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Surgical Outcome and Treatment of Thyrotropin-Secreting Pituitary Tumors in a Tertiary Referral Center.
World Neurosurg. 2019 Oct; 130:e634-e639.WN

Abstract

OBJECTIVE

Thyrotropin (TSH)-secreting pituitary tumors are rare and typically present with hyperthyroidism. Here we report the diagnosis, treatment, and surgical outcomes in a series of patients with TSH-secreting pituitary tumors in a tertiary referral center.

METHODS

Descriptive retrospective study that included all patients with TSH-secreting pituitary tumors who underwent transsphenoidal surgery in the endocrinology and nutrition unit of the Virgen del Rocío University Hospital (Seville, Spain) between 2004 and 2016.

RESULTS

The mean age at diagnosis was 42.8 ± 17 years. The mean time from onset of symptoms to diagnosis was 13 ± 10 months. Four patients displayed symptoms indicating hyperthyroidism (1 suffered from tachycardia); 3 patients showed symptoms because of mass effect (visual impairment and headache) and 3 patients were diagnosed based on incidental findings after routine blood tests (high free thyroxine levels). Eight patients had macroadenomas, and 2 patients had microadenomas. Five patients underwent conventional pituitary surgery, and 5 patients underwent expanded endoscopic transsphenoidal surgery. Six patients achieved cure after surgery. The other patients received radiotherapy and/or treatment with somatostatin analogs. Analysis of somatostatin receptor (SSTR) expression by immunohistochemistry could be performed in 6 tumors.

CONCLUSIONS

Our results confirm the clinical and hormonal heterogeneity caused by TSH-secreting pituitary adenomas. Surgery is considered the first choice of treatment for these tumors. We observed surgical cure rates similar to those reported in recent published series. SSTR2 and SSTR3 are highly expressed in TSH-secreting pituitary adenomas. Our results suggest that somatostatin analog treatment may be also helpful in the treatment of TSH-secreting pituitary adenomas.

Authors+Show Affiliations

Unidad de Gestión de Endocrinología y Nutrición, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain.Unidad de Gestión de Endocrinología y Nutrición, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain.Unidad de Gestión de Endocrinología y Nutrición, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain.Unidad de Gestión de Endocrinología y Nutrición, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain.Unidad de Gestión de Endocrinología y Nutrición, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain.Unidad de Gestión de Endocrinología y Nutrición, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain.Unidad de Gestión de Endocrinología y Nutrición, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain.Servicios de Radiología, Hospital Universitario Virgen del Rocío, Sevilla, Spain.Servicios de Radiología, Hospital Universitario Virgen del Rocío, Sevilla, Spain.Servicios de Neurocirugía, Hospital Universitario Virgen del Rocío, Sevilla, Spain.Servicios de Neurocirugía, Hospital Universitario Virgen del Rocío, Sevilla, Spain.Servicios de Neurocirugía, Hospital Universitario Virgen del Rocío, Sevilla, Spain.Unidad de Gestión de Endocrinología y Nutrición, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain.Unidad de Gestión de Endocrinología y Nutrición, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain. Electronic address: alfonsom.soto.sspa@juntadeandalucia.es.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31276853

Citation

Herguido, Noelia Gros, et al. "Surgical Outcome and Treatment of Thyrotropin-Secreting Pituitary Tumors in a Tertiary Referral Center." World Neurosurgery, vol. 130, 2019, pp. e634-e639.
Herguido NG, Fuentes ED, Venegas-Moreno E, et al. Surgical Outcome and Treatment of Thyrotropin-Secreting Pituitary Tumors in a Tertiary Referral Center. World Neurosurg. 2019;130:e634-e639.
Herguido, N. G., Fuentes, E. D., Venegas-Moreno, E., Maorad, L. B., Flores-Martinez, A., Ruiz, P. R., Dueñas, M. C., Roldán, F., Fajardo, E., Ruiz-Valdepeñas, E. C., Kaen, A., Martín Schrader, I., Cano, D. A., & Soto-Moreno, A. (2019). Surgical Outcome and Treatment of Thyrotropin-Secreting Pituitary Tumors in a Tertiary Referral Center. World Neurosurgery, 130, e634-e639. https://doi.org/10.1016/j.wneu.2019.06.180
Herguido NG, et al. Surgical Outcome and Treatment of Thyrotropin-Secreting Pituitary Tumors in a Tertiary Referral Center. World Neurosurg. 2019;130:e634-e639. PubMed PMID: 31276853.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Surgical Outcome and Treatment of Thyrotropin-Secreting Pituitary Tumors in a Tertiary Referral Center. AU - Herguido,Noelia Gros, AU - Fuentes,Elena Dios, AU - Venegas-Moreno,Eva, AU - Maorad,Laura Borau, AU - Flores-Martinez,Alvaro, AU - Ruiz,Pablo Remón, AU - Dueñas,Miriam Cózar, AU - Roldán,Florinda, AU - Fajardo,Elena, AU - Ruiz-Valdepeñas,Eugenio Cárdenas, AU - Kaen,Ariel, AU - Martín Schrader,Ignacio, AU - Cano,David A, AU - Soto-Moreno,Alfonso, Y1 - 2019/07/02/ PY - 2019/04/06/received PY - 2019/06/23/revised PY - 2019/06/24/accepted PY - 2019/7/6/pubmed PY - 2020/1/21/medline PY - 2019/7/6/entrez KW - SSTRs KW - Somatostatin receptors KW - TSH-Secreting pituitary tumors SP - e634 EP - e639 JF - World neurosurgery JO - World Neurosurg VL - 130 N2 - OBJECTIVE: Thyrotropin (TSH)-secreting pituitary tumors are rare and typically present with hyperthyroidism. Here we report the diagnosis, treatment, and surgical outcomes in a series of patients with TSH-secreting pituitary tumors in a tertiary referral center. METHODS: Descriptive retrospective study that included all patients with TSH-secreting pituitary tumors who underwent transsphenoidal surgery in the endocrinology and nutrition unit of the Virgen del Rocío University Hospital (Seville, Spain) between 2004 and 2016. RESULTS: The mean age at diagnosis was 42.8 ± 17 years. The mean time from onset of symptoms to diagnosis was 13 ± 10 months. Four patients displayed symptoms indicating hyperthyroidism (1 suffered from tachycardia); 3 patients showed symptoms because of mass effect (visual impairment and headache) and 3 patients were diagnosed based on incidental findings after routine blood tests (high free thyroxine levels). Eight patients had macroadenomas, and 2 patients had microadenomas. Five patients underwent conventional pituitary surgery, and 5 patients underwent expanded endoscopic transsphenoidal surgery. Six patients achieved cure after surgery. The other patients received radiotherapy and/or treatment with somatostatin analogs. Analysis of somatostatin receptor (SSTR) expression by immunohistochemistry could be performed in 6 tumors. CONCLUSIONS: Our results confirm the clinical and hormonal heterogeneity caused by TSH-secreting pituitary adenomas. Surgery is considered the first choice of treatment for these tumors. We observed surgical cure rates similar to those reported in recent published series. SSTR2 and SSTR3 are highly expressed in TSH-secreting pituitary adenomas. Our results suggest that somatostatin analog treatment may be also helpful in the treatment of TSH-secreting pituitary adenomas. SN - 1878-8769 UR - https://www.unboundmedicine.com/medline/citation/31276853/Surgical_Outcome_and_Treatment_of_Thyrotropin_Secreting_Pituitary_Tumors_in_a_Tertiary_Referral_Center_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1878-8750(19)31837-6 DB - PRIME DP - Unbound Medicine ER -