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Thyrotropin-secreting pituitary adenomas: clinical and biochemical heterogeneity. Case reports and follow-up of nine patients.
Ann Intern Med. 1989 Nov 15; 111(10):827-35.AIM

Abstract

STUDY OBJECTIVE

To evaluate the clinical and biochemical features of patients with TSH (thyroid-stimulating hormone, thyrotropin)-secreting pituitary tumors; to measure the biologic activity in vitro of circulating TSH from selected patients before and after pituitary surgery.

DESIGN

Case series.

SETTING

Patients in an endocrinology unit.

PATIENTS

Nine patients with TSH-secreting pituitary tumors.

MEASUREMENTS AND MAIN RESULTS

All patients had hyperthyroidism, elevated free thyroxine and triiodothyronine levels, and detected levels of TSH. The free alpha subunit, a tumor marker for neoplasms of gonadotropic or thyrotropic cell origin, was elevated in all nine patients. Seven of the nine patients had been treated with thionamides, radioactive iodine, or thyroidectomy for presumed primary hyperthyroidism. The delay from the initial treatment of hyperthyroidism to the correct diagnosis of a pituitary neoplasm was 6.2 +/- 4.8 (mean +/- SD) years. Two of the seven patients with macroadenomas died in the perioperative period (one at NIH, one at a referring hospital). Of the remaining five patients with macroadenomas, four have residual tumor and inappropriate TSH secretion, despite surgery and radiation therapy, at follow-up from 3.5 to 6 years. In contrast, the two patients with microadenomas are clinically cured 2.5 and 4 years after transsphenoidal adenomectomy. The biologic to immunologic (B/I) ratio of serum TSH, determined preoperatively in five patients with TSH-secreting tumors, was elevated compared with euthyroid subjects. In three patients the B/I ratio of serum TSH was also measured after pituitary surgery; in two the elevated B/I ratio returned to normal after successful pituitary adenomectomy, while in the third this ratio remained elevated after incomplete adenoma resection.

CONCLUSIONS

With the routine availability of ultrasensitive TSH assays and their increasing use to confirm thyrotoxicosis from all causes, we expect that TSH-secreting pituitary tumors will be diagnosed earlier, before inappropriate antithyroid therapy, permitting an improved outcome.

Authors+Show Affiliations

National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

2479309

Citation

Gesundheit, N, et al. "Thyrotropin-secreting Pituitary Adenomas: Clinical and Biochemical Heterogeneity. Case Reports and Follow-up of Nine Patients." Annals of Internal Medicine, vol. 111, no. 10, 1989, pp. 827-35.
Gesundheit N, Petrick PA, Nissim M, et al. Thyrotropin-secreting pituitary adenomas: clinical and biochemical heterogeneity. Case reports and follow-up of nine patients. Ann Intern Med. 1989;111(10):827-35.
Gesundheit, N., Petrick, P. A., Nissim, M., Dahlberg, P. A., Doppman, J. L., Emerson, C. H., Braverman, L. E., Oldfield, E. H., & Weintraub, B. D. (1989). Thyrotropin-secreting pituitary adenomas: clinical and biochemical heterogeneity. Case reports and follow-up of nine patients. Annals of Internal Medicine, 111(10), 827-35.
Gesundheit N, et al. Thyrotropin-secreting Pituitary Adenomas: Clinical and Biochemical Heterogeneity. Case Reports and Follow-up of Nine Patients. Ann Intern Med. 1989 Nov 15;111(10):827-35. PubMed PMID: 2479309.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Thyrotropin-secreting pituitary adenomas: clinical and biochemical heterogeneity. Case reports and follow-up of nine patients. AU - Gesundheit,N, AU - Petrick,P A, AU - Nissim,M, AU - Dahlberg,P A, AU - Doppman,J L, AU - Emerson,C H, AU - Braverman,L E, AU - Oldfield,E H, AU - Weintraub,B D, PY - 1989/11/15/pubmed PY - 1989/11/15/medline PY - 1989/11/15/entrez SP - 827 EP - 35 JF - Annals of internal medicine JO - Ann Intern Med VL - 111 IS - 10 N2 - STUDY OBJECTIVE: To evaluate the clinical and biochemical features of patients with TSH (thyroid-stimulating hormone, thyrotropin)-secreting pituitary tumors; to measure the biologic activity in vitro of circulating TSH from selected patients before and after pituitary surgery. DESIGN: Case series. SETTING: Patients in an endocrinology unit. PATIENTS: Nine patients with TSH-secreting pituitary tumors. MEASUREMENTS AND MAIN RESULTS: All patients had hyperthyroidism, elevated free thyroxine and triiodothyronine levels, and detected levels of TSH. The free alpha subunit, a tumor marker for neoplasms of gonadotropic or thyrotropic cell origin, was elevated in all nine patients. Seven of the nine patients had been treated with thionamides, radioactive iodine, or thyroidectomy for presumed primary hyperthyroidism. The delay from the initial treatment of hyperthyroidism to the correct diagnosis of a pituitary neoplasm was 6.2 +/- 4.8 (mean +/- SD) years. Two of the seven patients with macroadenomas died in the perioperative period (one at NIH, one at a referring hospital). Of the remaining five patients with macroadenomas, four have residual tumor and inappropriate TSH secretion, despite surgery and radiation therapy, at follow-up from 3.5 to 6 years. In contrast, the two patients with microadenomas are clinically cured 2.5 and 4 years after transsphenoidal adenomectomy. The biologic to immunologic (B/I) ratio of serum TSH, determined preoperatively in five patients with TSH-secreting tumors, was elevated compared with euthyroid subjects. In three patients the B/I ratio of serum TSH was also measured after pituitary surgery; in two the elevated B/I ratio returned to normal after successful pituitary adenomectomy, while in the third this ratio remained elevated after incomplete adenoma resection. CONCLUSIONS: With the routine availability of ultrasensitive TSH assays and their increasing use to confirm thyrotoxicosis from all causes, we expect that TSH-secreting pituitary tumors will be diagnosed earlier, before inappropriate antithyroid therapy, permitting an improved outcome. SN - 0003-4819 UR - https://www.unboundmedicine.com/medline/citation/2479309/Thyrotropin_secreting_pituitary_adenomas:_clinical_and_biochemical_heterogeneity__Case_reports_and_follow_up_of_nine_patients_ L2 - https://www.acpjournals.org/doi/10.7326/0003-4819-111-10-827?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -