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Endocrine Abstracts (2016) 41 OC13.4 | DOI: 10.1530/endoabs.41.OC13.4

ECE2016 Oral Communications Pituitary Clinical (5 abstracts)

Diagnosis and management of thyrotropin-secreting pituitary tumors: a single center experience with a long-term follow-up of 30 patients

Oana-Maria Capraru 1 , Celine Gaillard 2 , Alexandre Vasiljevic 3 , Veronique Raverot 4 , Françoise Borson-Chazot 5 , Emmanuel Jouanneau 6 & Gerald Raverot 5

1University of Medicine and Pharmacy, Department of Physiology, Targu Mures, Targu Mures, Romania; 2Service d’Endocrinologie, Groupement Hospitalier Sud, Hospices Civils de Lyon, Lyon, France; 3Service d’Anatomopathologie, Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon, France; 4Centre de Biologie, Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon, France; 5Federation d’Endocrinologie, Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon, France; 6Service de Neurochirurgie, Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon, France.

TSH secreting pituitary adenomas are rare tumours for which the treatment of choice is neurosurgery but in some cases medical treatment with somatostatin analogs (SSA) can lead to a good control of symptoms and shrinkage of the tumour.

The objective of this study was to review 30 patients diagnosed with TSH-omas between October 1981–July 2014, followed-up for a median of 43.93 months (1.12–192.11) in our University Hospital from Lyon, France.

The median age was 49 years, 73% of the patients were females. Fourteen patients presented signs and symptoms of hyperthyroidism, nine presented signs of a pituitary tumour. Before diagnosis, 2 patients undergone thyroidectomy and one received radioactive iodine. The median delay until positive diagnosis of TSH-oma was 18 months (2–264). Biochemical hyperthyroidism was found in 22 patients, alpha subunit was above upper normal limit in 77.7% of patients, nine patients presented hyperprolactinemia and 3 were also diagnosed with acromegaly. In 80% of cases, the tumours were macroadenomas with a median diameter of 13.2 mm. Fourteen adenomas had suprasellar extension, cavernous sinus invasion was present in 26.6% (n=8) of cases and 13.3% (n=4) of cases presented with sphenoid sinus invasion.

Ten patients were treated with SSA that lead to adequate control of the disease in 4 cases. In other six patients, SSA therapy was followed by surgery after achieving euthyroidism (n=3) or because of side effects (n=3). After a median follow-up of 45.63 months (2.3–190.82) after surgery of 26 patients, 78.9% (n=15) were in complete remission, 3 with macroadenomas had persistent disease controlled by medical treatment (SSA or SSA and GHRA) and one patient with a macroadenoma was controlled after pituitary radiotherapy and SSA while 7 patients were lost during follow-up.

In conclusion, neurosurgery should be first line therapy for microadenomas, while SSA treatment could be used for invasive macroadenomas.

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