Endocrine Abstracts

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.