Criteria of cure and follow-up of central hyperthyroidism due to thyrotropin-secreting pituitary adenomas

Marco Losa, Massimo Giovanelli, Luca Persani, Pietro Mortini, Giovanni Faglia, Paolo Beck-Peccoz

Research output: Contribution to journalArticle

109 Citations (Scopus)

Abstract

The recorded number of patients with central hyperthyroidism due to TSH- secreting pituitary adenoma doubled in the last few years after the introduction of ultrasensitive TSH assays in the assessment of thyroid function; however, information about the results and the criteria for cure after pituitary surgery is scanty. Seventeen patients with a TSH-secreting adenoma, diagnosed on the basis of detectable TSH levels in the face of high free thyroid hormone concentrations and pituitary lesion at neuroimaging, underwent pituitary surgery. Hypersecretion of other pituitary hormones was diagnosed in 5 of 17 patients. Four patients were initially misdiagnosed and treated with thyroid surgery or radioiodine therapy. The majority (86%) of hyperthyroid patients normalized thyroid hormone concentrations and regained euthyroidism, although pituitary imaging, α-subunit, and α-subunit/TSH molar ratio normalized in only 47%, 54%, and 58% of patients, respectively. Moreover, TSH secretion was normally suppressed by T3 in 40% of the patients. Interestingly, the finding of undetectable TSH levels 7 days after surgery was highly predictive of successful outcome. During long term follow- up, there was one relapse of hyperthyroidism. Early diagnosis of TSH- secreting adenomas permits a high rate of remission of hyperthyroidism after surgery. However, normalization of thyroid function alone does not necessarily reflect complete removal of the tumor, and more comprehensive criteria of cure based on pituitary imaging, hormone measurement, and suppression of TSH during T3 administration should be used. Lastly, all patients need an accurate long term follow-up to monitor the possible recurrence of the adenoma.

Original languageEnglish
Pages (from-to)3084-3090
Number of pages7
JournalJournal of Clinical Endocrinology and Metabolism
Volume81
Issue number8
DOIs
Publication statusPublished - 1996

Fingerprint

Pituitary Neoplasms
Thyrotropin
Hyperthyroidism
Surgery
Thyroid Hormones
Adenoma
Thyroid Gland
Pituitary Hormones
Neuroimaging
Imaging techniques
Tumors
Assays
Recurrence
Hormones
Diagnostic Errors
Ambulatory Surgical Procedures
Early Diagnosis

ASJC Scopus subject areas

  • Biochemistry
  • Endocrinology, Diabetes and Metabolism

Cite this

Criteria of cure and follow-up of central hyperthyroidism due to thyrotropin-secreting pituitary adenomas. / Losa, Marco; Giovanelli, Massimo; Persani, Luca; Mortini, Pietro; Faglia, Giovanni; Beck-Peccoz, Paolo.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 81, No. 8, 1996, p. 3084-3090.

Research output: Contribution to journalArticle

@article{c5e2c0327f2d4ce390c1c79c9de9b474,
title = "Criteria of cure and follow-up of central hyperthyroidism due to thyrotropin-secreting pituitary adenomas",
abstract = "The recorded number of patients with central hyperthyroidism due to TSH- secreting pituitary adenoma doubled in the last few years after the introduction of ultrasensitive TSH assays in the assessment of thyroid function; however, information about the results and the criteria for cure after pituitary surgery is scanty. Seventeen patients with a TSH-secreting adenoma, diagnosed on the basis of detectable TSH levels in the face of high free thyroid hormone concentrations and pituitary lesion at neuroimaging, underwent pituitary surgery. Hypersecretion of other pituitary hormones was diagnosed in 5 of 17 patients. Four patients were initially misdiagnosed and treated with thyroid surgery or radioiodine therapy. The majority (86{\%}) of hyperthyroid patients normalized thyroid hormone concentrations and regained euthyroidism, although pituitary imaging, α-subunit, and α-subunit/TSH molar ratio normalized in only 47{\%}, 54{\%}, and 58{\%} of patients, respectively. Moreover, TSH secretion was normally suppressed by T3 in 40{\%} of the patients. Interestingly, the finding of undetectable TSH levels 7 days after surgery was highly predictive of successful outcome. During long term follow- up, there was one relapse of hyperthyroidism. Early diagnosis of TSH- secreting adenomas permits a high rate of remission of hyperthyroidism after surgery. However, normalization of thyroid function alone does not necessarily reflect complete removal of the tumor, and more comprehensive criteria of cure based on pituitary imaging, hormone measurement, and suppression of TSH during T3 administration should be used. Lastly, all patients need an accurate long term follow-up to monitor the possible recurrence of the adenoma.",
author = "Marco Losa and Massimo Giovanelli and Luca Persani and Pietro Mortini and Giovanni Faglia and Paolo Beck-Peccoz",
year = "1996",
doi = "10.1210/jc.81.8.3084",
language = "English",
volume = "81",
pages = "3084--3090",
journal = "Journal of Clinical Endocrinology and Metabolism",
issn = "0021-972X",
publisher = "The Endocrine Society",
number = "8",

}

TY - JOUR

T1 - Criteria of cure and follow-up of central hyperthyroidism due to thyrotropin-secreting pituitary adenomas

AU - Losa, Marco

AU - Giovanelli, Massimo

AU - Persani, Luca

AU - Mortini, Pietro

AU - Faglia, Giovanni

AU - Beck-Peccoz, Paolo

PY - 1996

Y1 - 1996

N2 - The recorded number of patients with central hyperthyroidism due to TSH- secreting pituitary adenoma doubled in the last few years after the introduction of ultrasensitive TSH assays in the assessment of thyroid function; however, information about the results and the criteria for cure after pituitary surgery is scanty. Seventeen patients with a TSH-secreting adenoma, diagnosed on the basis of detectable TSH levels in the face of high free thyroid hormone concentrations and pituitary lesion at neuroimaging, underwent pituitary surgery. Hypersecretion of other pituitary hormones was diagnosed in 5 of 17 patients. Four patients were initially misdiagnosed and treated with thyroid surgery or radioiodine therapy. The majority (86%) of hyperthyroid patients normalized thyroid hormone concentrations and regained euthyroidism, although pituitary imaging, α-subunit, and α-subunit/TSH molar ratio normalized in only 47%, 54%, and 58% of patients, respectively. Moreover, TSH secretion was normally suppressed by T3 in 40% of the patients. Interestingly, the finding of undetectable TSH levels 7 days after surgery was highly predictive of successful outcome. During long term follow- up, there was one relapse of hyperthyroidism. Early diagnosis of TSH- secreting adenomas permits a high rate of remission of hyperthyroidism after surgery. However, normalization of thyroid function alone does not necessarily reflect complete removal of the tumor, and more comprehensive criteria of cure based on pituitary imaging, hormone measurement, and suppression of TSH during T3 administration should be used. Lastly, all patients need an accurate long term follow-up to monitor the possible recurrence of the adenoma.

AB - The recorded number of patients with central hyperthyroidism due to TSH- secreting pituitary adenoma doubled in the last few years after the introduction of ultrasensitive TSH assays in the assessment of thyroid function; however, information about the results and the criteria for cure after pituitary surgery is scanty. Seventeen patients with a TSH-secreting adenoma, diagnosed on the basis of detectable TSH levels in the face of high free thyroid hormone concentrations and pituitary lesion at neuroimaging, underwent pituitary surgery. Hypersecretion of other pituitary hormones was diagnosed in 5 of 17 patients. Four patients were initially misdiagnosed and treated with thyroid surgery or radioiodine therapy. The majority (86%) of hyperthyroid patients normalized thyroid hormone concentrations and regained euthyroidism, although pituitary imaging, α-subunit, and α-subunit/TSH molar ratio normalized in only 47%, 54%, and 58% of patients, respectively. Moreover, TSH secretion was normally suppressed by T3 in 40% of the patients. Interestingly, the finding of undetectable TSH levels 7 days after surgery was highly predictive of successful outcome. During long term follow- up, there was one relapse of hyperthyroidism. Early diagnosis of TSH- secreting adenomas permits a high rate of remission of hyperthyroidism after surgery. However, normalization of thyroid function alone does not necessarily reflect complete removal of the tumor, and more comprehensive criteria of cure based on pituitary imaging, hormone measurement, and suppression of TSH during T3 administration should be used. Lastly, all patients need an accurate long term follow-up to monitor the possible recurrence of the adenoma.

UR - http://www.scopus.com/inward/record.url?scp=0029787256&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0029787256&partnerID=8YFLogxK

U2 - 10.1210/jc.81.8.3084

DO - 10.1210/jc.81.8.3084

M3 - Article

VL - 81

SP - 3084

EP - 3090

JO - Journal of Clinical Endocrinology and Metabolism

JF - Journal of Clinical Endocrinology and Metabolism

SN - 0021-972X

IS - 8

ER -