Document Detail

Thyrotropin-secreting pituitary adenomas: clinical and biochemical heterogeneity. Case reports and follow-up of nine patients.
MedLine Citation:
PMID:  2479309     Owner:  NLM     Status:  MEDLINE    
STUDY OBJECTIVE: To evaluate the clinical and biochemical features of patients with TSH (thyroid-stimulating hormone, thyrotropin)-secreting pituitary tumors; to measure the biologic activity in vitro of circulating TSH from selected patients before and after pituitary surgery. DESIGN: Case series. SETTING: Patients in an endocrinology unit. PATIENTS: Nine patients with TSH-secreting pituitary tumors. MEASUREMENTS AND MAIN RESULTS: All patients had hyperthyroidism, elevated free thyroxine and triiodothyronine levels, and detected levels of TSH. The free alpha subunit, a tumor marker for neoplasms of gonadotropic or thyrotropic cell origin, was elevated in all nine patients. Seven of the nine patients had been treated with thionamides, radioactive iodine, or thyroidectomy for presumed primary hyperthyroidism. The delay from the initial treatment of hyperthyroidism to the correct diagnosis of a pituitary neoplasm was 6.2 +/- 4.8 (mean +/- SD) years. Two of the seven patients with macroadenomas died in the perioperative period (one at NIH, one at a referring hospital). Of the remaining five patients with macroadenomas, four have residual tumor and inappropriate TSH secretion, despite surgery and radiation therapy, at follow-up from 3.5 to 6 years. In contrast, the two patients with microadenomas are clinically cured 2.5 and 4 years after transsphenoidal adenomectomy. The biologic to immunologic (B/I) ratio of serum TSH, determined preoperatively in five patients with TSH-secreting tumors, was elevated compared with euthyroid subjects. In three patients the B/I ratio of serum TSH was also measured after pituitary surgery; in two the elevated B/I ratio returned to normal after successful pituitary adenomectomy, while in the third this ratio remained elevated after incomplete adenoma resection. CONCLUSIONS: With the routine availability of ultrasensitive TSH assays and their increasing use to confirm thyrotoxicosis from all causes, we expect that TSH-secreting pituitary tumors will be diagnosed earlier, before inappropriate antithyroid therapy, permitting an improved outcome.
N Gesundheit; P A Petrick; M Nissim; P A Dahlberg; J L Doppman; C H Emerson; L E Braverman; E H Oldfield; B D Weintraub
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Publication Detail:
Type:  Case Reports; Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Annals of internal medicine     Volume:  111     ISSN:  0003-4819     ISO Abbreviation:  Ann. Intern. Med.     Publication Date:  1989 Nov 
Date Detail:
Created Date:  1989-12-13     Completed Date:  1989-12-13     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  0372351     Medline TA:  Ann Intern Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  827-35     Citation Subset:  AIM; IM    
National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland.
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MeSH Terms
Adenoma / complications,  secretion*,  surgery,  therapy
Biological Assay
Combined Modality Therapy
Diagnosis, Differential
Follow-Up Studies
Glycoprotein Hormones, alpha Subunit / blood
Hyperthyroidism / etiology*
Middle Aged
Pituitary Neoplasms / complications,  secretion*,  surgery,  therapy
Thyrotropin / blood,  secretion*
Grant Support
Reg. No./Substance:
0/Glycoprotein Hormones, alpha Subunit; 9002-71-5/Thyrotropin
Comment In:
Ann Intern Med. 1990 Feb 15;112(4):309   [PMID:  2297211 ]

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