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Clinical characteristics of patients with thyrotropin-secreting pituitary adenoma.
J Formos Med Assoc. 2003 Mar; 102(3):164-71.JF

Abstract

BACKGROUND AND PURPOSE

Thyroid-stimulating hormone (thyrotropin, TSH)-secreting pituitary adenoma is a very rare cause of hyperthyroidism. Diagnosis of this condition is often delayed due to lack of availability of TSH radioimmunoassay (RIA), the failure to recognize the utility of RIA and the incorrect attribution of the condition to other causes of thyrotoxicosis. This retrospective study analyzed the clinical characteristics of patients with this disorder treated from 1991 to 2002.

METHODS

Seven patients (6 females, 1 male; mean age, 48 years; range, 33 to 72 years) with a diagnosis of TSHsecreting pituitary adenoma based on detectable TSH levels with high serum free thyroid hormone or triiodothyronine concentrations and pituitary lesions found on neuroimaging were included in this study. Patient records including clinical features, endocrine studies, immunohistochemistry studies, and response to treatment were reviewed.

RESULTS

All 7 patients had hyperthyroidism, elevated free thyroxine or triiodothyronine levels, and unsuppressed levels of TSH. Imaging studies demonstrated a pituitary mass or lesion in all patients. Six patients had macroadenomas and 1 patient had a microadenoma. One of the patients had coexisting acromegalic features and hypersecretion of growth hormone was diagnosed. All of the patients had been treated with thionamides or thyroidectomy for presumed primary hyperthyroidism. Serum alpha-subunit level was uncharacteristically normal in 2 patients and elevated in 1 patient. Alpha-subunit/TSH molar ratios were elevated in 3 patients. Five patients underwent transsphenoidal adenomectomy but only one of them remained well-controlled at follow-up. Three patients received administration of somatostatin analogs and they achieved normalization of serum TSH and free thyroid hormones during the period of therapy.

CONCLUSIONS

TSH immunoassay has an important role in the evaluation of hyperthyroid patients to determine the presence of inappropriate secretion. TSH-secreting pituitary adenoma exhibits heterogeneity in clinical presentation, hormonal expression and therapeutic response.

Authors+Show Affiliations

Divisions of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

12783133

Citation

Wu, Yung-Yen, et al. "Clinical Characteristics of Patients With Thyrotropin-secreting Pituitary Adenoma." Journal of the Formosan Medical Association = Taiwan Yi Zhi, vol. 102, no. 3, 2003, pp. 164-71.
Wu YY, Chang HY, Lin JD, et al. Clinical characteristics of patients with thyrotropin-secreting pituitary adenoma. J Formos Med Assoc. 2003;102(3):164-71.
Wu, Y. Y., Chang, H. Y., Lin, J. D., Chen, K. W., Huang, Y. Y., & Jung, S. M. (2003). Clinical characteristics of patients with thyrotropin-secreting pituitary adenoma. Journal of the Formosan Medical Association = Taiwan Yi Zhi, 102(3), 164-71.
Wu YY, et al. Clinical Characteristics of Patients With Thyrotropin-secreting Pituitary Adenoma. J Formos Med Assoc. 2003;102(3):164-71. PubMed PMID: 12783133.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical characteristics of patients with thyrotropin-secreting pituitary adenoma. AU - Wu,Yung-Yen, AU - Chang,Hung-Yu, AU - Lin,Jen-Der, AU - Chen,Kwang-Wen, AU - Huang,Yu-Yao, AU - Jung,Shih-Ming, PY - 2003/6/5/pubmed PY - 2003/10/3/medline PY - 2003/6/5/entrez SP - 164 EP - 71 JF - Journal of the Formosan Medical Association = Taiwan yi zhi JO - J Formos Med Assoc VL - 102 IS - 3 N2 - BACKGROUND AND PURPOSE: Thyroid-stimulating hormone (thyrotropin, TSH)-secreting pituitary adenoma is a very rare cause of hyperthyroidism. Diagnosis of this condition is often delayed due to lack of availability of TSH radioimmunoassay (RIA), the failure to recognize the utility of RIA and the incorrect attribution of the condition to other causes of thyrotoxicosis. This retrospective study analyzed the clinical characteristics of patients with this disorder treated from 1991 to 2002. METHODS: Seven patients (6 females, 1 male; mean age, 48 years; range, 33 to 72 years) with a diagnosis of TSHsecreting pituitary adenoma based on detectable TSH levels with high serum free thyroid hormone or triiodothyronine concentrations and pituitary lesions found on neuroimaging were included in this study. Patient records including clinical features, endocrine studies, immunohistochemistry studies, and response to treatment were reviewed. RESULTS: All 7 patients had hyperthyroidism, elevated free thyroxine or triiodothyronine levels, and unsuppressed levels of TSH. Imaging studies demonstrated a pituitary mass or lesion in all patients. Six patients had macroadenomas and 1 patient had a microadenoma. One of the patients had coexisting acromegalic features and hypersecretion of growth hormone was diagnosed. All of the patients had been treated with thionamides or thyroidectomy for presumed primary hyperthyroidism. Serum alpha-subunit level was uncharacteristically normal in 2 patients and elevated in 1 patient. Alpha-subunit/TSH molar ratios were elevated in 3 patients. Five patients underwent transsphenoidal adenomectomy but only one of them remained well-controlled at follow-up. Three patients received administration of somatostatin analogs and they achieved normalization of serum TSH and free thyroid hormones during the period of therapy. CONCLUSIONS: TSH immunoassay has an important role in the evaluation of hyperthyroid patients to determine the presence of inappropriate secretion. TSH-secreting pituitary adenoma exhibits heterogeneity in clinical presentation, hormonal expression and therapeutic response. SN - 0929-6646 UR - https://www.unboundmedicine.com/medline/citation/12783133/Clinical_characteristics_of_patients_with_thyrotropin_secreting_pituitary_adenoma_ L2 - https://medlineplus.gov/pituitarytumors.html DB - PRIME DP - Unbound Medicine ER -