ICEECE2012 Poster Presentations Pituitary Clinical (183 abstracts)
Thyrotropin-secreting pituitary adenomas: experience of a single centre
E. Malchiodi 1, , G. Mantovani 1, , E. Ferrante 1, , E. Sala 1, , E. Verrua 1, , C. Giavoli 1, , E. Profka 1, , S. Bergamaschi 1, , M. Filopanti 1, , A. Lania 2, , A. Spada 1, & P. Beck-Peccoz 1,
1Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy; 2University of Milan, Milan, Italy; 3Istituto Clinico Humanitas, IRCCS, Milan, Italy.
Thyrotropin-secreting pituitary adenomas (TSH-omas) account for less than 1% of all pituitary adenomas. Here we report retrospective data of 17 patients (seven M and 10 F) with TSH-oma followed at our centre from 1990 to present. Median follow-up time was 9.7 years. The mean age at diagnosis was 43±12 years. Radiological evaluation revealed macroadenomas in 11 of 17 patients (71.6%). Macroadenomas were extrasellar in 58.4% of cases, while only one microadenoma had extrasellar extension. At baseline, TSH levels were measurable in all patients (4.8±3.2 μIU/ml) in the presence of elevated free thyroid hormones. Serum SHBG concentrations were in the hyperthyroid range in all patients. Serum α-GSU levels were normal in all microadenomas. All patients had abnormal TSH suppression during T3 administration but in three patients, serum TSH did not increase after TRH injection. A mixed GH/TSH secreting adenoma was observed in two patients, whereas a mixed gonadotropin/TSH adenoma was seen in one. In total, 16 patients were treated with trans-sphenoidal adenomactomy (TNS), 10 with somatostatin analogue (SSA) and six with radiotherapy (RT). About 35% of patients received one treatment, 24% two and 41% three. Combination of therapies were more frequent in macroadenomas (63%). At last follow-up nine patients (56%) were cured, three patients had normal free thyroid hormones but did not respond to TRH test, four patients were on SSA and one was recently treated with RT. Macroadenomas were cured in 45% of cases, 36% after TNS and 9% after TNS+RT, microadenomas in 80%, all after TNS alone. Last MRI was negative for residual/recurrence of adenoma in 11 patients. In conclusion, our series confirms the importance of T3 suppression test and measurement of serum SHBG for the diagnosis of TSH-omas and the efficacy of TNS surgery, in particular for microadenomas.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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