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The changing spectrum of TSH-secreting pituitary adenomas: diagnosis and management in 43 patients.
Eur J Endocrinol. 2003 Apr; 148(4):433-42.EJ

Abstract

OBJECTIVE

Our aim was to report the recent changes in diagnosis and management of TSH-secreting pituitary adenomas.

METHODS

We retrieved 43 consecutive patients with TSH-secreting pituitary tumors (23 male and 20 female) among 4400 pituitary adenomas followed between 1976 and 2001 in six Belgian and French centers.

RESULTS

TSH was elevated in 18/43 and alpha subunit in 13/32 patients. In patients with intact thyroid (n=30), mean free tri-iodothyronine was 13.1 pmol/l (range 3.5-23) and mean free thyroxine was 38.4 pmol/l (range 10.2-62.7). Hyperprolactinemia and acromegaly were associated in 9/43 and 8/43 cases. The number of associated hypersecretions was higher in macroadenomas than in microadenomas (Chi square = 11.2, P<0.01). Two women had sporadic multiple endocrine neoplasia type 1-associated syndrome. The proportion of microadenomas versus macroadenomas was 1/11 (period 1974-1986) and 8/32 (period 1987-2001). Bilateral petrosal sinus sampling, (111)In-pentreotide scintigraphy and ((11)C)-l-methionine positron emission tomography scan confirmed diagnosis in four questionable microadenomas. Macroadenomas with extrasellar extension (31 cases) had a tendency to be medially located. Medical treatment with somatostatin analogs was initiated as first-line treatment in 26 patients. TSH levels were reduced by more than 50% in 23/26 cases. A tumoral shrinkage of more than 20% was observed in 5/13 cases. Surgery was performed in 36 patients. After 1 year, 21 of them (58.3%) met the criteria of surgical favorable outcome. Pituitary radiotherapy (n=8) and somatostatin analogs allowed normalization in cases not cured by surgery.

CONCLUSION

Ultrasensitive methods for TSH measurement led to an earlier recognition of TSH-secreting pituitary tumors. In this series, we observed that TSH-secreting pituitary tumors are today more frequently found at the stage of microadenomas, medially located, without associated hypersecretions and needing new exploration methods as compared with older series. This changing spectrum in the presentation of TSH-secreting pituitary tumors and the excellent response to somatostatin analogs has been accompanied by an improvement in the prognosis of the disease.

Authors+Show Affiliations

Service d'Endocrinologie et Neurochirurgie, CHU de Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, Belgium.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

12656664

Citation

Socin, H Valdes, et al. "The Changing Spectrum of TSH-secreting Pituitary Adenomas: Diagnosis and Management in 43 Patients." European Journal of Endocrinology, vol. 148, no. 4, 2003, pp. 433-42.
Socin HV, Chanson P, Delemer B, et al. The changing spectrum of TSH-secreting pituitary adenomas: diagnosis and management in 43 patients. Eur J Endocrinol. 2003;148(4):433-42.
Socin, H. V., 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. European Journal of Endocrinology, 148(4), 433-42.
Socin HV, et al. The Changing Spectrum of TSH-secreting Pituitary Adenomas: Diagnosis and Management in 43 Patients. Eur J Endocrinol. 2003;148(4):433-42. PubMed PMID: 12656664.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The changing spectrum of TSH-secreting pituitary adenomas: diagnosis and management in 43 patients. AU - Socin,H Valdes, AU - Chanson,P, AU - Delemer,B, AU - Tabarin,A, AU - Rohmer,V, AU - Mockel,J, AU - Stevenaert,A, AU - Beckers,A, PY - 2003/3/27/pubmed PY - 2003/5/16/medline PY - 2003/3/27/entrez SP - 433 EP - 42 JF - European journal of endocrinology JO - Eur J Endocrinol VL - 148 IS - 4 N2 - OBJECTIVE: Our aim was to report the recent changes in diagnosis and management of TSH-secreting pituitary adenomas. METHODS: We retrieved 43 consecutive patients with TSH-secreting pituitary tumors (23 male and 20 female) among 4400 pituitary adenomas followed between 1976 and 2001 in six Belgian and French centers. RESULTS: TSH was elevated in 18/43 and alpha subunit in 13/32 patients. In patients with intact thyroid (n=30), mean free tri-iodothyronine was 13.1 pmol/l (range 3.5-23) and mean free thyroxine was 38.4 pmol/l (range 10.2-62.7). Hyperprolactinemia and acromegaly were associated in 9/43 and 8/43 cases. The number of associated hypersecretions was higher in macroadenomas than in microadenomas (Chi square = 11.2, P<0.01). Two women had sporadic multiple endocrine neoplasia type 1-associated syndrome. The proportion of microadenomas versus macroadenomas was 1/11 (period 1974-1986) and 8/32 (period 1987-2001). Bilateral petrosal sinus sampling, (111)In-pentreotide scintigraphy and ((11)C)-l-methionine positron emission tomography scan confirmed diagnosis in four questionable microadenomas. Macroadenomas with extrasellar extension (31 cases) had a tendency to be medially located. Medical treatment with somatostatin analogs was initiated as first-line treatment in 26 patients. TSH levels were reduced by more than 50% in 23/26 cases. A tumoral shrinkage of more than 20% was observed in 5/13 cases. Surgery was performed in 36 patients. After 1 year, 21 of them (58.3%) met the criteria of surgical favorable outcome. Pituitary radiotherapy (n=8) and somatostatin analogs allowed normalization in cases not cured by surgery. CONCLUSION: Ultrasensitive methods for TSH measurement led to an earlier recognition of TSH-secreting pituitary tumors. In this series, we observed that TSH-secreting pituitary tumors are today more frequently found at the stage of microadenomas, medially located, without associated hypersecretions and needing new exploration methods as compared with older series. This changing spectrum in the presentation of TSH-secreting pituitary tumors and the excellent response to somatostatin analogs has been accompanied by an improvement in the prognosis of the disease. SN - 0804-4643 UR - https://www.unboundmedicine.com/medline/citation/12656664/The_changing_spectrum_of_TSH_secreting_pituitary_adenomas:_diagnosis_and_management_in_43_patients_ L2 - https://eje.bioscientifica.com/doi/10.1530/eje.0.1480433 DB - PRIME DP - Unbound Medicine ER -