title: Clinical outcome and evidence of high rate post-surgical anterior hypopituitarism in a cohort of TSH-secreting adenoma patients: Might somatostatin analogs have a role as first-line therapy?
abstract: OBJECTIVE
  Thyrotropin-secreting pituitary adenomas (TSHomas) represent a rare subtype of pituitary tumors. Neurosurgery (NCH) is still considered the first-line therapy. In this study we aimed to investigate the outcome of different treatment modalities, including first line somatostatin analogs (SSA) treatment, with a specific focus on neurosurgery-related complications.
  
  
  METHODS
  We retrospectively evaluated thirteen patients diagnosed for TSHomas (9 M; age range 27-61). Ten patients had a magnetic resonance evidence of macroadenoma, three with slight visual field impairment. In the majority of patients, thyroid ultrasonography showed the presence of goiter and/or increased gland vascularization. Median TSH value at diagnosis was 3.29 mU/L (normal ranges 0.2-4.2 mIU/L), with median fT4 2.52 ng/dL (0.9-1.7 ng/dL).
  
  
  RESULTS
  Three patients (two microadenoma) were primarily treated with NCH and achieved disease remission, whereas ten patients (nine macroadenomas) were initially treated with SSA. Despite the optimal biochemical response observed during medical treatment in most patients (mean TSH decrease -72%), only two stayed on medical therapy alone, achieving stable biochemical control at the end of the follow-up. The remaining patients (n = 7) underwent NCH later on during their clinical history, followed by radiotherapy or adjuvant SSA treatment in two cases. Noteworthy, five of them developed hypopituitarism. All patients reached a biochemical control, after a multimodal therapeutic approach.
  
  
  CONCLUSIONS
  Neurosurgery ultimately led to complete disease remission or to biochemical control in majority of patients, whereas resulting in a considerable percentage of post-operative complications (mainly hypopituitarism, 50%). In the light of the optimal results unanimously reported for medical treatment with SSA, our experience suggests that a careful evaluation of risk/benefit ratio should be taken into consideration when directing the treatment approach in patients with TSHoma.
authors.affiliation: Endocrinology Unit, Department of Internal Medicine and Medical Specialties (DiMI), Center of Excellence for Biomedical Research (CEBR), University of Genova, Viale Benedetto XV, 6, 16132, Genoa, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Gatto
authors.forename: Ludovica F
authors.initials: LF
authors.lastname: Grasso
authors.forename: Elena
authors.initials: E
authors.lastname: Nazzari
authors.forename: Thomas
authors.initials: T
authors.lastname: Cuny
authors.forename: Pasquale
authors.initials: P
authors.lastname: Anania
authors.forename: Carolina
authors.initials: C
authors.lastname: Di Somma
authors.forename: Annamaria
authors.initials: A
authors.lastname: Colao
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Zona
authors.forename: Georges
authors.initials: G
authors.lastname: Weryha
authors.forename: Rosario
authors.initials: R
authors.lastname: Pivonello
authors.forename: Diego
authors.initials: D
authors.lastname: Ferone
mesh_terms: D000236:Adenoma / Q000097:blood / Q000378:metabolism / Q000473:pathology / Q000628:therapy*; D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000097:blood / Q000378:metabolism*; D017024:Chemotherapy, Adjuvant; D005260:Female; D005602:France; D006801:Humans; D007016:Hypophysectomy / Q000009:adverse effects*; D007018:Hypopituitarism / Q000175:diagnosis / Q000209:etiology*; D007558:Italy; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010910:Pituitary Irradiation; D010911:Pituitary Neoplasms / Q000097:blood / Q000378:metabolism / Q000473:pathology / Q000628:therapy*; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012307:Risk Factors; D013004:Somatostatin / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use*; D013972:Thyrotropin / Q000097:blood / Q000378:metabolism*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D014408:Biomarkers, Tumor; D013004:Somatostatin; D013972:Thyrotropin