title: Pathologic and clinical features of pituitary adenomas showing TSH immunoreactivity.
abstract: Patients with thyrotropin-secreting pituitary adenomas may present with mass effect, hypopituitarism, and/or hyperthyroidism. The spectrum of pathologic and clinical features of patients whose tumors demonstrate β-thyrotropin immunoreactivity (β-TSH IR) has not been characterized. To characterize the phenotype of patients with pituitary adenomas with positive β-TSH IR, we conducted a retrospective analysis of patient records of all adult patients (n = 1,223) undergoing pituitary surgery in our institution over one decade (1999-2009). The search identified 166 adults with tumors which had β-TSH IR. These patients were individually matched to 166 patients whose tumors revealed no β-TSH IR. Clinical, pathological, imaging and biochemical data were extracted. 332 patients, aged 51.4 ± 15.1 years [150 women (45 %) and 182 men (55 %)], with pituitary adenomas (mean tumor diameter ± SD: 22.7 ± 9.0 mm) were studied. The degree of β-TSH IR was associated with the presence of central hyperthyroidism (p < 0.0001) or goiter (p = 0.0217). Patients whose tumors expressed more extensive β-TSH IR were less likely to develop pituitary apoplexy than those without β-TSH IR (p = 0.0428). In addition, the degree of β-TSH IR correlated with the presence of immunoreactivity for β-FSH (p < 0.0001), β-LH (p < 0.0001), alpha subunit (p < 0.0001), and GH (p = 0.0036).
  
  
  CONCLUSIONS
  Pituitary adenomas expressing β-TSH IR were more likely to demonstrate immunoreactivity for β-FSH, β-LH, GH or alpha subunit. Patients with such tumors were more likely to exhibit hyperthyroidism and goiter, but less likely to develop pituitary apoplexy than patients without β-TSH IR. These findings suggest that β-TSH IR is associated with specific phenotypic features in patients with pituitary adenomas.
authors.affiliation: Neuroendocrine Unit, Department of Medicine, Massachusetts General Hospital, Zero Emerson Place # 112, Boston, MA 02114, USA. ntritos@partners.org
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Tritos
authors.forename: Samatha
authors.initials: S
authors.lastname: Eppakayala
authors.forename: Brooke
authors.initials: B
authors.lastname: Swearingen
authors.forename: E Tessa
authors.initials: ET
authors.lastname: Hedley-Whyte
authors.forename: Karen K
authors.initials: KK
authors.lastname: Miller
authors.forename: Lisa B
authors.initials: LB
authors.lastname: Nachtigall
authors.forename: Steven K
authors.initials: SK
authors.lastname: Grinspoon
authors.forename: Beverly M K
authors.initials: BM
authors.lastname: Biller
authors.forename: Anne
authors.initials: A
authors.lastname: Klibanski
mesh_terms: D000236:Adenoma / Q000473:pathology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D066298:In Vitro Techniques; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000473:pathology*; D012189:Retrospective Studies; D013972:Thyrotropin / Q000378:metabolism*; D055815:Young Adult
chemical_list: D013972:Thyrotropin