Primary Medical Treatment of Thyrotropin–Secreting Pituitary Adenomas by First-Generation Somatostatin Analogs: A Case Study of Seven Patients
Abstract
BACKGROUND: The first-choice treatment of thyrotropin (TSH)-secreting pituitary adenomas is surgical adenomectomy, with 40-60% of patients cured after surgery. The presence of somatostatin receptors on the adenomatous cells suggests that first-generation somatostatin analogs (octreotide, lanreotide) could be used as an adjuvant treatment to surgery for TSH-secreting pituitary adenomas. The aim of this study is to describe the efficacy and safety of primary medical treatment with first-generation somatostatin analogs in patients with a TSH-secreting pituitary adenoma. METHODS: Retrospective study on 7 patients (5 women, 2 men) aged 57±14 years with pure TSH (n=4) or mixed TSH/GH (n=3) secreting pituitary adenomas primarily treated with first generation somatostatin analogs. Magnetic resonance imaging revealed a microadenoma in 3 patients and a macroadenoma in 4 patients. The follow-up period was 8.5±7.3 years. RESULTS: At initial diagnosis, the patients presented with thyrotoxicosis with elevated free thyroxine (26.5±6.5 pg/mL) and free triiodothyronine (7.3±0.9 pg/mL) levels and a mean TSH of 4.3±1.4 mU/L. During somatostatin analog treatment, free thyroid hormones and TSH levels normalized after 4.4±3.9 and 7.0±8.4 months, respectively. At the time of the last visit, 6 patients were biochemically controlled. Adenoma volume decreased in 6 patients and a decrease in adenoma volume persisted in 2 patients several years after initiation of somatostatin analog treatment. Safety of treatment was good and no patients discontinued somatostatin analogs due to side effects. CONCLUSION: This study confirms the efficacy of primary medical treatment with first-generation somatostatin analogs in terms of hormonal control and tumor volume reduction in patients with TSH-secreting pituitary adenomas, and its good safety profile. First-generation somatostatin analogs may serve as a medical alternative to surgical treatment, especially in patients where surgery is contraindicated or in subjects presenting with invasive macroadenomas that render complete surgical resection difficult.
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In a recent case series of seven patients treated with octreotide without prior surgery, mean free T4 and T3 levels were reduced by nearly 50% in the first 3 months of therapy and six of seven patients experienced tumor volume reduction.
“In a recent case series of seven patients treated with octreotide without prior surgery, mean free T 4 and T 3 levels were reduced by nearly 50% in the first 3 months of therapy and six of seven patients experienced tumor volume reduction (661).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [661]
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- Authors
- Rimareix, F., Grunenwald, S., Vezzosi, D., Rivière, L.-D., Bennet, A., & Caron, P.
- Affiliations
- Centre Hospitalier Universitaire de Toulouse (FR)
- Corresponding author
- Caron, Philippe
- Venue
- Thyroid
- Publisher
- SAGE Publications
- Published
- 2015-08
- Volume
- 25
- Issue
- 8
- Pages
- 877-882
- ISSN
- 1050-7256 (ISSN-L)
- 1557-9077
- OpenAlex
- W1642172759
- Cited by
- 32
- References
- 19
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 1 · 2023: 5 · 2022: 5 · 2021: 2 · 2020: 4 · 2019: 3 · 2018: 3 · 2017: 2 · 2016: 4
- FWCI
- 2.60
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Thyroid (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Ipsen
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
- Health Sciences › Medicine › Epidemiology › Neuroendocrine Tumor Research Advances
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Growth Hormone and Insulin-like Growth Factors
- Keywords
- TSH-secreting pituitary adenoma, octreotide, lanreotide, thyrotoxicosis, tumor shrinkage, biochemical control, treatment safety, alternative to surgery, macroadenoma, pituitary microadenoma
- MeSH terms
- Adenoma, Adult, Aged, Female, Follow-Up Studies, Humans, Injections, Intramuscular, Insulin-Like Growth Factor I, Magnetic Resonance Imaging, Male, Middle Aged, Pituitary Neoplasms, Retrospective Studies, Somatostatin, Growth Hormone, Thyrotropin, Thyroxine, Triiodothyronine, Octreotide
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