Effect of TRH on beta-gonadotropin subunits in patients with pituitary microincidentalomas.
OBJECTIVE
To explore the hypothesis that most of the pituitary abnormalities compatible with the diagnosis of microadenoma, and detected in about 10% of the normal adult population, represent asymptomatic gonadotropinomas.


METHODS
Patients diagnosed with pituitary microincidentalomas at the Institute of Endocrinology of the Tel Aviv Medical Center were evaluated. Circulating beta-subunits of gonadotropin hormones were measured before and 30, 45, 60 and 90 min after the intravenous injection of 400 microgram TRH.


METHODS
Twenty-two patients with pituitary incidentaloma and 16 normal volunteers were tested.


RESULTS
In 16 of the 22 patients, an abnormal beta-subunit response was detected after the TRH challenge. Three patients had an abnormal increase in both beta-FSH and beta-LH after TRH administration. Isolated pathological beta-FSH or beta-LH responses were demonstrated in five and eight patients respectively. Six patients had normal basal and stimulated gonadotropin subunit values, raising the possibility that their lesions were not pituitary microadenomas. There was a significant overall difference between the response to TRH of the patient and control groups. In the gonadotropin positive group, comprising 16 patients, serum beta-FSH increased from 6.4+/-1.6 ng/ml to 9.2+/-1.3 ng/ml (P=0.042) 1 h after TRH stimulation, whereas no changes were detected in the control group after TRH injection (basal: 4.1+/-0.8 ng/ml, peak: 5.1+/-0.8 ng/ml; P=0.15). Serum beta-LH increased from 10.5+/-3.2 ng/ml to 23.4+/-4.9 ng/ml (P=0.0037) at this time, in contrast to a lack of response in controls (basal: 6.4+/-1.5 ng/ml, peak: 8.2+/-2.3 ng/ml; P=0.24).


CONCLUSIONS
In about 73% of patients with pituitary incidentalomas smaller than 10 mm, TRH elicits an increase in gonadotropin beta-subunits. This observation raises the possibility that non-functioning pituitary micro- and macroadenomas, which share a similar response to TRH, originate in a common ancestor cell type, probably a pituitary gonadotrope.
Institute of Endocrinology, Tel Aviv-Elias Sourasky Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Israel.
Y
Y
Greenman
Y
Y
Trostanetsky
D
D
Sömjen
K
K
Tordjman
F
F
Kohen
N
N
Stern
D000236:Adenoma / Q000097:blood*; D000328:Adult; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood*; D037201:Follicle Stimulating Hormone, beta Subunit; D006801:Humans; D007700:Kinetics; D007986:Luteinizing Hormone / Q000097:blood*; D008297:Male; D010911:Pituitary Neoplasms / Q000097:blood*; D013973:Thyrotropin-Releasing Hormone
D037201:Follicle Stimulating Hormone, beta Subunit; D013973:Thyrotropin-Releasing Hormone; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone