Advertisement

Thyrotroph Adenomas

  • Michael Buchfelder
  • Rudolf Fahlbusch
Chapter

Abstract

Physiological thyroid function is intricately controlled by an elegant interplay between stimulatory hypothalamic influences and a negative feedback system. The major stimulatory influence is hypothalamic thyrotrophin-releasing hormone (TRH), which induces thyroid-stimulating hormone (TSH) secretion by pituitary thyrotrophs. TSH, in turn, is transported by the bloodstream to the thyroid gland, where it promotes synthesis and release of the thyroid hormones, tri-iodotyronine (T3) and thyroxine (T4). T3 is the most important physiological inhibitor of TSH secretion whereby its elevated circulating serum levels act at the hypothalamus and pituitary to downregulate the hypothalamo—pituitary—thyroid axis. In addition to these major influences, dopamine, somatostatin, and corticosteroids have been shown to possess TSH secretion-inhibiting properties, whereas epinephrine and estrogens contribute to stimulatory control (1). Modern immunoassay techniques allow the clear differentiation between normal and subnormal serum TSH levels. Hyperthyroidism is most usually because of primary thyroid disease, such as autonomous hyperfunctioning nodular goiter or overstimulation by immunoglobulins (Graves’s disease).

Keywords

Thyroid Hormone Pituitary Adenoma Pituitary Tumor Luteinizing Hormone Release Hormone Inappropriate Secretion 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Jackson IMD. Regulation of thyrotropin secretion. In: Imura H, ed. The Pituitary Gland. Raven, New York 1994, pp. 179–216.Google Scholar
  2. 2.
    Gershengorn MC, Weintraub BD. Thyrotropin-induced hyperthyroidism caused by selective pituitary resistance to thyroid hormone: a new syndrome of inappropriate secretion of TSH. J Clin Invest 1975;56:633–642.PubMedCrossRefGoogle Scholar
  3. 3.
    Weintraub BD, Gershengorn MC, Kourides IA, Fein H. Inappropriate secretion of thyroid-stimulating hormone. Ann Int Med 1981; 95:339–351.Google Scholar
  4. 4.
    Faglia G, Beck-Peccoz P, Piscitelli G, Medri G. Inappropriate secretion of thyrotropin by the pituitary. Horm Res 1987;26:79–99.PubMedCrossRefGoogle Scholar
  5. 5.
    Hamilton CR, Adams LC, Maloof F. Hyperthyroidism due to thyrotropin-producing pituitary chromophobe adenomas. N Engl J Med 1970;283:1077–1080.PubMedCrossRefGoogle Scholar
  6. 6.
    Buchfelder M, Fahlbusch R, Becker W, Mann K. TSH-sezernierende Hypophysenadenome. Med Welt 1991;42:1033–1037.Google Scholar
  7. 7.
    Beckers A, Abs R, Mahler C, Vandalem JL, Pirens G, Hennen G, et al. Thyrotropin-secreting pituitary adenomas: Report of seven cases. J Clin Endocrinol Metab 1991;72:477–483.PubMedCrossRefGoogle Scholar
  8. 8.
    Wilson CB. A decade of pituitary microsurgery. The Herbert Olivecrona Lecture. J Neurosurg 1984;61:814–833.PubMedCrossRefGoogle Scholar
  9. 9.
    Horn K, Erhardt F, Fahlbusch R, Pickardt CR, von Werder K, Scriba PC. Recurrent goiter, hyperthyroidism, galactorrhea and amenorrhea due to a thyrotropin and prolactin-producing pituitary tumor. J Clin Endocrinol Metab 1976;43:137–143.PubMedCrossRefGoogle Scholar
  10. 10.
    Yovos SJG, Falko JM, O’Dorisio TM, Malarkey WB, Cataland S, Capen CC. Thyrotoxicosis and a thyrotropin-secreting pituitary tumor causing unilateral exophthalmus. J Clin Endocrinol Metab 1981;53:338–343.PubMedCrossRefGoogle Scholar
  11. 11.
    Korn EA, Gaich G, Brines M, Carpenter TO. Thyrotropin-secreting adenoma in an adolescent girl without increased serum thyrotropinalpha. Horm Res 1994;42:120–123.PubMedCrossRefGoogle Scholar
  12. 12.
    Gesundheit N. Thyrotropin-induced hyperthyroidism. In: Braverman LE, Utiger RD, eds. The Thyroid. J.B. Lippincott, Philadelphia, 1991, pp. 682–691.Google Scholar
  13. 13.
    Wolansky LJ, Leavitt GD, Elias BJ, Lee HJ, Dasmahapatra A, Byrne W. MRI of pituitary hyperplasia in hypothyroidism. Neuroradiology 1996;38:50–52.PubMedCrossRefGoogle Scholar
  14. 13a.
    Beck-Peccoz P, Persani L, Asteria C, Romoli R. In: von Werder K, Fahlbusch R, eds. Pituitary Adenomas: From Basic Research to Diagnosis and Therapy. Elsevier, Amsterdam, 1996, pp. 277–290.Google Scholar
  15. 14.
    Gharib H, Carpenter PC, Scheithauer BW, Service FJ. The spectrum of inappropriate pituitary thyrotropin secretion associated with hyperthyroidism. Mayo Clin Proc 1982;57:556–563.PubMedGoogle Scholar
  16. 15.
    Gesundheit N, Petrick PA, Nissim M, Dahlberg A, Doppman JL, Emerson CH, et al. Thyrotropin-secreting pituitary adenomas: Clinical and biochemical heterogeneity. Ann Int Med 1989;111:827–835.PubMedGoogle Scholar
  17. 15a.
    Bruckner-Davis F, Oldfield EH, Skarulis MC, Doppman JL, Weintraub BD. Thyrotropin-secreting pituitary tumors: Diagnostic criteria, thyroid hormone sensitivity, and treatment outcome in 25 patients followed at the National Institutes of Health. J Clin Endocrinol Metab 1999;84:476–486.CrossRefGoogle Scholar
  18. 16.
    Beck-Peccoz P, Persani L. Variable biological activity of thyroid- stimulating hormone. Eur J Endocrinol 1994;131:331–340.PubMedCrossRefGoogle Scholar
  19. 17.
    Beck-Peccoz P, Piscitelli G, Amr S, Ballabio M, Bassetti M, Giannattasio G, et al. Endocrine, biochemical and morphological studies of a pituitary adenoma secreting growth hormone, thyreotropin (TSH) and a-subunit: Evidence for secretion of TSH with increase of bioactivity. J Clin Endocrinol Metab 1986;62:704–711.PubMedCrossRefGoogle Scholar
  20. 18.
    Bevan JS, Esiri MM, Loveridge N, Faglia G, Burke CW. TSH secreting pituitary adenoma: case report, characterization of TSH and tumor cell perifusion. J Endocrinol 1985; 104, Suppl.:51.Google Scholar
  21. 19.
    Jackson JA, Smigiel M, Green JF. Hyperthyroidism due to a thyrotropin-secreting pituitary microadenoma. Henry Ford Hosp Med J 1987;35:198–200.PubMedGoogle Scholar
  22. 20.
    Moore GE, Brackney EL, Bock FG. Production of pituitary tumors in mice by chronic administration of a thiouracil derivative. Proc Soc Exp Biol Med 1953;82:643–645.PubMedGoogle Scholar
  23. 21.
    Chanson P, Orgiazzi J, Derome PJ, Bression D, Jedynac CP, et al. Paradoxical response of thyrotropin to L-dopa and presence of dopaminergic receptors in a thyrotropin-secreting pituitary adenoma. J Clin Endocrinol Metab 1984;59:542–546.PubMedCrossRefGoogle Scholar
  24. 22.
    Koide Y, Kugai N, Kimura S, Fujita T, Kameya T, Azukizawa M, et al. A case of pituitary adenoma with possible simultaneous secretion of thyrotropin and follicle-stimulating hormone. J Clin Endocrinol Metab 1982;54:397–403.PubMedCrossRefGoogle Scholar
  25. 23.
    Caron P, Gerbeau C, Prodagrol L, Simonetta C, Bayard F. Successful pregnancy in an infertile woman with a thyrotropin-secreting macroadenoma treated with somatostatin analog (octreotide). J Clin Endocrinol Metab 1996;81:1164–1168.PubMedCrossRefGoogle Scholar
  26. 24.
    Refetoff S, Weiss RE, Usala SJ. The syndromes of resistance to thyroid hormone. Endocr Rev 1993;14:348–399.PubMedGoogle Scholar
  27. 25.
    Chanson P, Li JY, Le Dafniet M, Derome P, Kujas M, Murat A, et al. Absence of receptors for thyrotropin (TSH)-releasing hormone in human TSH-secreting pituitary adenomas associated with hyperthyroidism. J Clin Endocrinol Metab 1988;66:447–450.PubMedCrossRefGoogle Scholar
  28. 26.
    Kourides IA, Ridgway EC, Weintraub BD, Bigos ST, Gershengorn MC, Maloof F. Thyrotropin-induced hyperthyroidism: Use of a- and β-subunit levels to identify patients with pituitary tumors. J Clin Endocrinol Metab 1977;45:534–543.PubMedCrossRefGoogle Scholar
  29. 27.
    Samuels MH, Wood WM, Gordon DF, Kleinschmidt-DeMasters BK, Lillehei K, Ridgway EC. Clinical and molecular studies of a thyrotropin-secreting pituitary adenoma. J Clin Endocrinol Metab 1989;68:1211–1215.PubMedCrossRefGoogle Scholar
  30. 28.
    Simard M, Mirell CJ, Pekary AE, Drexler J, Kovacs K, Hershman JM. Hormonal control of thyrotropin and growth hormone secretion in a human thyrotrop pituitary adenoma studied in vitro. Acta Endocrinol 1988;119:283–290.PubMedGoogle Scholar
  31. 29.
    Smallridge RC. Thyrotropin-secreting pituitary tumors. Diagnostic and therapeutic considerations. Endocrinol Metabol Clin North Am 1987;16:765–792.Google Scholar
  32. 30.
    Meinders AE, Willekens FLA, Bardens CAE, Seevinck J, Kruseman AC. Acromegaly and thyrotoxicosis induced by a GH- and TSH-producing pituitary tumour which also contained prolactin. Neth J Med 1981;24:136–144.PubMedGoogle Scholar
  33. 30a.
    Patrick AW, Atkin SL, MacKenzie J, Foy PM, White MC, MacFarlane IA. Hyperthyroidism secondary to a pituitary adenoma secreting TSH, FSH, alpha-subunit and GH. Clin Endocrinol 1994;40:275–278.CrossRefGoogle Scholar
  34. 31.
    Mashiter K, van Noorden S, Fahlbusch R, Skrabal K. Hyperthyroidism due to a TSH secreting pituitary adenoma: Case report, treatment and evidence for adenoma TSH by morphological and cell culture studies. Clin Endocrinol 1983;18:473–483.CrossRefGoogle Scholar
  35. 32.
    Levy A, Eckland DJA, Gurney AM, Reubi JC, Lightman SL. Somatostatin and thyrotropin-releasing hormone response and receptor status of a thyrotropin-secreting pituitary adenoma: clinical and in vitro studies. J Neuroendocrinol 1989;1:321–326.PubMedCrossRefGoogle Scholar
  36. 33.
    Bertherat J, Brue T, Enjalbert A, Gunz G, Rasolonjanahary R, Warnet A, et al. Somatostatin receptors on thyrotropin-secreting pituitary adenomas: comparison with the inhibitory effects of octreotide upon in vivo and in vitro hormonal secretion. J Clin Endocrinol Metab 1992;75:540–546.PubMedCrossRefGoogle Scholar
  37. 34.
    Pioro EP, Scheithauer BW, Laws ER, Randall RV, Kovacs KT, Horvath E. Combined thyrotroph and lactotroph cell hyperplasia simulating prolactin-secreting pituitary adenoma in longstanding hypothyroidism. Surg Neurol 1988;29:218–226.PubMedCrossRefGoogle Scholar
  38. 35.
    Buchfelder M, Fahlbusch R, Becker W, Berger P, Schwarz S, Mann K. Concomitant TSH and alpha-subunit secretion in 2 cases of successfully operated thyreotropinomas. Acta Endocrinol 1990; 122, Suppl. 1:70.Google Scholar
  39. 36.
    Sanno N, Teramoto A, Matsuno A, Inada K, Itoh J, Osamura RY. Clinical and immunohistochemical studies on TSH-secreting pituitary adenomas: Its multihormonality and expression of Pit-1. Mod Pathol 1994;7:893–899.PubMedGoogle Scholar
  40. 37.
    Dong Q, Brucker-Davis F, Weintraub BD, Smallridge RC, Carr FE, Battey J, et al. Screening of candidate oncogenes in human thyrotroph tumors: absence of activating mutations of the Gαq, Gαq, Gal 1, Gas or thyrotropin-releasing hormone receptor gene. J Clin Endocrinol Metab 1996;81:1134–1140.PubMedCrossRefGoogle Scholar
  41. 38.
    Buchfelder M, Fahlbusch R, Adams EF, Kiesewetter F, Thierauf P. Proliferation parameters for pituitary adenomas. Acta Neurochir 1996; 65, Suppl: 18–21.Google Scholar
  42. 39.
    Grisoli F, Leclerq T, Winteler JP, Jaquet P, Diaz-Vasquez P, Hassoun J, et al. Thyroid-stimulating hormone pituitary adenomas and hyperthyroidism. Surg Neurol 1986;25:361–368.PubMedCrossRefGoogle Scholar
  43. 40.
    Mixons AJ, Friedman IC, Katz DA, Feuerstein IM, Taubenberger JM, Colandrea JM, et al. Thyrotropin-secreting pituitary carcinoma. J Clin Endocrinol Metab 1993;76:529–533.CrossRefGoogle Scholar
  44. 41.
    Kovacs K, Horvath E, Stefaneanu L. Anatomy and pathology of the thyrotrophs. In: Braverman LE, Utiger RD, eds. The Thyroid. J.B. Lippincott, Philadelphia, 1991, pp. 40–50.Google Scholar
  45. 42.
    Terzolo M, Orlandi F, Bassetti M, Medri G, Paccotti P, Cortelazzi D, et al. Hyperthyroidism due to a pituitary adenoma composed of two different cell types, one secreting alpha-subunit alone and another cosecreting alpha-subunit and thyrotropin. J Clin Endocrinol Metab 1991;72:415–421.PubMedCrossRefGoogle Scholar
  46. 43.
    Saeger W, Lodecke DK. Pituitary adenomas with hyperfunction of TSH. Frequency, histological classification, immunocytochemistry and ultrastructure. Virchows Arch [Pathol Anat] 1982;394: 255–267.CrossRefGoogle Scholar
  47. 43a.
    Fischler MP, Reinhart WH. TSH-secreting pituitary macro- adenoma: Rapid tumor shrinkage and recovery from hyperthyroidism with octreotide. J Endocrinol Invest 1999;22:64–65.PubMedGoogle Scholar
  48. 44.
    Kourides IA, Re RN, Weintraub BD, Ridgway EC, Maloof F. Metabolic clearance and secretion rates of subunits of human thyrotropin. J Clin Invest 1977;59:508–516.PubMedCrossRefGoogle Scholar
  49. 44a.
    Losa M, Giovanelli M, Persani L, Mortini F, Faglia G, Beck-Peccoz P. Criteria of cure and follow-up of central hyperthyroidism due to thyrotropin-secreting pituitary adenomas. J Clin Endocrinol Metab 1996;81:3084–3090.PubMedCrossRefGoogle Scholar
  50. 45.
    Kellett HA, Wyllie AH, Dale BAB, Best JJK, Toft AD. Hyperthyroidism due to a thyrotrophin-secreting microadenoma. Clin Endocrinol 1983;19:57–65.CrossRefGoogle Scholar
  51. 46.
    McCutcheon IE, Weintraub BD, Oldfield EH. Surgical treatment of thyrotropin-secreting pituitary adenomas. J Neurosurg 1990;73: 674–683.PubMedCrossRefGoogle Scholar
  52. 47.
    Ridgway EC, Weintraub BD, Maloof F. Metabolic clearance and production rates of human thyrotropin. J Clin Invest 1974;53: 895–903.PubMedCrossRefGoogle Scholar
  53. 48.
    McLellan AR, Connell JMC, Alexander WD, Davies DL. Clinical response of thyrotropin-secreting macroadenoma to bromocriptine and radiotherapy. Acta Endocrinol 1988;119:189–194.PubMedGoogle Scholar
  54. 49.
    Chanson P, Warnet A. Treatment of thyroid-stimulating hormone- secreting adenomas with octreotide. Metabolism 1992; 41, Suppl 2:62–65.PubMedCrossRefGoogle Scholar
  55. 50.
    Comi RJ, Gesundheit N, Murray L, Gorden P, Weintraub B. Response of thyrotropin-secreting pituitary adenomas to a long- acting somatostatin analogue. N Engl J Med 1987;317:12–17.PubMedCrossRefGoogle Scholar
  56. 51.
    Allyn GSR, Bernstein R, Chynn KY, Kourides IA. Reduction in size of a thyrotropin- and gonadotropin-secreting pituitary adenoma treated with octreotide acetate (somatostatin analog). J Clin Endocrinol Metab 1992;74:690–694.CrossRefGoogle Scholar
  57. 52.
    Lee EJ, Kyung RK, Sung KL, Hyun CL, Dong IK, Sun HK, et al. Reduction in size of a thyrotropin-secreting pituitary adenoma treated with octreotide acetate (somatostatin analog). Eur J Endocrinol 1994;131:109–112.PubMedCrossRefGoogle Scholar
  58. 53.
    Shaker JL, Brickner RC, Sirus SR, Cerletty JM. Ocreotide acetate- induced size reduction of a large thyrotropin (TSH) secreting pituitary tumor with correction of hyperthyroidism and hypopituitarism. 73rd Annual Meeting of the Endocrine Society, Washington 1991 [abstract No. 1138].Google Scholar
  59. 54.
    Sy RAG, Bernstein R, Chynn KY, Kourides IA. Reduction in size of a thyrotropin- and gonadotropin secreting pituitary adenoma treated with octreotide acetate (somatostatin analog). J Clin Endocrinol Metab 1992;74:690–694.PubMedCrossRefGoogle Scholar
  60. 54a.
    Iglesias P, Diez JJ. Long-term preoperative management of thyrotropin-secreting pituitary adenoma with octreotide. J Endocrinol Invest 1998;21:775–778.PubMedGoogle Scholar
  61. 54b.
    Kuhn JM, Arlot S, Levebre H, Caron P, Cortet-Rudelli C, Archambaud F, et al. Evaluation of the treatment of thyrotropin-secreting pituitary adenomas with a slow release formulation of the somatostatin analog lanreotide. J Clin Endocrinol Metab 2000;85: 1487–1491.PubMedCrossRefGoogle Scholar
  62. 55.
    Wémeau JL, Dewailly D, Leroy R, D’Herbomz M, Mazzuca M, Decoulx M, et al. Long-term treatment with the somatostatin analog SMS 201–995 in a patient with a thyrotropin- and growth hormone secreting tumor. J Clin Endocrinol Metab 1988;66:636–639.PubMedCrossRefGoogle Scholar
  63. 56.
    Karisson FA, Burman P, Kämpe O, Westlin JE, Wide L. Large somatostatin-insensitive thyrotropin-secreting pituitary tumour responsive to D-thyroxine and dopamine agonists. Acta Endocrinol 1991;129:291–295.Google Scholar
  64. 56a.
    Chatterjee VKK. Resistance to thyroid hormone. Horm Res 1997;48 (suppl 4):43–46.PubMedCrossRefGoogle Scholar
  65. 57.
    Beck-Peccoz P, Mariotti S, Guillausseau PJ, Medri G, Piscitelli G, Berth A, et al. Treatment of hyperthyroidism due to inappropriate secretion of thyrotropin with the somatostatin analog SMS 201–995. J Clin Endocrinol Metab 1989;68:208–214.PubMedCrossRefGoogle Scholar
  66. 58.
    Dulgeroff AJ, Geffner ME, Koyal SN, Wong M, Hershman JM. Bromocriptine and Triac therapy for hyperthyroidism due to pituitary resistance to thyroid hormone. J Clin Endocrinol Metab 1992;75:1071–1075.PubMedCrossRefGoogle Scholar
  67. 59.
    Niepce B. Traite du Goitre et du Cretinism. J.B. Ballière, Paris, 1851.Google Scholar
  68. 60.
    Scheithauer BW, Kovacs K, Randall RV, Ryan N. Pituitary gland in hypothyroidism: histologic and immunocytologic study. Arch Pathol Lab Med 1985;109:499–503.PubMedGoogle Scholar
  69. 61.
    Furth J, Dent JN, Burnett WT, Gadsden EL. The mechanism of induction and the characteristics of pituitary tumors induced by thyroidectomy. J Clin Endocrinol Metab 1955;15:81–91.PubMedCrossRefGoogle Scholar
  70. 62.
    Valenta LJ, Tamkin JRS, Elias AN, Eisenberg H. Regression of a pituitary adenoma following levothyroxine therapy of primary hypothyroidism. Fertil Steril 1983;40:389–392.PubMedGoogle Scholar
  71. 63.
    Yamada T, Tsukui T, Ikejiri K, Yukimura Y, Kotani M. Volume of sella turcica in normal subjects and in patients with primary hypothyroidism and in hyperthyroidism. J Clin Endocrinol Metab 1976;42:817–822.PubMedCrossRefGoogle Scholar
  72. 64.
    Okuno T, Sudo M, Momoi T, Takao T, Ito M, Konishi Y, et al. Pituitary hyperplasia due to hypothyroidism. J Comput Assist Tomogr 1980;4:600–602.PubMedCrossRefGoogle Scholar
  73. 65.
    Pita JC, Shafey S, Pina R. Diminution of large pituitary tumor after replacement therapy for primary hypothyroidism. Neurology 1979;29:1169–1172.PubMedCrossRefGoogle Scholar
  74. 66.
    Hutchins WW, Crues JV, Miya P, Pojunas KW. MR demonstration of pituitary hyperplasia and regression after therapy for hypothyroidism. AJNR 1990;11:410.PubMedGoogle Scholar
  75. 67.
    Wynne AG, Gharib H, Scheithauer BW, Davis DH, Freeman SL. Hyperthyroidism due to inappropriate secretion of Thyrotropin in 10 patients. Am J Med 1992;92:15–24.PubMedCrossRefGoogle Scholar
  76. 67a.
    Sarlis NJ, Brucker-Davis F, Doppman JL, Skarulis MC. MRI-demonstrable regression of a pituitary mass in a case of primary hypothyroidism after a week of acute thyroid hormone therapy. J Clin Endocrinol Metab 1997;82:808–811.PubMedCrossRefGoogle Scholar
  77. 68.
    Katevuo K, Välimäki M, Ketonen L, Lamberg BA, Pelkonen R. Computed tomography of the pituitary fossa in primary hypothyroidism. Effect of thyroxine treatment. Clin Endocrinol 1985;22: 617–621.CrossRefGoogle Scholar
  78. 69.
    Gup RS, Sheeler LR, Maeder MC, Tew JM. Pituitary enlargement and primary hypothyroidism: a report of two cases with sharply contrasting outcomes. Neurosurgery 1982;11:792–794.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2001

Authors and Affiliations

  • Michael Buchfelder
  • Rudolf Fahlbusch

There are no affiliations available

Personalised recommendations