatelli M, Mortini P, Losa M, Motti E, Beck-Peccoz P, Spada A, Mantovani G (2014) Thyrotropin-secreting pituitary adenomas: outcome of pituitary surgery and irradiation. J Clin Endocrinol Metab 99(6):2069–2076. https://doi.org/10.1210/jc.2013-4376

    Article  CAS  PubMed  Google Scholar 

  10. Chanson P, Weintraub BD, Harris AG (1993) Octreotide therapy for thyroid-stimulating hormone-secreting pituitary adenomas. A follow-up of 52 patients. Ann Intern Med 119(3):236–240. https://doi.org/10.7326/0003-4819-119-3-199308010-00010

    Article  CAS  PubMed  Google Scholar 

  11. Rimareix F, Grunenwald S, Vezzosi D, Riviere LD, Bennet A, Caron P (2015) Primary medical treatment of thyrotropin-secreting pituitary adenomas by first-generation somatostatin analogs: a case study of seven patients. Thyroid 25(8):877–882. https://doi.org/10.1089/thy.2015.0041

    Article  CAS  PubMed  Google Scholar 

  12. Fliers E, van Furth WR, Bisschop PH (2012) Cure of a thyrotrophin (TSH)-secreting pituitary adenoma by medical therapy. Clin Endocrinol (Oxf) 77(5):788–790

    Article  PubMed  Google Scholar 

  13. Albano L, Losa M, Barzaghi LR, Niranjan A, Siddiqui Z, Flickinger JC, Lunsford LD, Mortini P (2021) Gamma knife radiosurgery for pituitary tumors: a systematic review and meta-analysis. Cancers (Basel) 13(19):4998. https://doi.org/10.3390/cancers13194998

    Article  PubMed  Google Scholar 

  14. Losa M, Spatola G, Albano L, Gandolfi A, Del Vecchio A, Bolognesi A, Mortini P (2017) Frequency, pattern, and outcome of recurrences after gamma knife radiosurgery for pituitary adenomas. Endocrine 56(3):595–602. https://doi.org/10.1007/s12020-016-1081-8

    Article  CAS  PubMed  Google Scholar 

  15. Cozzi R, Lasio G, Cardia A, Felisati G, Montini M, Attanasio R (2009) Perioperative cortisol can predict hypothalamus-pituitary-adrenal status in clinically non-functioning pituitary adenomas. J Endocrinol Invest 32(5):460–464. https://doi.org/10.1007/BF03346486

    Article  CAS  PubMed  Google Scholar 

  16. Michaelidou M, Yadegarfar G, Morris L, Dolan S, Robinson A, Naseem A, Livingston M, Duff CJ, Trainer P, Fryer AA, Heald AH (2021) Recalibration of thinking about adrenocortical function assessment: how the “random” cortisol relates to the short synacthen test results. Cardiovasc Endocrinol Metab 10(2):137–145. https://doi.org/10.1097/XCE.0000000000000250

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Ohki M, Sato K, Tuchiya D, Sato S, Saito S, Kinjo T, Kayama T, Jokura H, Yoshimoto T (1999) A case of TSH-secreting pituitary adenoma associated with an unruptured aneurysm: successful treatment by two stage operation and gamma-knife. No To Shinkei 51(10):895–899

    CAS  PubMed  Google Scholar 

  18. Kon YC, Loh KC, Tambyah JA, Lim LH, Marshall JC (2001) Thyrotrophin (TSH)-secreting pituitary macroadenoma with cavernous sinus invasion. Singap Med J 42(9):433–437

    CAS  Google Scholar 

  19. Kasliwal M, Gupta A, Sharma M (2012) Single low dose adjuvant Gamma knife radiosurgery for thyrotropin secreting pituitary adenoma. Acta Neurochir (Wien) 154(4):665–666. https://doi.org/10.1007/s00701-012-1284-6

    Article  PubMed  Google Scholar 

  20. Mouslech Z, Somali M, Sakali AK, Savopoulos C, Mastorakos G, Hatzitolios AI (2016) TSH-secreting pituitary adenomas treated by gamma knife radiosurgery: our case experience and a review of the literature. Hormones (Athens) 15(1):122–128. https://doi.org/10.14310/horm.2002.1640

    Article  PubMed  Google Scholar 

  21. Losa M, Mortini P, Franzin A, Barzaghi R, Mandelli C, Giovanelli M (1999) Surgical management of thyrotropin secreting pituitary adenomas. Pituitary 2(2):127–131. https://doi.org/10.1023/a:1009987530852

    Article  CAS  PubMed  Google Scholar 

  22. Clarke MJ, Erickson D, Castro MR, Atkinson JLD (2008) Thyroid-stimulating hormone pituitary adenomas. J Neurosurg 109(1):17–22. https://doi.org/10.3171/JNS/2008/109/7/0017

    Article  PubMed  Google Scholar 

  23. Macchia E, Gasperi M, Lombardi M, Morselli L, Pinchera A, Acerbi G, Rossi G, Martino E (2009) Clinical aspects and therapeutic outcome in thyrotropin-secreting pituitary adenomas: a single center experience. J Endocrinol Invest 32(9):773–779. https://doi.org/10.1007/BF03346535

    Article  CAS  PubMed  Google Scholar 

  24. Zhao W, Ye H, Li Y, Zhou L, Lu B, Zhang S, Wen J, Li S, Yang Y, Hu R (2012) Thyrotropin-secreting pituitary adenomas: diagnosis and management of patients from one Chinese center. Wien Klin Wochenschr 124(19–20):678–684. https://doi.org/10.1007/s00508-012-0216-z

    Article  CAS  PubMed  Google Scholar 

  25. Byun J, Kim JH, Kim YH, Cho YH, Hong SH, Kim CJ (2020) Thyroid-stimulating hormone-secreting pituitary adenomas: single institutional experience of 14 consecutive cases. J Korean Neurosurg Soc 63(4):495–503. https://doi.org/10.3340/jkns.2019.0169

    Article  PubMed  PubMed Central  Google Scholar 

  26. Mortini P, Barzaghi LR, Albano L, Panni P, Losa M (2018) Microsurgical therapy of pituitary adenomas. Endocrine 59(1):72–81. https://doi.org/10.1007/s12020-017-1458-3

    Article  CAS  PubMed  Google Scholar 

  27. Pomeraniec IJ, Dallapiazza RF, Xu Z, Jane J, Sheehan JP (2016) Early versus late Gamma Knife radiosurgery following transsphenoidal resection for nonfunctioning pituitary macroadenomas: a matched cohort study. J Neurosurg 125(1):202–212. https://doi.org/10.3171/2015.5.JNS15581

    Article  CAS  PubMed  Google Scholar 

  28. Sheehan JP, Starke RM, Mathieu D, Young B, Sneed PK, Chiang VL, Lee JY, Kano H, Park KJ, Niranjan A, Kondziolka D, Barnett GH, Rush S, Golfinos JG, Lunsford LD (2013) Gamma Knife radiosurgery for the management of nonfunctioning pituitary adenomas: a multicenter study. J Neurosurg 119(2):446–456. https://doi.org/10.3171/2013.3.JNS12766

    Article  PubMed  Google Scholar 

  29. Sicignano G, Losa M, del Vecchio A, Cattaneo GM, Picozzi P, Bolognesi A, Mortini P, Calandrino R (2012) Dosimetric factors associated with pituitary function after Gamma Knife Surgery (GKS) of pituitary adenomas. Radiother Oncol 104(1):119–124. https://doi.org/10.1016/j.radonc.2012.03.021

    Article  PubMed  Google Scholar 

  30. Ironside N, Chen CJ, Xu Z, Schlesinger D, Lee Vance M, Hong GK, Jane JA Jr, Patel S, Bindal SK, Niranjan A, Lunsford LD, Liscak R, Chytka T, Jezkova J, Saifi O, Trifiletti DM, Berger A, Alzate J, Bernstein K, Kondziolka D, Speckter H, Hernandez W, Lazo E, Peker S, Samanci Y, Zacharia BE, Mau C, Wegner RE, Shepard MJ, Mathieu D, Maillet M, Sheehan JP (2023) Effects of neuroanatomic structural distances on pituitary function after stereotactic radiosurgery: a multicenter study. Neurosurgery 92(5):1035–1042. https://doi.org/10.1227/neu.0000000000002347

    Article  PubMed  Google Scholar 

  31. Maione L, Li CY, Chanson P (2021) Endocrinological diagnosis and treatment of TSH-secreting pituitary adenomas. In: Honegger JB, Reincke M, Petersenn S (eds) Pituitary tumors: a comprehensive and interdisciplinary approach. Academic Press, London, pp 245–260

    Chapter  Google Scholar 

  32. Losa M, Barzaghi LR, Albano L, Mortini P (2021) Pituitary adenomas: Radiosurgery. In: Honegger JB, Reincke M, Petersenn S (eds) Pituitary tumors: a comprehensive and interdisciplinary approach. Academic Press, London, pp 471–481

    Chapter  Google Scholar 

Download references

Funding

This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.

Author information

Authors and Affiliations

  1. Neurosurgery and Radiosurgery Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute University San Raffaele, Via Olgettina 60, 20132, Milan, Italy

    M. Losa, L. Albano, L. R. Barzaghi, M. Bailo & P. Mortini

Authors
  1. M. Losa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. L. Albano
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. L. R. Barzaghi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Bailo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. P. Mortini
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Losa.

Ethics declarations

Conflict of interest

L. Albano was a recipient of the Lars Leksell Gamma Knife Fellowship. The other authors declare that they have no conflicts of interest.

Ethical approval

This study was approved by the Ethics Committee of Istituto Scientifico San Raffaele, Milan, Italy.

Informed consent

Informed consent was waived for this retrospective, observational study.

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.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Losa, M., Albano, L., Barzaghi, L.R. et al. Gamma knife radiosurgery is effective in patients with thyrotropin-secreting pituitary adenomas. J Endocrinol Invest (2024). https://doi.org/10.1007/s40618-023-02291-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s40618-023-02291-1

Keywords

Search

Navigation