Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Thyroid-Stimulating Hormone-Secreting Pituitary Adenomas : Single Institutional Experience of 14 Consecutive Cases

  • Byun, Joonho (Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Jeong Hoon (Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Young-Hoon (Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Cho, Young Hyun (Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Hong, Seok Ho (Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Chang Jin (Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2019.08.05
  • Accepted : 2019.10.06
  • Published : 2020.07.01
Download PDF
⟨ Previous Next ⟩

Abstract

Objective : Thyroid-stimulating hormone (TSH)-secreting pituitary adenoma (PA) is an extremely rare functioning form of PA that accounts for 0.7-2% of all such cases. The previously reported outcomes of the surgical removal of TSH-PA are poor. Owing to its extremely low incidence, most available reports on TSH-PA are case reports or small case series. Thus, we investigated the clinical and endocrinological outcomes of surgically treated TSH-PA through our institutional series. Methods : We retrospectively reviewed 14 consecutive cases of surgically treated TSH-PA, focusing on the clinical, radiological, surgical, and endocrinological data. Results : There were seven male (50%) and seven female (50%) patients. The mean age was 42.5 years (range, 19-63). The mean tumor size was 16.6 mm (range, 4-30). Optic chiasm compression was noted in six patients (42.9%), and no patient showed cavernous sinus invasion. Thirteen of 14 patients (92.8%) underwent transnasal transsphenoidal approach (TSA), and one patient underwent TSA followed by transcranial approach for residual tumor removal. Thirteen of 14 patients (92.8%) showed endocrinological remission; all patients who experienced remission showed subnormal levels of TSH (<0.4 μU/mL) on postoperative day 2. Recurrence occurred in two patients (14.2%). One patient underwent subsequent revision transnasal TSA for recurrent tumor removal, and the other patient underwent gamma knife radiosurgery for recurrence. Conclusion : Surgical treatment showed excellent surgical outcomes. The TSH level in the immediate postoperative period may be a predictor for endocrinological remission.

Keywords

References

  1. Beck-Peccoz P, Lania A, Beckers A, Chatterjee K, Wemeau JL : 2013 European thyroid association guidelines for the diagnosis and treatment of thyrotropin-secreting pituitary tumors. Eur Thyroid J 2 : 76-82, 2013 https://doi.org/10.1159/000351007
  2. Beck-Peccoz P, Persani L : Medical management of thyrotropin-secreting pituitary adenomas. Pituitary 5 : 83-88, 2002 https://doi.org/10.1023/A:1022360414062
  3. Brucker-Davis F, Oldfield EH, Skarulis MC, Doppman JL, Weintraub BD : Thyrotropin-secreting pituitary tumors: diagnostic criteria, thyroid hormone sensitivity, and treatment outcome in 25 patients followed at the National Institutes of Health. J Clin Endocrinol Metab 84 : 476-486, 1999 https://doi.org/10.1210/jc.84.2.476
  4. Ezzat S, Horvath E, Kovacs K, Smyth HS, Singer W, Asa SL : Basic fibroblast growth factor expression by two prolactin and thyrotropinproducing pituitary adenomas. Endocr Pathol 6 : 125-134, 1995 https://doi.org/10.1007/BF02739875
  5. Hughes JD, Young WF, Chang AY, Link MJ, Garces YI, Laack NN, et al. : Radiosurgical management of patients with persistent or recurrent cushing disease after prior transsphenoidal surgery: a management algorithm based on a 25-year experience. Neurosurgery 86 : 557-564, 2020
  6. Knosp E, Steiner E, Kitz K, Matula C : Pituitary adenomas with invasion of the cavernous sinus space: a magnetic resonance imaging classification compared with surgical findings. Neurosurgery 33 : 610-617; discussion 617-618, 1993 https://doi.org/10.1097/00006123-199310000-00008
  7. Macchia E, Gasperi M, Lombardi M, Morselli L, Pinchera A, Acerbi G, et al. : Clinical aspects and therapeutic outcome in thyrotropin-secreting pituitary adenomas: a single center experience. J Endocrinol Invest 32 : 773-779, 2009 https://doi.org/10.1007/BF03346535
  8. Micko AS, Wohrer A, Wolfsberger S, Knosp E : Invasion of the cavernous sinus space in pituitary adenomas: endoscopic verification and its correlation with an MRI-based classification. J Neurosurg 122 : 803-811, 2015 https://doi.org/10.3171/2014.12.JNS141083
  9. Minniti G, Osti MF, Niyazi M : Target delineation and optimal radiosurgical dose for pituitary tumors. Radiat Oncol 11 : 135, 2016 https://doi.org/10.1186/s13014-016-0710-y
  10. Minnitia G, Clarkea E, Scaringia C, Enrici RM : Stereotactic radiotherapy and radiosurgery for non-functioning and secreting pituitary adenomas. Rep Pract Oncol Radiother 21 : 370-378, 2016 https://doi.org/10.1016/j.rpor.2014.09.004
  11. Mouslech Z, Somali M, Sakali AK, Savopoulos C, Mastorakos G, Hatzitolios AI : TSH-secreting pituitary adenomas treated by gamma knife radiosurgery: our case experience and a review of the literature. Hormones (Athens) 15 : 122-128, 2016 https://doi.org/10.1007/bf03401412
  12. Mouslech Z, Somali M, Sakali AK, Savopoulos C, Mastorakos G, Hatzitolios AI : TSH-secreting pituitary adenomas treated by gamma knife radiosurgery: our case experience and a review of the literature. Hormones 15 : 122-128, 2016 https://doi.org/10.1007/bf03401412
  13. Onnestam L, Berinder K, Burman P, Dahlqvist P, EdenEngstrom B, Wahlberg J, et al. : National incidence and prevalence of TSH-secreting pituitary adenomas in Sweden. J Clin Endocrinol Metab 98 : 626-635, 2013 https://doi.org/10.1210/jc.2012-3362
  14. Ostrom QT, Gittleman H, Fulop J, Liu M, Blanda R, Kromer C, et al. : CBTRUS statistical report: primary brain and central nervous system tumors diagnosed in the United States in 2008-2012. Neuro Oncol 17 Suppl 4 : iv1-iv62, 2015 https://doi.org/10.1093/neuonc/nov189
  15. Palace MR : Perioperative management of thyroid dysfunction. Health Serv Insights 10 : 1178632916689677, 2017
  16. Rotermund R, Riedel N, Burkhardt T, Matschke J, Schmidt N-O, Aberle J, et al. : Surgical treatment and outcome of TSH-producing pituitary adenomas. Acta Neurochir (Wien) 159 : 1219-1226, 2017 https://doi.org/10.1007/s00701-017-3105-4
  17. Sanno N, Teramoto A, Osamura RY : Long-term surgical outcome in 16 patients with thyrotropin pituitary adenoma. J Neurosurg 93 : 194-200, 2000 https://doi.org/10.3171/jns.2000.93.2.0194
  18. Tjornstrand A, Gunnarsson K, Evert M, Holmberg E, Ragnarsson O, Rosen T, et al. : The incidence rate of pituitary adenomas in western Sweden for the period 2001-2011. Eur J Endocrinol 171 : 519-526, 2014 https://doi.org/10.1530/EJE-14-0144
  19. Tjornstrand A, Nystrom HF : Diagnostic approach to TSH-producing pituitary adenoma. Eur J Endocrinol 177 : R183-R197, 2017 https://doi.org/10.1530/EJE-16-1029
  20. Yamada S, Fukuhara N, Horiguchi K, Yamaguchi-Okada M, Nishioka H, Takeshita A, et al. : Clinicopathological characteristics and therapeutic outcomes in thyrotropin-secreting pituitary adenomas: a single-center study of 90 cases. J Neurosurg 121 : 1462-1473, 2014 https://doi.org/10.3171/2014.7.JNS1471
  21. Zhao W, Ye H, Li Y, Zhou L, Lu B, Zhang S, et al. : Thyrotropin-secreting pituitary adenomas: diagnosis and management of patients from one Chinese center. Wien Klin Wochenschr 124 : 678-684, 2012 https://doi.org/10.1007/s00508-012-0216-z