title: Comprehensive evaluation of thyrotropinomas: single-center 20-year experience.
abstract: OBJECTIVE
  To present a single-center 20-year experience with operated thyrotropinomas, including prevalence, clinical, biochemical and histological characteristics, and postoperative outcomes.
  
  
  METHODS
  Retrospective series of histopathologically-proven thyrotropinomas (1993-2013), divided in two groups: A (active, central hyperthyroidism) and B (silent, no hyperthyroidism).
  
  
  RESULTS
  Of 1628 operated pituitary adenomas, 20 were β-TSH-positive (1.2%). In increments of 5 years, proportion of thyrotropinomas was 1, 1, 0.04 and 1.77% respectively. Median follow-up was 10.4 months (1.2-150). Group A: 6 patients (5 men), age 41 ± 12 years presented with hyperthyroidism (3), pituitary incidentaloma (2) and acromegaly (1). Tumor diameter was 2.1 ± 1.2 cm, FT4 2.68 ± 2.73 ng/dL; TSH 6.50 ± 3.68 µIU/mL. Glycoprotein alpha subunit (GSU) was uniformly elevated. Two patients had biochemical evidence of acromegaly. Tumors were plurihormonal (5 GH-positive); none atypical. Postoperative euthyroidism was achieved in 4 of 6 patients (66%). Group B: 14 patients (7 men), age 47 ± 14 years presented with acromegaly (6), mass effect (4), incidentaloma (3) and galactorrhea (1). Tumor diameter was 2.0 ± 1.0 cm. Free T4 (1.00 ± 0.24 ng/dL) and TSH (2.02 ± 1.65 mIU/L) were lower than in group A (p < 0.01). GSU was elevated in all tested cases. Nine patients had biochemical evidence of acromegaly. Tumors were plurihormonal (12 GH-positive); none atypical. Gross total resection was achieved in 12 of 14 (86%), and 1 (7%) recurred.
  
  
  CONCLUSIONS
  In our series, more thyrotropinomas were operated in recent years. These tumors were often plurihormonal with heterogenous clinical presentation and frequent GH co-secretion. Surgical outcomes were good but long-term follow up is necessary.
authors.affiliation: Division of Endocrinology and Metabolism, Department of Medicine and Neurosurgery, Emory Pituitary Center, Emory University School of Medicine, 1365 B Clifton Rd., NE, B6209, Atlanta, GA, 30322, USA.
authors.forename: Alice
authors.initials: A
authors.lastname: Azzalin
authors.affiliation: Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: Christina L
authors.initials: CL
authors.lastname: Appin
authors.affiliation: Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA.|Department of Pathology, Children's Healthcare of Atlanta, Atlanta, GA, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Schniederjan
authors.affiliation: Division of Endocrinology and Metabolism, Department of Medicine and Neurosurgery, Emory Pituitary Center, Emory University School of Medicine, 1365 B Clifton Rd., NE, B6209, Atlanta, GA, 30322, USA.
authors.forename: Tina
authors.initials: T
authors.lastname: Constantin
authors.affiliation: Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: James C
authors.initials: JC
authors.lastname: Ritchie
authors.affiliation: Baptist Health South Florida, Miami, FL, USA.
authors.forename: Emir
authors.initials: E
authors.lastname: Veledar
authors.affiliation: Division of Endocrinology and Metabolism, Department of Medicine and Neurosurgery, Emory Pituitary Center, Emory University School of Medicine, 1365 B Clifton Rd., NE, B6209, Atlanta, GA, 30322, USA.|Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: Nelson M
authors.initials: NM
authors.lastname: Oyesiku
authors.affiliation: Division of Endocrinology and Metabolism, Department of Medicine and Neurosurgery, Emory Pituitary Center, Emory University School of Medicine, 1365 B Clifton Rd., NE, B6209, Atlanta, GA, 30322, USA. aioachi@emory.edu.|Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA. aioachi@emory.edu.
authors.forename: Adriana G
authors.initials: AG
authors.lastname: Ioachimescu
mesh_terms: D000172:Acromegaly / Q000150:complications / Q000453:epidemiology; D000236:Adenoma / Q000175:diagnosis / Q000453:epidemiology* / Q000378:metabolism / Q000628:therapy*; D000328:Adult; D005260:Female; D006801:Humans; D006980:Hyperthyroidism / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D033162:Incidental Findings; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000706:statistics & numerical data; D010911:Pituitary Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000378:metabolism / Q000628:therapy*; D012189:Retrospective Studies; D013972:Thyrotropin / Q000378:metabolism*; D016896:Treatment Outcome
chemical_list: D013972:Thyrotropin
keywords: Central hyperthyroidism; Plurihormonal pituitary adenoma; Silent thyrotropinoma; TSH-secreting pituitary adenoma