title: Active and silent thyroid-stimulating hormone-expressing pituitary adenomas: presenting symptoms, treatment, outcomes, and recurrence.
abstract: OBJECTIVE
  Thyroid-stimulating hormone (TSH)-expressing pituitary adenomas are a rare but important entity with a spectrum of clinical manifestations. There are currently no data to indicate whether a difference exists in the natural progression of active and silent TSH-expressing pituitary adenomas (defined by the presence or absence of clinical hyperthyroidism, respectively). Here we report our experience (including presenting symptoms, treatment, and outcome) with managing both groups over 11 years in the largest single-center study published to date.
  
  
  METHODS
  We reviewed retrospectively all patients with histopathologically proven TSH-expressing pituitary adenomas who presented to our center between 2002 and 2012. Data reviewed included clinical presentation, biochemical status, tumor size, management, histopathologic results, and long-term postoperative outcomes.
  
  
  RESULTS
  A total of 32 patients (16 male) were identified from a total of 902 operations for pituitary adenomas performed between 2002 and 2012. Mean follow-up was 6.7 years. One-quarter (25%) of patients were clinically hyperthyroid at presentation. Visual disturbance was the commonest presenting complaint in 34%. All patients underwent transsphenoidal surgery. Thirty-one percent of patients had a recurrence. The clinically active and silent TSH-expressing pituitary adenomas behaved in a similar manner with respect to recurrence rates.
  
  
  CONCLUSIONS
  TSH-expressing pituitary adenomas present with a wide clinical spectrum. Visual disturbances are common. Despite radiologic evidence of clearance after surgery and extended follow-up, they may still recur whether clinically "active" or "silent." Our data support the need for close, long-term follow-up of these patients.
authors.affiliation: Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Kirkman
authors.affiliation: Division of Neuropathology, Institute of Neurology, Queen Square, London, United Kingdom.
authors.forename: Zane
authors.initials: Z
authors.lastname: Jaunmuktane
authors.affiliation: Division of Neuropathology, Institute of Neurology, Queen Square, London, United Kingdom.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Brandner
authors.affiliation: Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom.
authors.forename: Akbar A
authors.initials: AA
authors.lastname: Khan
authors.affiliation: Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom.
authors.forename: Michael
authors.initials: M
authors.lastname: Powell
authors.affiliation: Department of Endocrinology, University College London Hospital, London, United Kingdom. Electronic address: stephanie.baldeweg@uclh.nhs.uk.
authors.forename: Stephanie E
authors.initials: SE
authors.lastname: Baldeweg
mesh_terms: D000236:Adenoma / Q000378:metabolism* / Q000601:surgery*; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D019635:Neurosurgical Procedures; D010911:Pituitary Neoplasms / Q000378:metabolism* / Q000601:surgery*; D012189:Retrospective Studies; D016019:Survival Analysis; D013972:Thyrotropin / Q000096:biosynthesis*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D013972:Thyrotropin
keywords: Recurrence; Thyroid-stimulating hormone pituitary adenoma; Thyrotroph adenoma; Transsphenoidal surgery