Thyrotropin-Secreting Pituitary Adenomas: Outcome of Pituitary Surgery and Irradiation
Abstract
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 imaging and hormonal profile, 9% developed pituitary deficiencies, and 3% 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 in 37% of patients within 2 years, whereas 32% of patients developed new pituitary 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.
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In a recent series of 68 patients undergoing transsphenoidal surgery for TSH-secreting pituitary tumors, 75% normalized thyroid function after surgery, 58% normalized both pituitary imaging and TSH hypersecretion, 9% developed new deficiencies, and 3% experienced tumor recurrence.
“In a recent series of 68 patients undergoing transsphenoidal surgery, 75% normalized thyroid function after surgery, 58% normalized both pituitary imaging and TSH hypersecretion, 9% developed new deficiencies, and 3% experienced tumor recurrence (659).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [659]
Presurgical medical treatment did not significantly improve surgical outcome (63% vs. 57% had negative tumor imaging after surgery).
“However, presurgical medical treatment did not significantly improve surgical outcome (63% vs. 57% had negative tumor imaging after surgery) (659).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [659]
Radiotherapy controlled thyroid hypersecretion in 37% of patients treated with this modality, but hypopituitarism occurred in 32% of those treated.
“Radiotherapy controlled thyroid hypersecretion in 37% of patients treated with this modality, but hypopituitarism occurred in 32% of those treated (659).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [659]
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Abreu-Lomba, A., Viáfara, M. F. L., Mejía, A. F., Zambrano-Urbano, J. L., & Muñoz, J. F. (2020) · Revista Colombiana Salud Libre · doi:10.18041/1900-7841/rcslibre.2020v15n2.7761 · Cited by 1 · see citing works
TSH-Producing Adenomas and Resistance to Thyroid Hormones
Beck-Peccoz, P., Lania, A. G., & Persani, L. (2015) · Elsevier eBooks · doi:10.1016/b978-0-12-801238-3.04206-9 · Cited by 1 · see citing works
Self-citationJohnston, P. C., Hamrahian, A. H., Prayson, R. A., Kennedy, L., & Weil, R. J. (2015)
Physiopathology, Diagnosis and Treatment of Secondary Hyperthyroidism
Beck‐Peccoz, P., Giavoli, C., Rodari, G., & Lania, A. G. (2017) · Endocrinology · doi:10.1007/978-3-319-38681-2_8-1
Self-citationTsh-Staining Pituitary Adenoma: A Rare Entity With Changing Facets
Ioachimescu, A. G. (2018) · Endocrine Practice · doi:10.4158/ep-2018-0203
Approccio diagnostico e terapeutico agli adenomi ipofisari TSH-secernenti
Lania, A. G., & Gatto, F. (2018) · L Endocrinologo · doi:10.1007/s40619-018-0456-x
Self-citationA Rare Entity: TSH-Secreting Adenoma
Dichtel, L. E. (2018) · Springer eBooks · doi:10.1007/978-3-319-90909-7_9
TSH-Secreting Pituitary Adenomas
Lania, A. G., Betella, N., & Milani, D. (2019) · Contemporary Endocrinology · doi:10.1007/978-3-030-11339-1_8
Self-citationPituitary adenomas: current principles of diagnosis and treatment
Astafyeva, L. I., Chernov, I. V., Chekhonin, I. V., Shults, E. I., Pronin, I., & Kalinin, P. L. (2021) · Russian journal of neurosurgery · doi:10.17650/1683-3295-2020-22-4-94-111
Thyreotroop adenoom van de hypofyse: een zeldzame oorzaak van hyperthyreoïdie
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Tirotoxicosis e hipertiroidismo
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Neoplasms of the Endocrine Glands: Pituitary Neoplasms
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TSH-producing adenomas and resistance to thyroid hormones
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Liu, J., Zhu, Y., Wei, Y., Yu, L., Li, Y., Wang, Q., Zhuang, L., Jin, G., & Pei, X. (2026) · Journal of Medical Case Reports · doi:10.1186/s13256-026-06160-2
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- Authors
- Malchiodi, E., Profka, E., Ferrante, E., Sala, E., Verrua, E., Campi, I., Lania, A. G., Arosio, M., Locatelli, M., Mortini, P., Losa, M., Motti, E., Beck-Peccoz, P., Spada, A., & Mantovani, G.
- Affiliations
- Maria Cecilia Hospital (IT)
- Departments of Clinical Sciences and Community Health (E.M., E.P., E.F., E.S., E.V., I.C., M.A., P.B.P., A.S., G.M.), 20112 Milan, Italy;
- University of Milan (IT)
- MultiMedica (IT)
- Vita-Salute San Raffaele University (IT)
- ORCID
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2014-06-01
- Volume
- 99
- Issue
- 6
- Pages
- 2069-2076
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W1990497879
- Cited by
- 89
- References
- 18
- Citations by year
- 2026: 4 · 2025: 1 · 2024: 7 · 2023: 7 · 2022: 10 · 2021: 10 · 2020: 6 · 2019: 11 · 2018: 11 · 2017: 10 · 2016: 4 · 2015: 6 · 2014: 2
- FWCI
- 5.90
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Archivio Istituzionale della Ricerca - Università Vita-Salute San Raffaele (submittedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
- Health Sciences › Medicine › Epidemiology › Neuroendocrine Tumor Research Advances
- Health Sciences › Medicine › Surgery › Adrenal and Paraganglionic Tumors
- Keywords
- TSHoma, thyrotropinoma, pituitary adenoma, pituitary surgery, radiotherapy, somatostatin analogues, hyperthyroidism, thyroid function normalization, hypopituitarism, tumor recurrence, macroadenoma, methimazole
- MeSH terms
- Adenoma, Adult, Aged, Combined Modality Therapy, Female, Follow-Up Studies, Humans, Male, Middle Aged, Pituitary Neoplasms, Retrospective Studies, Thyrotropin, Cranial Irradiation, Treatment Outcome, Neurosurgical Procedures, Young Adult
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