The changing spectrum of TSH-secreting pituitary adenomas: diagnosis and management in 43 patients

• DOI: 10.1530/eje.0.1480433
• Publication Date: 2005-01-24T21:34:41Z
• Authors: HV Socin; P Chanson; B Delemer; A Tabarin; V Rohmer; J Mockel; A Stevenaert; A Beckers
• Keywords: Adenoma; Adult; Male; Antineoplastic Agents, Hormonal; Octreotide; Hyperthyroidism; 03 medical and health sciences; 0302 clinical medicine; Métabolisme; Belgium; Multiple Endocrine Neoplasia Type 1; Humans; Pituitary Neoplasms; Insulin-Like Growth Factor I; Aged; Aged, 80 and over; Diabétologie; Middle Aged; Magnetic Resonance Imaging; Endocrinologie; 3. Good health; Hyperprolactinemia; Acromegaly; Mutation; Female; France

Our aim was to report the recent changes in diagnosis and management of TSH-secreting pituitary adenomas.We retrieved 43 consecutive patients with tumors (23 male 20 female) among 4400 adenomas followed between 1976 2001 six Belgian French centers.TSH elevated 18/43 alpha subunit 13/32 patients. In intact thyroid (n=30), mean free tri-iodothyronine 13.1 pmol/l (range 3.5-23) thyroxine 38.4 10.2-62.7). Hyperprolactinemia acromegaly were associated 9/43 8/43 cases. The number hypersecretions higher macroadenomas than microadenomas (Chi square = 11.2, P<0.01). Two women had sporadic multiple endocrine neoplasia type 1-associated syndrome. proportion versus 1/11 (period 1974-1986) 8/32 1987-2001). Bilateral petrosal sinus sampling, (111)In-pentreotide scintigraphy ((11)C)-l-methionine positron emission tomography scan confirmed four questionable microadenomas. Macroadenomas extrasellar extension (31 cases) a tendency be medially located. Medical treatment somatostatin analogs initiated as first-line 26 TSH levels reduced by more 50% 23/26 A tumoral shrinkage 20% observed 5/13 Surgery performed 36 After 1 year, 21 them (58.3%) met criteria surgical favorable outcome. Pituitary radiotherapy (n=8) allowed normalization cases not cured surgery.Ultrasensitive methods for measurement led an earlier recognition tumors. this series, we that are today frequently found at stage microadenomas, located, without needing new exploration compared older series. This changing spectrum presentation excellent response has been accompanied improvement prognosis disease.