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A Rare Entity: TSH-Secreting Adenoma

  • Laura E. Dichtel
Chapter

Abstract

TSH-secreting adenomas are rare but must be considered in the differential diagnosis of inappropriately normal to elevated TSH in the presence of elevated free serum thyroid hormone levels (FT4, FT3), which is termed central hyperthyroidism. The diagnosis of TSH-secreting adenoma in a patient with central hyperthyroidism is usually made based on clinical and family history, α-subunit testing, SHBG levels, and pituitary MRI after ruling out other thyroid-related conditions as discussed in this chapter. A full pituitary hormone evaluation must be completed upon diagnosis of a TSH-secreting adenoma, and neuroophthomology evaluation should be obtained in the presence of a macroadenoma with concern for contact with the optic nerve or chiasm. Therapeutic options for patients with TSH-secreting adenomas include transsphenoidal pituitary surgery, medical treatment with somatostatin analogs (SSAs), radiation therapy, or a combination of these modalities. Regardless of treatment, these patients should have long-term endocrine follow-up with continued biochemical and radiologic surveillance.

Keywords

Macroadenoma Pituitary adenoma Sellar mass Central hyperthyroidism Thyrotropinomas TSH-secreting pituitary adenoma Somatostatin analogs 

References

  1. 1.
    Beck-Peccoz P, Lania A, Beckers A, Chatterjee K, Wemeau JL. European thyroid association guidelines for the diagnosis and treatment of thyrotropin-secreting pituitary tumors. Eur Thyroid J. 2013;2:76–82.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Onnestam L, Berinder K, Burman P, et al. National incidence and prevalence of TSH-secreting pituitary adenomas in Sweden. J Clin Endocrinol Metab. 2013;98:626–35.CrossRefPubMedGoogle Scholar
  3. 3.
    Amlashi FG, Tritos NA. Thyrotropin-secreting pituitary adenomas: epidemiology, diagnosis, and management. Endocrine. 2016;52:427–40.CrossRefPubMedGoogle Scholar
  4. 4.
    Beck-Peccoz P, Persani L, Mannavola D, Campi I. Pituitary tumours: TSH-secreting adenomas. Best Pract Res Clin Endocrinol Metab. 2009;23:597–606.CrossRefPubMedGoogle Scholar
  5. 5.
    Mindermann T, Wilson CB. Age-related and gender-related occurrence of pituitary adenomas. Clin Endocrinol. 1994;41:359–64.CrossRefGoogle Scholar
  6. 6.
    Yamada S, Fukuhara N, Horiguchi K, et al. Clinicopathological characteristics and therapeutic outcomes in thyrotropin-secreting pituitary adenomas: a single-center study of 90 cases. J Neurosurg. 2014;121:1462–73.CrossRefPubMedGoogle Scholar
  7. 7.
    Malchiodi E, Profka E, Ferrante E, et al. Thyrotropin-secreting pituitary adenomas: outcome of pituitary surgery and irradiation. J Clin Endocrinol Metab. 2014;99:2069–76.CrossRefPubMedGoogle Scholar
  8. 8.
    Brown RL, Muzzafar T, Wollman R, Weiss RE. A pituitary carcinoma secreting TSH and prolactin: a non-secreting adenoma gone awry. Eur J Endocrinol. 2006;154:639–43.CrossRefPubMedGoogle Scholar
  9. 9.
    Lee W, Cheung AS, Freilich R. TSH-secreting pituitary carcinoma with intrathecal drop metastases. Clin Endocrinol. 2012;76:604–6.CrossRefGoogle Scholar
  10. 10.
    Nguyen HD, Galitz MS, Mai VQ, Clyde PW, Glister BC, Shakir MK. Management of coexisting thyrotropin/growth-hormone-secreting pituitary adenoma and papillary thyroid carcinoma: a therapeutic challenge. Thyroid. 2010;20:99–103.CrossRefPubMedGoogle Scholar
  11. 11.
    Poggi M, Monti S, Pascucci C, Toscano V. A rare case of follicular thyroid carcinoma in a patient with thyrotropin-secreting pituitary adenoma. Am J Med Sci. 2009;337:462–5.CrossRefPubMedGoogle Scholar
  12. 12.
    Brucker-Davis F, Oldfield EH, Skarulis MC, Doppman JL, Weintraub BD. 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. 1999;84:476–86.CrossRefPubMedGoogle Scholar
  13. 13.
    Sanno N, Teramoto A, Osamura RY. Thyrotropin-secreting pituitary adenomas. Clinical and biological heterogeneity and current treatment. J Neuro-Oncol. 2001;54:179–86.CrossRefGoogle Scholar
  14. 14.
    Socin HV, Chanson P, Delemer B, et al. The changing spectrum of TSH-secreting pituitary adenomas: diagnosis and management in 43 patients. Eur J Endocrinol. 2003;148:433–42.CrossRefPubMedGoogle Scholar
  15. 15.
    Koulouri O, Moran C, Halsall D, Chatterjee K, Gurnell M. Pitfalls in the measurement and interpretation of thyroid function tests. Best Pract Res Clin Endocrinol Metab. 2013;27:745–62.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Beck-Peccoz P, Chatterjee VK. The variable clinical phenotype in thyroid hormone resistance syndrome. Thyroid. 1994;4:225–32.CrossRefPubMedGoogle Scholar
  17. 17.
    Refetoff S, Weiss RE, Usala SJ. The syndromes of resistance to thyroid hormone. Endocr Rev. 1993;14:348–99.PubMedGoogle Scholar
  18. 18.
    Cartwright D, O'Shea P, Rajanayagam O, et al. Familial dysalbuminemic hyperthyroxinemia: a persistent diagnostic challenge. Clin Chem. 2009;55:1044–6.CrossRefPubMedGoogle Scholar
  19. 19.
    Beck-Peccoz P, Brucker-Davis F, Persani L, Smallridge RC, Weintraub BD. Thyrotropin-secreting pituitary tumors. Endocr Rev. 1996;17:610–38.PubMedGoogle Scholar
  20. 20.
    Rapaport R, Akler G, Regelmann MO, Greig F. Time for thyrotropin releasing hormone to return to the United States of America. Thyroid. 2010;20:947–8.CrossRefPubMedGoogle Scholar
  21. 21.
    Beck-Peccoz P, Persani L, Lania A. Thyrotropin-secreting pituitary adenomas. In: De Groot LJ, Chrousos G, Dungan K, et al., editors. Endotext. South Dartmouth, MA: MDText.com, Inc.; 2000.Google Scholar
  22. 22.
    Kirkman MA, Jaunmuktane Z, Brandner S, Khan AA, Powell M, Baldeweg SE. Active and silent thyroid-stimulating hormone-expressing pituitary adenomas: presenting symptoms, treatment, outcomes, and recurrence. World Neurosurg. 2014;82:1224–31.CrossRefPubMedGoogle Scholar
  23. 23.
    van Varsseveld NC, Bisschop PH, Biermasz NR, Pereira AM, Fliers E, Drent ML. A long-term follow-up study of eighteen patients with thyrotrophin-secreting pituitary adenomas. Clin Endocrinol. 2014;80:395–402.CrossRefGoogle Scholar
  24. 24.
    Beck-Peccoz P, Persani L. Medical management of thyrotropin-secreting pituitary adenomas. Pituitary. 2002;5:83–8.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Neuroendocrine UnitMassachusetts General Hospital, Harvard Medical SchoolBostonUSA

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