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01-02-2019

Thyrotropin-secreting pituitary adenomas: a systematic review and meta-analysis of postoperative outcomes and management

Authors: Giulia Cossu, Roy Thomas Daniel, Katarzyna Pierzchala, Moncef Berhouma, Nelly Pitteloud, Faiza Lamine, Annamaria Colao, Mahmoud Messerer

Published in: Pituitary | Issue 1/2019

Abstract

Purpose

TSH-secreting pituitary adenomas are rare pituitary tumors. An efficient treatment is essential to limit the mortality and morbidity in untreated patients. The aim of this study is to summarize the evidence about the postoperative outcomes and management of this rare pathology.

Methods

A systematic search and meta-analysis of surgical series was performed.

Results

Our analysis included 23 articles (536 patients). No sex difference was observed and mean age at diagnosis was 45 years. Hyperthyroidism was reportedly clinical in 67% and biochemical in 90% of patients. Co-secretion of other pituitary hormones was present in 42% of cases. Macroadenomas were found in 79% of patients, showing in 44% and 30% of cases respectively extrasellar extension and cavernous sinus invasion. The pooled rate of postoperative biochemical remission was 69.7% and a gross total resection (GTR) was observed in 54% of patients. The extent of resection was significantly increased in microadenomas (p < 0.001) and cavernous sinus invasion was predictive of lower GTR rate (p < 0.001). A biochemical remission was achieved in 66% of patients after adjuvant radiation therapy and in 76% after adjuvant medical treatment. The combination of both allowed remission in 67% of cases. At final follow-up the overall biochemical remission rate was significantly improved (85.8%) when compared to the postoperative biochemical remission (p < 0.001).

Conclusion

When compared to the early postoperative period, at last follow-up biochemical remission was significantly greater (p < 0.001). GTR was achieved in half of patients; the size of tumor and cavernous sinus invasion determined the extent of resection.

Beck-Peccoz P, Brucker-Davis F, Persani L, Smallridge RC, Weintraub BD (1996) Thyrotropin-secreting pituitary tumors. Endocr Rev 17:610–638PubMed

Onnestam L, Berinder K, Burman P, Dahlqvist P, Engstrom BE et al (2013) National incidence and prevalence of TSH-secreting pituitary adenomas in Sweden. J Clin Endocrinol Metab 98:626–635CrossRefPubMed

Tjornstrand A, Gunnarsson K, Evert M, Holmberg E, Ragnarsson O et al (2014) The incidence rate of pituitary adenomas in western Sweden for the period 2001–2011. Eur J Endocrinol 171:519–526CrossRefPubMed

Dong Q, Brucker-Davis F, Weintraub BD, Smallridge RC, Carr FE et al (1996) Screening of candidate oncogenes in human thyrotroph tumors: absence of activating mutations of the G alpha q, G alpha 11, G alpha s, or thyrotropin-releasing hormone receptor genes. J Clin Endocrinol Metab 81:1134–1140PubMed

Herman V, Drazin NZ, Gonsky R, Melmed S (1993) Molecular screening of pituitary adenomas for gene mutations and rearrangements. J Clin Endocrinol Metab 77:50–55PubMed

Minematsu T, Miyai S, Kajiya H, Suzuki M, Sanno N et al (2005) Recent progress in studies of pituitary tumor pathogenesis. Endocrine 28:37–41CrossRefPubMed

Tagami T, Usui T, Shimatsu A, Beniko M, Yamamoto H et al (2011) Aberrant expression of thyroid hormone receptor beta isoform may cause inappropriate secretion of TSH in a TSH-secreting pituitary adenoma. J Clin Endocrinol Metab 96:E948–E952CrossRefPubMed

Ando S, Sarlis NJ, Oldfield EH, Yen PM (2001) Somatic mutation of TRbeta can cause a defect in negative regulation of TSH in a TSH-secreting pituitary tumor. J Clin Endocrinol Metab 86:5572–5576PubMed

Gittoes NJ, McCabe CJ, Verhaeg J, Sheppard MC, Franklyn JA (1998) An abnormality of thyroid hormone receptor expression may explain abnormal thyrotropin production in thyrotropin-secreting pituitary tumors. Thyroid 8:9–14CrossRefPubMed

10.

Klein I, Ojamaa K (2001) Thyroid hormone and the cardiovascular system. N Engl J Med 344:501–509CrossRefPubMed

11.

Malchiodi E, Profka E, Ferrante E, Sala E, Verrua E et al (2014) Thyrotropin-secreting pituitary adenomas: outcome of pituitary surgery and irradiation. J Clin Endocrinol Metab 99:2069–2076CrossRefPubMed

12.

Yamada S, Fukuhara N, Horiguchi K, Yamaguchi-Okada M, Nishioka H et al (2014) Clinicopathological characteristics and therapeutic outcomes in thyrotropin-secreting pituitary adenomas: a single-center study of 90 cases. J Neurosurg 121:1462–1473CrossRefPubMed

13.

Azzalin A, Appin CL, Schniederjan MJ, Constantin T, Ritchie JC et al (2016) Comprehensive evaluation of thyrotropinomas: single-center 20-year experience. Pituitary 19:183–193CrossRefPubMed

14.

Marucci G, Faustini-Fustini M, Righi A, Pasquini E, Frank G et al (2009) Thyrotropin-secreting pituitary tumours: significance of “atypical adenomas” in a series of 10 patients and association with Hashimoto thyroiditis as a cause of delay in diagnosis. J Clin Pathol 62:455–459CrossRefPubMed

15.

van Varsseveld NC, Bisschop PH, Biermasz NR, Pereira AM, Fliers E et al (2014) A long-term follow-up study of eighteen patients with thyrotrophin-secreting pituitary adenomas. Clin Endocrinol 80:395–402CrossRef

16.

Socin HV, Chanson P, Delemer B, Tabarin A, Rohmer V et al (2003) The changing spectrum of TSH-secreting pituitary adenomas: diagnosis and management in 43 patients. Eur J Endocrinol 148:433–442CrossRefPubMed

17.

Brucker-Davis F, Oldfield EH, Skarulis MC, Doppman JL, Weintraub BD (1999) 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 84:476–486CrossRefPubMed

18.

Losa M, Giovanelli M, Persani L, Mortini P, Faglia G et al (1996) Criteria of cure and follow-up of central hyperthyroidism due to thyrotropin-secreting pituitary adenomas. J Clin Endocrinol Metab 81:3084–3090PubMed

19.

Elston MS, Conaglen JV (2010) Clinical and biochemical characteristics of patients with thyroid-stimulating hormone-secreting pituitary adenomas from one New Zealand centre. Intern Med J 40:214–219CrossRefPubMed

20.

Rotermund R, Riedel N, Burkhardt T, Matschke J, Schmidt NO et al (2017) Surgical treatment and outcome of TSH-producing pituitary adenomas. Acta Neurochir 159:1219–1226CrossRefPubMed

21.

Beck-Peccoz P, Lania A, Beckers A, Chatterjee K, Wemeau JL (2013) 2013 European thyroid association guidelines for the diagnosis and treatment of thyrotropin-secreting pituitary tumors. Eur Thyroid J 2:76–82CrossRefPubMedPubMedCentral

22.

Kuhn JM, Arlot S, Lefebvre H, Caron P, Cortet-Rudelli C et al (2000) Evaluation of the treatment of thyrotropin-secreting pituitary adenomas with a slow release formulation of the somatostatin analog lanreotide. J Clin Endocrinol Metab 85:1487–1491CrossRefPubMed

23.

Caron P, Arlot S, Bauters C, Chanson P, Kuhn JM et al (2001) Efficacy of the long-acting octreotide formulation (octreotide-LAR) in patients with thyrotropin-secreting pituitary adenomas. J Clin Endocrinol Metab 86:2849–2853CrossRefPubMed

24.

Colao A (2015) Treatment of pituitary tumours in 2014: advances in therapy of adenomas secreting GH, ACTH and TSH. Nat Rev Endocrinol 11:73–74CrossRefPubMed

25.

Colao A, Pivonello R, Di Somma C, Savastano S, Grasso LF et al (2009) Medical therapy of pituitary adenomas: effects on tumor shrinkage. Rev Endocr Metab Disord 10:111–123CrossRefPubMed

26.

Colao A, Filippella M, Pivonello R, Di Somma C, Faggiano A et al (2007) Combined therapy of somatostatin analogues and dopamine agonists in the treatment of pituitary tumours. Eur J Endocrinol 156(Suppl 1):S57–S63CrossRefPubMed

27.

Colao A, Filippella M, Di Somma C, Manzi S, Rota F et al (2003) Somatostatin analogs in treatment of non-growth hormone-secreting pituitary adenomas. Endocrine 20:279–283CrossRefPubMed

28.

Astaf’eva LI, Kadashev BA, Shishkina LV, Kalinin PL, Fomichev DV et al (2016) Clinical and morphological characteristics, diagnostic criteria, and outcomes of surgical treatment of TSH-secreting pituitary adenomas. Zh Vopr Neirokhir Im N N Burdenko 80:24–35CrossRefPubMed

29.

Beckers A, Stevenaert A, Foidart JM, Hennen G, Frankenne F (1990) Placental and pituitary growth hormone secretion during pregnancy in acromegalic women. J Clin Endocrinol Metab 71:725–731CrossRefPubMed

30.

Clarke MJ, Erickson D, Castro MR, Atkinson JL (2008) Thyroid-stimulating hormone pituitary adenomas. J Neurosurg 109:17–22CrossRefPubMed

31.

Gatto F, Grasso LF, Nazzari E, Cuny T, Anania P et al (2015) Clinical outcome and evidence of high rate post-surgical anterior hypopituitarism in a cohort of TSH-secreting adenoma patients: might somatostatin analogs have a role as first-line therapy? Pituitary 18:583–591CrossRefPubMed

32.

Kirkman MA, Jaunmuktane Z, Brandner S, Khan AA, Powell M et al (2014) Active and silent thyroid-stimulating hormone-expressing pituitary adenomas: presenting symptoms, treatment, outcomes, and recurrence. World Neurosurg 82:1224–1231CrossRefPubMed

33.

Losa M, Mortini P, Franzin A, Barzaghi R, Mandelli C et al (1999) Surgical management of thyrotropin-secreting pituitary adenomas. Pituitary 2:127–131CrossRefPubMed

34.

Macchia E, Gasperi M, Lombardi M, Morselli L, Pinchera A et al (2009) Clinical aspects and therapeutic outcome in thyrotropin-secreting pituitary adenomas: a single center experience. J Endocrinol Invest 32:773–779CrossRefPubMed

35.

Mindermann T, Wilson CB (1993) Thyrotropin-producing pituitary adenomas. J Neurosurg 79:521–527CrossRefPubMed

36.

Ness-Abramof R, Ishay A, Harel G, Sylvetzky N, Baron E et al (2007) TSH-secreting pituitary adenomas: follow-up of 11 cases and review of the literature. Pituitary 10:307–310CrossRefPubMed

37.

Sanno N, Teramoto A, Osamura RY (2000) Long-term surgical outcome in 16 patients with thyrotropin pituitary adenoma. J Neurosurg 93:194–200CrossRefPubMed

38.

Wu YY, Chang HY, Lin JD, Chen KW, Huang YY et al (2003) Clinical characteristics of patients with thyrotropin-secreting pituitary adenoma. J Formos Med Assoc 102:164–171PubMed

39.

Wynne AG, Gharib H, Scheithauer BW, Davis DH, Freeman SL et al (1992) Hyperthyroidism due to inappropriate secretion of thyrotropin in 10 patients. Am J Med 92:15–24CrossRefPubMed

40.

Zhao W, Ye H, Li Y, Zhou L, Lu B et al (2012) Thyrotropin-secreting pituitary adenomas: diagnosis and management of patients from one Chinese center. Wien Klin Wochenschr 124:678–684CrossRefPubMed

41.

Trouillas J, Roy P, Sturm N, Dantony E, Cortet-Rudelli C et al (2013) A new prognostic clinicopathological classification of pituitary adenomas: a multicentric case-control study of 410 patients with 8 years post-operative follow-up. Acta Neuropathol 126:123–135CrossRefPubMed

42.

Knosp E, Steiner E, Kitz K, Matula C (1993) 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)PubMed

43.

Beck-Peccoz P, Persani L, Mannavola D, Campi I (2009) Pituitary tumours: TSH-secreting adenomas. Best Pract Res Clin Endocrinol Metab 23:597–606CrossRefPubMed

44.

Osamura RY, Egashira N, Miyai S, Yamazaki M, Takekoshi S et al (2004) Molecular pathology of the pituitary. Development and functional differentiation of pituitary adenomas. Front Horm Res 32:20–33CrossRefPubMed

45.

Kontogeorgos G, Kovacs K, Horvath E, Scheithauer BW (1991) Multiple adenomas of the human pituitary. A retrospective autopsy study with clinical implications. J Neurosurg 74:243–247CrossRefPubMed

46.

Shimono T, Hatabu H, Kasagi K, Miki Y, Nishizawa S et al (1999) Rapid progression of pituitary hyperplasia in humans with primary hypothyroidism: demonstration with MR imaging. Radiology 213:383–388CrossRefPubMed

47.

Vidal S, Horvath E, Kovacs K, Cohen SM, Lloyd RV et al (2000) Transdifferentiation of somatotrophs to thyrotrophs in the pituitary of patients with protracted primary hypothyroidism. Virchows Arch 436:43–51CrossRefPubMed

48.

Nelson DH, Meakin JW, Dealy JB Jr, Matson DD, Emerson K Jr et al (1958) ACTH-producing tumor of the pituitary gland. N Engl J Med 259:161–164CrossRefPubMed

49.

Ahmadi J, North CM, Segall HD, Zee CS, Weiss MH (1986) Cavernous sinus invasion by pituitary adenomas. AJR Am J Roentgenol 146:257–262CrossRefPubMed

50.

Fahlbusch R, Buchfelder M (1988) Transsphenoidal surgery of parasellar pituitary adenomas. Acta Neurochir 92:93–99CrossRefPubMed

51.

Micko AS, Wohrer A, Wolfsberger S, Knosp E (2015) Invasion of the cavernous sinus space in pituitary adenomas: endoscopic verification and its correlation with an MRI-based classification. J Neurosurg 122:803–811CrossRefPubMed

52.

Jho HD (2001) Endoscopic transsphenoidal surgery. J Neurooncol 54:187–195CrossRefPubMed

53.

Jho HD, Carrau RL (1996) Endoscopy assisted transsphenoidal surgery for pituitary adenoma. Acta Neurochir 138:1416–1425CrossRefPubMed

54.

Jho HD, Carrau RL (1997) Endoscopic endonasal transsphenoidal surgery: experience with 50 patients. J Neurosurg 87:44–51CrossRefPubMed

55.

Amlashi FG, Tritos NA (2016) Thyrotropin-secreting pituitary adenomas: epidemiology, diagnosis, and management. Endocrine 52:427–440CrossRefPubMed

56.

Starnoni D, Daniel RT, Marino L, Pitteloud N, Levivier M et al (2016) Surgical treatment of acromegaly according to the 2010 remission criteria: systematic review and meta-analysis. Acta Neurochir 158:2109–2121CrossRefPubMed

57.

Feng M, Liu Z, Liu X, Bao X, Yao Y et al (2018) Diagnosis and outcomes of 341 patients with Cushing’s disease following transsphenoid surgery: a single-center experience. World Neurosurg 109:e75–e80CrossRefPubMed

58.

Giustina A, Chanson P, Bronstein MD, Klibanski A, Lamberts S et al (2010) A consensus on criteria for cure of acromegaly. J Clin Endocrinol Metab 95:3141–3148CrossRefPubMed

59.

Nishioka H, Haraoka J (2008) Biochemical cure of acromegaly after transsphenoidal surgery despite residual tumor on magnetic resonance imaging: case report. Neurol Med Chir 48:311–313CrossRef

Title: Thyrotropin-secreting pituitary adenomas: a systematic review and meta-analysis of postoperative outcomes and management
Authors: Giulia Cossu
Roy Thomas Daniel
Katarzyna Pierzchala
Moncef Berhouma
Nelly Pitteloud
Faiza Lamine
Annamaria Colao
Mahmoud Messerer
Publication date: 01-02-2019
Publisher: Springer US
Published in: Pituitary / Issue 1/2019
Print ISSN: 1386-341X
Electronic ISSN: 1573-7403
DOI: https://doi.org/10.1007/s11102-018-0921-3

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