ACTH‐secreting pituitary microadenomas are associated with a higher prevalence of central hypothyroidism compared to other microadenoma types
Open accessAbstract
Summary: Context: Unlike pituitary macroadenomas, microadenomas (micros) are not commonly associated with hypopituitarism. In clinical practice, we have observed that patients with ACTH‐secreting micros have a higher than expected prevalence of central hypothyroidism (HT), and we speculated that this effect might be because of glucocorticoid‐induced suppression of the hypothalamic–pituitary–thyroid axis. Objective: To determine whether there is a difference in the prevalence of central HT among ACTH micros compared to other types of microadenoma, and if so, to investigate whether this is directly related to the degree of hypercortisolism. Design, setting and patients: Retrospective study of 149 newly diagnosed patients with pituitary micros: 34 ACTH‐secreting, 72 prolactin‐secreting (PRL omas) and 43 clinically nonfunctioning adenomas (NFA s). Main outcomes measures: Prevalence of central HT, correlation between normalized free T 4 or TSH vs normalized urinary free cortisol (UFC) or salivary cortisol. Results: The prevalence of central HT was significantly higher in the ACTH compared to the non‐ACTH adenomas: 18% (ACTH), 1% (PRL) and 0% (NFA s). The mean normalized free T 4 was lower in the ACTH micros compared to the non‐ACTH micros (1·29 ± 0·06 vs 1·50 ± 0·23, P = 0·0001). There was no correlation between the degree of hypercortisolism, as reflected by 24‐h urine free cortisol and salivary cortisol, and free T 4 or TSH levels among the ACTH adenomas. Similarly, there were no differences in mean UFC or salivary cortisol between ACTH adenomas with and without central HT. Following transsphenoidal adenomectomy, central HT recovered in three of six patients with ACTH micros. Conclusions: These findings suggest that patients with ACTH‐secreting microadenomas should always, at a minimum, undergo testing for central HT. However, given the potential for recovery of thyroid function following cure of C ushing disease, we recommend withholding thyroid hormone replacement until after pituitary surgery.
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Administering dopamine agonists to patients with macroprolactinoma leads to normoprolactinemia in 68% (range 40-100%).
“Administering dopamine agonists to patients with macroprolactinoma leads to normoprolactinemia in 68% (range 40-100%) and tumor shrinkage in 62% (range 20-100%) (224).”
From Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline (2016) · cites this paper as [224]
The Patients and methods section says that most prolactin-secreting microadenomas were treated with dopamine agonists, but it reports no normoprolactinemia rate for macroprolactinomas. Searches for the 68% figure and for dopamine-agonist outcomes found no supporting passage in our copy; the cited paper studied microadenomas. (LLM, conf=0.78)
Experimental — accuracy not yet measuredAdministering dopamine agonists to patients with macroprolactinoma leads to tumor shrinkage in 62% (range 20-100%).
“Administering dopamine agonists to patients with macroprolactinoma leads to normoprolactinemia in 68% (range 40-100%) and tumor shrinkage in 62% (range 20-100%) (224).”
From Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline (2016) · cites this paper as [224]
The Patients and methods section says most patients with prolactin-secreting microadenomas received dopamine agonists, but it does not report tumor shrinkage. Searches for macroprolactinoma outcomes and the 62% shrinkage figure found no supporting passage in our copy; no page numbers were available. (LLM, conf=0.74)
Experimental — accuracy not yet measuredCentral hypothyroidism in patients with acromegaly and Cushing's disease occurs more often due to influence from hormonal overproduction or treatment rather than tumour compression.
“Central hypothyroidism in patients with acromegaly and Cushing's disease (Cai et al., 2020;Mathioudakis et al., 2012) occurs more often due to influence from the hormonal overproduction or the treatment (with e.g.somatostatin analogues) rather than tumour compression.”
From The hypothalamus-pituitary-thyroid (HPT)-axis and its role in physiology and pathophysiology of other hypothalamus-pituitary functions (2021) · cites this paper as Mathioudakis et al., 2012
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Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline
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- Authors
- Mathioudakis, N., Thapa, S., Wand, G. S., & Salvatori, R.
- Affiliations
- Johns Hopkins University (US)
- Corresponding author
- Salvatori, Roberto
- Venue
- Clinical Endocrinology
- Publisher
- Wiley
- Published
- 2012-11-09
- Volume
- 77
- Issue
- 6
- Pages
- 871-876
- ISSN
- 0300-0664 (ISSN-L)
- 1365-2265
- PMC
- PMC6031125
- OpenAlex
- W2027190696
- Semantic Scholar
- 248448b68d513aca8dd4381a788cd78952268404
- Cited by
- 30
- References
- 22
- Citations by year
- 2026: 1 · 2024: 2 · 2023: 5 · 2022: 1 · 2021: 3 · 2020: 5 · 2019: 3 · 2018: 3 · 2017: 1 · 2016: 4 · 2013: 1 · 2012: 1
- FWCI
- 0.51
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Clinical Endocrinology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (T32DK007751)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Health Sciences › Medicine › Surgery › Adrenal and Paraganglionic Tumors
- Keywords
- central hypothyroidism, Cushing's disease, hypothalamic-pituitary-thyroid axis, hypercortisolism, prolactinoma, non-functioning pituitary adenoma, transsphenoidal adenomectomy, thyroid function recovery, thyroid hormone replacement
- MeSH terms
- Female, Humans, Hydrocortisone, Hypothyroidism, Male, Pituitary Gland, Anterior, Pituitary Neoplasms, Retrospective Studies, Saliva, Thyrotropin, Thyroxine, ACTH-Secreting Pituitary Adenoma
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