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. 1997;7(2):89–93. doi: 10.1055/s-2008-1058614

TSH-Secreting Pituitary Adenoma

Current Management and Review

Max K Kole, Jose Goldman, Jack P Rock
PMCID: PMC1656593  PMID: 17170995

Abstract

The neurosurgical literature contains little information about the current management of patients with thyroid-stimulating hormone (TSH)-secreting pituitary adenomas or about the usefulness of the somatostatin analogue octreotide in such cases. While TSH-secreting pituitary adenomas are rare, our review and illustrative case demonstrate the effectiveness of pretreating patients with octreotide therapy not only to reduce tumor size prior to surgical resection but also to increase the possibility of clinical remission.

A 52-year-old male presented with signs and symptoms of hyperthyroidism and elevated TSH, thyroxine, and triiodothyronine. Magnetic resonance imaging revealed a pituitary macroadenoma with extension into the suprasellar cistern. The patient was treated with octreotide for 6 months prior to surgery. Approximately 3 months after initiation of octreotide therapy, the patient exhibited excellent biochemical and clinical response. Tumor shrinkage of nearly 50% was associated with resolution of suprasellar extension and optic nerve compression. Subsequent transsphenoidal surgery for resection of residual adenoma was followed by symptomatic and hormonal remission without the need for reinstitution of octreotide therapy.

Pretreatment with octreotide for TSH-secreting pituitary adenomas has a beneficial effect on disease symptoms and reduces tumor mass. We suggest that patients with these rare tumors can be managed with a combination of octreotide therapy and subsequent surgical removal of residual tumor. Although this combination treatment helps to facilitate clinical remission, only short-term follow-up has been reported and thus the optimal management of these patients remains to be determined.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Beckers A., Abs R., Mahler C., Vandalem J. L., Pirens G., Hennen G., Stevenaert A. Thyrotropin-secreting pituitary adenomas: report of seven cases. J Clin Endocrinol Metab. 1991 Feb;72(2):477–483. doi: 10.1210/jcem-72-2-477. [DOI] [PubMed] [Google Scholar]
  2. Chanson P., Warnet A. Treatment of thyroid-stimulating hormone-secreting adenomas with octreotide. Metabolism. 1992 Sep;41(9 Suppl 2):62–65. doi: 10.1016/0026-0495(92)90033-7. [DOI] [PubMed] [Google Scholar]
  3. Chanson P., Weintraub B. D., Harris A. G. Octreotide therapy for thyroid-stimulating hormone-secreting pituitary adenomas. A follow-up of 52 patients. Ann Intern Med. 1993 Aug 1;119(3):236–240. doi: 10.7326/0003-4819-119-3-199308010-00010. [DOI] [PubMed] [Google Scholar]
  4. Comi R. J., Gesundheit N., Murray L., Gorden P., Weintraub B. D. Response of thyrotropin-secreting pituitary adenomas to a long-acting somatostatin analogue. N Engl J Med. 1987 Jul 2;317(1):12–17. doi: 10.1056/NEJM198707023170103. [DOI] [PubMed] [Google Scholar]
  5. Gancel A., Vuillermet P., Legrand A., Catus F., Thomas F., Kuhn J. M. Effects of a slow-release formulation of the new somatostatin analogue lanreotide in TSH-secreting pituitary adenomas. Clin Endocrinol (Oxf) 1994 Mar;40(3):421–428. doi: 10.1111/j.1365-2265.1994.tb03941.x. [DOI] [PubMed] [Google Scholar]
  6. Gorden P., Comi R. J., Maton P. N., Go V. L. NIH conference. Somatostatin and somatostatin analogue (SMS 201-995) in treatment of hormone-secreting tumors of the pituitary and gastrointestinal tract and non-neoplastic diseases of the gut. Ann Intern Med. 1989 Jan 1;110(1):35–50. doi: 10.7326/0003-4819-110-1-35. [DOI] [PubMed] [Google Scholar]
  7. Guillausseau P. J., Chanson P., Timsit J., Warnet A., Lajeunie E., Duet M., Lubetski J. Visual improvement with SMS 201-995 in a patient with a thyrotropin-secreting pituitary adenoma. N Engl J Med. 1987 Jul 2;317(1):53–54. doi: 10.1056/NEJM198707023170113. [DOI] [PubMed] [Google Scholar]
  8. Hamilton C. R., Jr, Adams L. C., Maloof F. Hyperthyroidism due to thyrotropin-producing pituitary chromophobe adenoma. N Engl J Med. 1970 Nov 12;283(20):1077–1080. doi: 10.1056/NEJM197011122832003. [DOI] [PubMed] [Google Scholar]
  9. Houdent C., Armangau M. F., Kuhn J. M., Delangre T., Tadie M., Clavier E., Basuyau J. P., Sassolas G., Wolf L. M. Adénome thyréotrope traité par un analogue de la somatostatine. Ann Endocrinol (Paris) 1989;50(3):227–231. [PubMed] [Google Scholar]
  10. Linquette M., Cappoen J. P., Mazzuca M. Eléments nouveaux dans le diagnostic et le traitement des adénomes hypophysaires thyréotropes avec hyperthyroïdie. Bull Acad Natl Med. 1989 Feb;173(2):217–222. [PubMed] [Google Scholar]
  11. McCutcheon I. E., Weintraub B. D., Oldfield E. H. Surgical treatment of thyrotropin-secreting pituitary adenomas. J Neurosurg. 1990 Nov;73(5):674–683. doi: 10.3171/jns.1990.73.5.0674. [DOI] [PubMed] [Google Scholar]
  12. Mindermann T., Wilson C. B. Thyrotropin-producing pituitary adenomas. J Neurosurg. 1993 Oct;79(4):521–527. doi: 10.3171/jns.1993.79.4.0521. [DOI] [PubMed] [Google Scholar]
  13. Orme S. M., Lamb J. T., Nelson M., Belchetz P. E. Shrinkage of thyrotrophin secreting pituitary adenoma treated with octreotide. Postgrad Med J. 1991 May;67(787):466–468. doi: 10.1136/pgmj.67.787.466. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Polak M., Bertherat J., Li J. Y., Kujas M., Le Dafniet M., Weizani H., Van Effenterre R., Epelbaum J., Turpin G. A human TSH-secreting adenoma: endocrine, biochemical and morphological studies. Evidence of somatostatin receptors by using quantitative autoradiography. Clinical and biological improvement by SMS 201-995 treatment. Acta Endocrinol (Copenh) 1991 Apr;124(4):479–486. doi: 10.1530/acta.0.1240479. [DOI] [PubMed] [Google Scholar]
  15. Reichlin S. Somatostatin (second of two parts). N Engl J Med. 1983 Dec 22;309(25):1556–1563. doi: 10.1056/NEJM198312223092506. [DOI] [PubMed] [Google Scholar]
  16. Smallridge R. C. Thyrotropin-secreting pituitary tumors. Endocrinol Metab Clin North Am. 1987 Sep;16(3):765–792. [PubMed] [Google Scholar]
  17. Sy R. A., Bernstein R., Chynn K. Y., Kourides I. A. Reduction in size of a thyrotropin- and gonadotropin-secreting pituitary adenoma treated with octreotide acetate (somatostatin analog). J Clin Endocrinol Metab. 1992 Mar;74(3):690–694. doi: 10.1210/jcem.74.3.1740506. [DOI] [PubMed] [Google Scholar]
  18. Takano K., Ajima M., Teramoto A., Hata K., Yamashita N. Mechanisms of action of somatostatin on human TSH-secreting adenoma cells. Am J Physiol. 1995 Apr;268(4 Pt 1):E558–E564. doi: 10.1152/ajpendo.1995.268.4.E558. [DOI] [PubMed] [Google Scholar]
  19. Warnet A., Lajeunie E., Gelbert F., Duet M., Chanson P., Cophignon J., Harris A. G. Shrinkage of a primary thyrotropin-secreting pituitary adenoma treated with the long-acting somatostatin analogue octreotide (SMS 201-995). Acta Endocrinol (Copenh) 1991 Apr;124(4):487–491. doi: 10.1530/acta.0.1240487. [DOI] [PubMed] [Google Scholar]
  20. Wémeau J. L., Dewailly D., Leroy R., D'Herbomez M., Mazzuca M., Decoulx M., Jaquet P. Long term treatment with the somatostatin analog SMS 201-995 in a patient with a thyrotropin- and growth hormone-secreting pituitary adenoma. J Clin Endocrinol Metab. 1988 Mar;66(3):636–639. doi: 10.1210/jcem-66-3-636. [DOI] [PubMed] [Google Scholar]

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