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Clinicopathological characteristics and therapeutic outcomes in thyrotropin-secreting pituitary adenomas: a single-center study of 90 cases.
J Neurosurg. 2014 Dec; 121(6):1462-73.JN

Abstract

OBJECT

The aim of this study was to analyze clinicopathological characteristics and treatment outcomes in a large single-center clinical series of cases of thyrotropin (TSH)-secreting pituitary adenomas.

METHODS

The authors retrospectively reviewed clinical, pathological, and treatment characteristics of 90 consecutive cases of TSH-secreting pituitary adenomas treated with transsphenoidal surgery between December 1991 and May 2013. The patient group included 47 females and 43 males (median age 42 years, range 11-74 years).

RESULTS

Sixteen tumors (18%) were microadenomas and 74 (82%) were macroadenomas. Microadenomas were significantly more frequent in the more recent half of our case series (12 of 45 cases) (p = 0.0274). Cavernous sinus invasion was confirmed in 21 patients (23%). In 67 cases (74%), the tumors were firm elastic or hard in consistency. Acromegaly and hyperprolactinemia were observed, respectively, in 14 (16%) and 11 (12%) of the 90 cases. Euthyroidism was achieved in 40 (83%) of 48 patients and tumor shrinkage was found in 24 (55%) of 44 patients following preoperative somatostatin analog treatment. Conventional transsphenoidal surgery, extended transsphenoidal surgery, and a simultaneous combined supra- and infrasellar approach were performed in 85, 2, and 3 patients, respectively. Total removal with endocrinological remission was achieved in 76 (84%) of 90 patients, including all 16 (100%) patients with microadenomas, 60 (81%) of the 74 with macroadenomas, and 8 (38%) of the 21 with cavernous sinus invasion. None of these 76 patients experienced tumor recurrence during a median follow-up period of 2.8 years. Stratifying by Knosp grade, total removal with endocrinological remission was achieved in 34 of 36 patients with Knosp Grade 0 tumors, all 24 of those with Grade 1 tumors, 12 of the 14 with Grade 2 tumors, 6 of the 8 with Grade 3 tumors, and none of the 8 with Grade 4 tumors. Cavernous sinus invasion and tumor size were significant independent predictors of surgical outcome. Immunoreactivity for growth hormone, prolactin, or both hormones was present in 32, 9, and 24 patients, respectively. The Ki-67 labeling index was less than 3% in 71 (97%) of 73 tumors for which it was obtained and 3% or more in 2. Postsurgery pituitary dysfunction was found in 15 patients (17%) and delayed hyponatremia was seen in 9.

CONCLUSIONS

TSH-secreting adenomas, particularly those in the microadenoma stage, have increased in frequency over the past 5 years. The high surgical success rate achieved in this series is due to relatively early diagnosis and relatively small tumor size. In addition, the surgical strategies used, such as extracapsular removal of hard or solid adenomas, aggressive resction of tumors with cavernous sinus invasion, or extended transsphenoidal surgery or a simultaneous combined approach for large/giant multilobulated adenomas, also may improve remission rate with a minimal incidence of complications.

Authors+Show Affiliations

Departments of Hypothalamic and Pituitary Surgery.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)

Journal Article

Language

eng

PubMed ID

25237847

Citation

Yamada, Shozo, et al. "Clinicopathological Characteristics and Therapeutic Outcomes in Thyrotropin-secreting Pituitary Adenomas: a Single-center Study of 90 Cases." Journal of Neurosurgery, vol. 121, no. 6, 2014, pp. 1462-73.
Yamada S, Fukuhara N, Horiguchi K, et al. Clinicopathological characteristics and therapeutic outcomes in thyrotropin-secreting pituitary adenomas: a single-center study of 90 cases. J Neurosurg. 2014;121(6):1462-73.
Yamada, S., Fukuhara, N., Horiguchi, K., Yamaguchi-Okada, M., Nishioka, H., Takeshita, A., Takeuchi, Y., Ito, J., & Inoshita, N. (2014). Clinicopathological characteristics and therapeutic outcomes in thyrotropin-secreting pituitary adenomas: a single-center study of 90 cases. Journal of Neurosurgery, 121(6), 1462-73. https://doi.org/10.3171/2014.7.JNS1471
Yamada S, et al. Clinicopathological Characteristics and Therapeutic Outcomes in Thyrotropin-secreting Pituitary Adenomas: a Single-center Study of 90 Cases. J Neurosurg. 2014;121(6):1462-73. PubMed PMID: 25237847.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinicopathological characteristics and therapeutic outcomes in thyrotropin-secreting pituitary adenomas: a single-center study of 90 cases. AU - Yamada,Shozo, AU - Fukuhara,Noriaki, AU - Horiguchi,Kentaro, AU - Yamaguchi-Okada,Mitsuo, AU - Nishioka,Hiroshi, AU - Takeshita,Akira, AU - Takeuchi,Yasuhiro, AU - Ito,Junko, AU - Inoshita,Naoko, Y1 - 2014/09/19/ PY - 2014/9/20/entrez PY - 2014/9/23/pubmed PY - 2015/1/28/medline KW - ACTH = adrenocorticotropic hormone KW - ADH = antidiuretic hormone KW - FSH = follicle stimulating hormone KW - FT3 = free triiodothyronine KW - FT4 = free thyroxine KW - GH = growth hormone KW - IGF-1 = insulin-like growth factor 1 KW - IQR = interquartile range KW - LH = luteinizing hormone KW - PRL = prolactin KW - SITSH = syndrome of inappropriate TSH secretion KW - TRH = thyrotropin-releasing hormone KW - TSH = thyrotropin (thyroid stimulating hormone) KW - hyperthyroidism KW - pituitary surgery KW - somatostatin analogs KW - syndrome of inappropriate TSH secretion KW - thyrotropin-secreting pituitary adenoma KW - transsphenoidal surgery SP - 1462 EP - 73 JF - Journal of neurosurgery JO - J Neurosurg VL - 121 IS - 6 N2 - OBJECT: The aim of this study was to analyze clinicopathological characteristics and treatment outcomes in a large single-center clinical series of cases of thyrotropin (TSH)-secreting pituitary adenomas. METHODS: The authors retrospectively reviewed clinical, pathological, and treatment characteristics of 90 consecutive cases of TSH-secreting pituitary adenomas treated with transsphenoidal surgery between December 1991 and May 2013. The patient group included 47 females and 43 males (median age 42 years, range 11-74 years). RESULTS: Sixteen tumors (18%) were microadenomas and 74 (82%) were macroadenomas. Microadenomas were significantly more frequent in the more recent half of our case series (12 of 45 cases) (p = 0.0274). Cavernous sinus invasion was confirmed in 21 patients (23%). In 67 cases (74%), the tumors were firm elastic or hard in consistency. Acromegaly and hyperprolactinemia were observed, respectively, in 14 (16%) and 11 (12%) of the 90 cases. Euthyroidism was achieved in 40 (83%) of 48 patients and tumor shrinkage was found in 24 (55%) of 44 patients following preoperative somatostatin analog treatment. Conventional transsphenoidal surgery, extended transsphenoidal surgery, and a simultaneous combined supra- and infrasellar approach were performed in 85, 2, and 3 patients, respectively. Total removal with endocrinological remission was achieved in 76 (84%) of 90 patients, including all 16 (100%) patients with microadenomas, 60 (81%) of the 74 with macroadenomas, and 8 (38%) of the 21 with cavernous sinus invasion. None of these 76 patients experienced tumor recurrence during a median follow-up period of 2.8 years. Stratifying by Knosp grade, total removal with endocrinological remission was achieved in 34 of 36 patients with Knosp Grade 0 tumors, all 24 of those with Grade 1 tumors, 12 of the 14 with Grade 2 tumors, 6 of the 8 with Grade 3 tumors, and none of the 8 with Grade 4 tumors. Cavernous sinus invasion and tumor size were significant independent predictors of surgical outcome. Immunoreactivity for growth hormone, prolactin, or both hormones was present in 32, 9, and 24 patients, respectively. The Ki-67 labeling index was less than 3% in 71 (97%) of 73 tumors for which it was obtained and 3% or more in 2. Postsurgery pituitary dysfunction was found in 15 patients (17%) and delayed hyponatremia was seen in 9. CONCLUSIONS: TSH-secreting adenomas, particularly those in the microadenoma stage, have increased in frequency over the past 5 years. The high surgical success rate achieved in this series is due to relatively early diagnosis and relatively small tumor size. In addition, the surgical strategies used, such as extracapsular removal of hard or solid adenomas, aggressive resction of tumors with cavernous sinus invasion, or extended transsphenoidal surgery or a simultaneous combined approach for large/giant multilobulated adenomas, also may improve remission rate with a minimal incidence of complications. SN - 1933-0693 UR - https://www.unboundmedicine.com/medline/citation/25237847/Clinicopathological_characteristics_and_therapeutic_outcomes_in_thyrotropin_secreting_pituitary_adenomas:_a_single_center_study_of_90_cases_ L2 - https://thejns.org/doi/10.3171/2014.7.JNS1471 DB - PRIME DP - Unbound Medicine ER -