TY - JOUR
T1 - Thyrotropin-secreting pituitary adenomas
T2 - Outcome of pituitary surgery and irradiation
AU - Malchiodi, Elena
AU - Profka, Eriselda
AU - Ferrante, Emanuele
AU - Sala, Elisa
AU - Verrua, Elisa
AU - Campi, Irene
AU - Lania, Andrea Gerardo
AU - Arosio, Maura
AU - Locatelli, Marco
AU - Mortini, Pietro
AU - Losa, Marco
AU - Motti, Enrico
AU - Beck-Peccoz, Paolo
AU - Spada, Anna
AU - Mantovani, Giovanna
PY - 2014
Y1 - 2014
N2 - Objective: Our objective was to describe the effects of surgery and radiotherapy on hormonal control and tumor mass in short- and long-term follow-up of TSH-secreting pituitary adenomas (TSHomas). Methods: This was a retrospective multicenter study. Results: We collected data of 70 TSHomas (70% macroadenomas). The mean follow-up was 64.4 (range 3-324) months. Overall, 97% of patients were treated with surgery; in 27% of them radiotherapy was associated. After surgery, 75% of patients normalized thyroid function, 58% normalized both pituitary imagingandhormonal profile,9%developed pituitary deficiencies,and3% had tumor or hormonal recurrence, all within the first 2 years after surgery. Presurgical medical treatment did not significantly improve surgical outcome (63% vs 57%). Radiotherapy controlled hypersecretion in37%of patients within 2 years, whereas32%of patients developednewpituitary deficiencies from 18 to 96 months from treatment. At last follow-up, 80% of patients normalized thyroid function, whereas 20% were currently on medical treatment: 85% with somatostatin analog (SSA) alone and 15% with SSA combined with methimazole. Subjects who achieved disease control had surgery as the only treatment in 80% of cases and surgery combined with irradiation in 20%. Conclusions: Surgery remains the first-choice treatment for TSHoma. If surgery is successful, recurrence is rare. When surgery is unsuccessful or contraindicated, SSA and radiotherapy are effective in controlling hyperthyroidism and tumor growth in the majority of patients. The effects of radiotherapy on TSH secretion and tumor mass are greater within the first years after treatment, whereas pituitary deficiencies may occur several years later.
AB - Objective: Our objective was to describe the effects of surgery and radiotherapy on hormonal control and tumor mass in short- and long-term follow-up of TSH-secreting pituitary adenomas (TSHomas). Methods: This was a retrospective multicenter study. Results: We collected data of 70 TSHomas (70% macroadenomas). The mean follow-up was 64.4 (range 3-324) months. Overall, 97% of patients were treated with surgery; in 27% of them radiotherapy was associated. After surgery, 75% of patients normalized thyroid function, 58% normalized both pituitary imagingandhormonal profile,9%developed pituitary deficiencies,and3% had tumor or hormonal recurrence, all within the first 2 years after surgery. Presurgical medical treatment did not significantly improve surgical outcome (63% vs 57%). Radiotherapy controlled hypersecretion in37%of patients within 2 years, whereas32%of patients developednewpituitary deficiencies from 18 to 96 months from treatment. At last follow-up, 80% of patients normalized thyroid function, whereas 20% were currently on medical treatment: 85% with somatostatin analog (SSA) alone and 15% with SSA combined with methimazole. Subjects who achieved disease control had surgery as the only treatment in 80% of cases and surgery combined with irradiation in 20%. Conclusions: Surgery remains the first-choice treatment for TSHoma. If surgery is successful, recurrence is rare. When surgery is unsuccessful or contraindicated, SSA and radiotherapy are effective in controlling hyperthyroidism and tumor growth in the majority of patients. The effects of radiotherapy on TSH secretion and tumor mass are greater within the first years after treatment, whereas pituitary deficiencies may occur several years later.
UR - http://www.scopus.com/inward/record.url?scp=84902338514&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84902338514&partnerID=8YFLogxK
U2 - 10.1210/jc.2013-4376
DO - 10.1210/jc.2013-4376
M3 - Article
C2 - 24552222
AN - SCOPUS:84902338514
VL - 99
SP - 2069
EP - 2076
JO - Journal of Clinical Endocrinology and Metabolism
JF - Journal of Clinical Endocrinology and Metabolism
SN - 0021-972X
IS - 6
ER -