Clinical characteristics of patients with thyrotropin-secreting pituitary adenoma.
OBJECTIVE
Thyroid-stimulating hormone (thyrotropin, TSH)-secreting pituitary adenoma is a very rare cause of hyperthyroidism. Diagnosis of this condition is often delayed due to lack of availability of TSH radioimmunoassay (RIA), the failure to recognize the utility of RIA and the incorrect attribution of the condition to other causes of thyrotoxicosis. This retrospective study analyzed the clinical characteristics of patients with this disorder treated from 1991 to 2002.


METHODS
Seven patients (6 females, 1 male; mean age, 48 years; range, 33 to 72 years) with a diagnosis of TSHsecreting pituitary adenoma based on detectable TSH levels with high serum free thyroid hormone or triiodothyronine concentrations and pituitary lesions found on neuroimaging were included in this study. Patient records including clinical features, endocrine studies, immunohistochemistry studies, and response to treatment were reviewed.


RESULTS
All 7 patients had hyperthyroidism, elevated free thyroxine or triiodothyronine levels, and unsuppressed levels of TSH. Imaging studies demonstrated a pituitary mass or lesion in all patients. Six patients had macroadenomas and 1 patient had a microadenoma. One of the patients had coexisting acromegalic features and hypersecretion of growth hormone was diagnosed. All of the patients had been treated with thionamides or thyroidectomy for presumed primary hyperthyroidism. Serum alpha-subunit level was uncharacteristically normal in 2 patients and elevated in 1 patient. Alpha-subunit/TSH molar ratios were elevated in 3 patients. Five patients underwent transsphenoidal adenomectomy but only one of them remained well-controlled at follow-up. Three patients received administration of somatostatin analogs and they achieved normalization of serum TSH and free thyroid hormones during the period of therapy.


CONCLUSIONS
TSH immunoassay has an important role in the evaluation of hyperthyroid patients to determine the presence of inappropriate secretion. TSH-secreting pituitary adenoma exhibits heterogeneity in clinical presentation, hormonal expression and therapeutic response.
Wu
Yung-Yen
YY
Divisions of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan.
Chang
Hung-Yu
HY
Lin
Jen-Der
JD
Chen
Kwang-Wen
KW
Huang
Yu-Yao
YY
Jung
Shih-Ming
SM
D000172:Acromegaly / Q000175:diagnosis; D000236:Adenoma / Q000097:blood / Q000175:diagnosis* / Q000378:metabolism; D000328:Adult; D000368:Aged; D005260:Female; D019382:Human Growth Hormone / Q000378:metabolism; D006801:Humans; D006980:Hyperthyroidism / Q000175:diagnosis; D006981:Hyperthyroxinemia / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000378:metabolism; D012189:Retrospective Studies; D013972:Thyrotropin / Q000097:blood*; D014284:Triiodothyronine / Q000097:blood
D014284:Triiodothyronine; D019382:Human Growth Hormone; D013972:Thyrotropin