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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?

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Abstract

Purpose

Thyrotropin-secreting pituitary adenomas (TSHomas) represent a rare subtype of pituitary tumors. Neurosurgery (NCH) is still considered the first-line therapy. In this study we aimed to investigate the outcome of different treatment modalities, including first line somatostatin analogs (SSA) treatment, with a specific focus on neurosurgery-related complications.

Methods

We retrospectively evaluated thirteen patients diagnosed for TSHomas (9 M; age range 27–61). Ten patients had a magnetic resonance evidence of macroadenoma, three with slight visual field impairment. In the majority of patients, thyroid ultrasonography showed the presence of goiter and/or increased gland vascularization. Median TSH value at diagnosis was 3.29 mU/L (normal ranges 0.2–4.2 mIU/L), with median fT4 2.52 ng/dL (0.9–1.7 ng/dL).

Results

Three patients (two microadenoma) were primarily treated with NCH and achieved disease remission, whereas ten patients (nine macroadenomas) were initially treated with SSA. Despite the optimal biochemical response observed during medical treatment in most patients (mean TSH decrease −72 %), only two stayed on medical therapy alone, achieving stable biochemical control at the end of the follow-up. The remaining patients (n = 7) underwent NCH later on during their clinical history, followed by radiotherapy or adjuvant SSA treatment in two cases. Noteworthy, five of them developed hypopituitarism. All patients reached a biochemical control, after a multimodal therapeutic approach.

Conclusions

Neurosurgery ultimately led to complete disease remission or to biochemical control in majority of patients, whereas resulting in a considerable percentage of post-operative complications (mainly hypopituitarism, 50 %). In the light of the optimal results unanimously reported for medical treatment with SSA, our experience suggests that a careful evaluation of risk/benefit ratio should be taken into consideration when directing the treatment approach in patients with TSHoma.

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Acknowledgments

The authors did not receive any specific funding for this study.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DiMI), Center of Excellence for Biomedical Research (CEBR), University of Genova, Viale Benedetto XV, 6, 16132, Genoa, Italy

    Federico Gatto, Elena Nazzari & Diego Ferone

  2. Department of Neurosurgery, IRCCS AOU San Martino-IST, University of Genova, Genoa, Italy

    Pasquale Anania & Gianluigi Zona

  3. Endocrinology, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy

    Ludovica F. Grasso, Annamaria Colao & Rosario Pivonello

  4. Department of Endocrinology, University Hospital of Nancy Brabois, Vandoeuvre-Les-Nancy, France

    Thomas Cuny & Georges Weryha

  5. Endocrinology Unit, IRCCS AOU San Martino-IST, University of Genova, Viale Benedetto XV, 6, 16132, Genoa, Italy

    Federico Gatto, Elena Nazzari & Diego Ferone

  6. IRCCS SDN, Naples, Italy

    Carolina Di Somma

Authors
  1. Federico Gatto
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  2. Ludovica F. Grasso
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  3. Elena Nazzari
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  7. Annamaria Colao
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  8. Gianluigi Zona
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  11. Diego Ferone
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Corresponding author

Correspondence to Diego Ferone.

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Gatto, F., Grasso, L.F., Nazzari, E. et al. 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, 583–591 (2015). https://doi.org/10.1007/s11102-014-0611-8

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  • DOI: https://doi.org/10.1007/s11102-014-0611-8

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