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Primary Medical Treatment of Thyrotropin-Secreting Pituitary Adenomas by First-Generation Somatostatin Analogs: A Case Study of Seven Patients.
Thyroid. 2015 Aug; 25(8):877-82.T

Abstract

BACKGROUND

The first-choice treatment of thyrotropin (TSH)-secreting pituitary adenomas is surgical adenomectomy, with 40-60% of patients cured after surgery. The presence of somatostatin receptors on the adenomatous cells suggests that first-generation somatostatin analogs (octreotide, lanreotide) could be used as an adjuvant treatment to surgery for TSH-secreting pituitary adenomas. The aim of this study is to describe the efficacy and safety of primary medical treatment with first-generation somatostatin analogs in patients with a TSH-secreting pituitary adenoma.

METHODS

Retrospective study on 7 patients (5 women, 2 men) aged 57±14 years with pure TSH (n=4) or mixed TSH/GH (n=3) secreting pituitary adenomas primarily treated with first generation somatostatin analogs. Magnetic resonance imaging revealed a microadenoma in 3 patients and a macroadenoma in 4 patients. The follow-up period was 8.5±7.3 years.

RESULTS

At initial diagnosis, the patients presented with thyrotoxicosis with elevated free thyroxine (26.5±6.5 pg/mL) and free triiodothyronine (7.3±0.9 pg/mL) levels and a mean TSH of 4.3±1.4 mU/L. During somatostatin analog treatment, free thyroid hormones and TSH levels normalized after 4.4±3.9 and 7.0±8.4 months, respectively. At the time of the last visit, 6 patients were biochemically controlled. Adenoma volume decreased in 6 patients and a decrease in adenoma volume persisted in 2 patients several years after initiation of somatostatin analog treatment. Safety of treatment was good and no patients discontinued somatostatin analogs due to side effects.

CONCLUSION

This study confirms the efficacy of primary medical treatment with first-generation somatostatin analogs in terms of hormonal control and tumor volume reduction in patients with TSH-secreting pituitary adenomas, and its good safety profile. First-generation somatostatin analogs may serve as a medical alternative to surgical treatment, especially in patients where surgery is contraindicated or in subjects presenting with invasive macroadenomas that render complete surgical resection difficult.

Authors+Show Affiliations

1 Department of Endocrinology and Metabolic Diseases , Larrey Centre Hospitalo-Universitaire, Toulouse, France .1 Department of Endocrinology and Metabolic Diseases , Larrey Centre Hospitalo-Universitaire, Toulouse, France .1 Department of Endocrinology and Metabolic Diseases , Larrey Centre Hospitalo-Universitaire, Toulouse, France .2 Department of Neuroradiology , Purpan Centre Hospitalo-Universitaire, Toulouse, France .1 Department of Endocrinology and Metabolic Diseases , Larrey Centre Hospitalo-Universitaire, Toulouse, France .2 Department of Neuroradiology , Purpan Centre Hospitalo-Universitaire, Toulouse, France .

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

26244412

Citation

Rimareix, Frédérique, et al. "Primary Medical Treatment of Thyrotropin-Secreting Pituitary Adenomas By First-Generation Somatostatin Analogs: a Case Study of Seven Patients." Thyroid : Official Journal of the American Thyroid Association, vol. 25, no. 8, 2015, pp. 877-82.
Rimareix F, Grunenwald S, Vezzosi D, et al. Primary Medical Treatment of Thyrotropin-Secreting Pituitary Adenomas by First-Generation Somatostatin Analogs: A Case Study of Seven Patients. Thyroid. 2015;25(8):877-82.
Rimareix, F., Grunenwald, S., Vezzosi, D., Rivière, L. D., Bennet, A., & Caron, P. (2015). Primary Medical Treatment of Thyrotropin-Secreting Pituitary Adenomas by First-Generation Somatostatin Analogs: A Case Study of Seven Patients. Thyroid : Official Journal of the American Thyroid Association, 25(8), 877-82. https://doi.org/10.1089/thy.2015.0041
Rimareix F, et al. Primary Medical Treatment of Thyrotropin-Secreting Pituitary Adenomas By First-Generation Somatostatin Analogs: a Case Study of Seven Patients. Thyroid. 2015;25(8):877-82. PubMed PMID: 26244412.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Primary Medical Treatment of Thyrotropin-Secreting Pituitary Adenomas by First-Generation Somatostatin Analogs: A Case Study of Seven Patients. AU - Rimareix,Frédérique, AU - Grunenwald,Solange, AU - Vezzosi,Delphine, AU - Rivière,Louis-David, AU - Bennet,Antoine, AU - Caron,Philippe, PY - 2015/8/6/entrez PY - 2015/8/6/pubmed PY - 2016/6/2/medline SP - 877 EP - 82 JF - Thyroid : official journal of the American Thyroid Association JO - Thyroid VL - 25 IS - 8 N2 - BACKGROUND: The first-choice treatment of thyrotropin (TSH)-secreting pituitary adenomas is surgical adenomectomy, with 40-60% of patients cured after surgery. The presence of somatostatin receptors on the adenomatous cells suggests that first-generation somatostatin analogs (octreotide, lanreotide) could be used as an adjuvant treatment to surgery for TSH-secreting pituitary adenomas. The aim of this study is to describe the efficacy and safety of primary medical treatment with first-generation somatostatin analogs in patients with a TSH-secreting pituitary adenoma. METHODS: Retrospective study on 7 patients (5 women, 2 men) aged 57±14 years with pure TSH (n=4) or mixed TSH/GH (n=3) secreting pituitary adenomas primarily treated with first generation somatostatin analogs. Magnetic resonance imaging revealed a microadenoma in 3 patients and a macroadenoma in 4 patients. The follow-up period was 8.5±7.3 years. RESULTS: At initial diagnosis, the patients presented with thyrotoxicosis with elevated free thyroxine (26.5±6.5 pg/mL) and free triiodothyronine (7.3±0.9 pg/mL) levels and a mean TSH of 4.3±1.4 mU/L. During somatostatin analog treatment, free thyroid hormones and TSH levels normalized after 4.4±3.9 and 7.0±8.4 months, respectively. At the time of the last visit, 6 patients were biochemically controlled. Adenoma volume decreased in 6 patients and a decrease in adenoma volume persisted in 2 patients several years after initiation of somatostatin analog treatment. Safety of treatment was good and no patients discontinued somatostatin analogs due to side effects. CONCLUSION: This study confirms the efficacy of primary medical treatment with first-generation somatostatin analogs in terms of hormonal control and tumor volume reduction in patients with TSH-secreting pituitary adenomas, and its good safety profile. First-generation somatostatin analogs may serve as a medical alternative to surgical treatment, especially in patients where surgery is contraindicated or in subjects presenting with invasive macroadenomas that render complete surgical resection difficult. SN - 1557-9077 UR - https://www.unboundmedicine.com/medline/citation/26244412/Primary_Medical_Treatment_of_Thyrotropin_Secreting_Pituitary_Adenomas_by_First_Generation_Somatostatin_Analogs:_A_Case_Study_of_Seven_Patients_ L2 - https://www.liebertpub.com/doi/10.1089/thy.2015.0041?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -