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Thyrotropin (TSH)-secreting pituitary adenomas (TSH-oma) are rare and account for about 0.5-3% of all pituitary adenomas. Patients with TSH-oma present themselves mostly with central hyperthyroidism expressing increased circulating levels of TSH, free T4 and T3.1 TSH-omas are usually benign tumours and express somatostatin receptors subtypes 2 and 5. This article is protected by copyright. All rights reserved.

ContextThyroid dysfunction is thought to be associated with stillbirth. Therefore, thyroid function is often recommended in the diagnostic investigations for stillbirth.ObjectiveWe aimed to evaluate the added value of thyroid function testing in the diagnostic investigations for stillbirth.Design and patientsA nationwide multicentre prospective cohort study in 1025 women who suffered stillbirth >20 weeks of gestation performed between 2002 and 2008. In each woman, an extensive diagnostic work-up was performed, including placental examination and autopsy. TSH and FT4 values below the 25th percentile or above the 975th percentile according local laboratory reference values were regarded as abnormal. Women with a history of thyroid disease were evaluated separately.Main outcome measuresThyroid function abnormalities in women with stillbirth.ResultsOf 1025 included women, 21 had a history of thyroid disease (2%). In the 875 with TSH and FT4 results and no history of thyroid disease, 10% had hypothyroxinemia, 46% subclinical hypothyroidism, 16% overt hypothyroidism and 15% subclinical hyperthyroidism. Women with a subclinical hyperthyroidism more often had a foetal death caused by foetal hydrops: 23% vs 29% (adjusted OR 103, 95% CI 25-42).ConclusionsWomen with a stillbirth had a slightly higher prevalence of overt hypothyroidism, subclinical hypothyroidism and hypothyroxinaemia compared to previous studies on thyroid dysfunction in pregnant women. Given the absence of a strong associations with the cause of stillbirth, and no demonstrated beneficial effects of treating thyroid dysfunction in these women, routine screening after stillbirth is not justified.

Background In untreated acromegaly patients, decreased cognitive functioning is reported to be associated with the degree of growth hormone (GH) and IGF-1 excess. Whether previous GH excess or current medical treatment for acromegaly specifically affects cognition remains unclear. The aim of this study was to compare cognitive functioning of patients who are treated for acromegaly with patients with non-functioning pituitary adenomas (NFA). In addition, we assessed the influence of prolonged medical treatment after initial transsphenoidal surgery on cognition. Design In this cross-sectional study, 74 patients participated, who were treated for acromegaly (n = 50; median [interquartile range] age: 53 [45‐65] years) or NFA (n = 24; age: 63 [59‐70] years). The NFA patients were selected for a high likelihood of normal GH secretion based on an IGF-1 z-score within the normal range (> )2) and zero or one axis substituted. Of the acromegaly patients, 28 had achieved remission, while 22 were biochemically controlled with long-acting somatostatin analogues and ⁄or pegvisomant. Memory and executive functioning were assessed by the 15 Words Test and the Ruff Figural Fluency Test, and reported as z-scores. Results The total patient group scored significantly poorer than the reference population on memory and executive functioning (P

Context and objective Cognitive deterioration is reported in patients with a nonfunctioning pituitary macroadenoma (NFA) and after pituitary radiotherapy. However, reported results are inconsistent and are potentially confounded by different underlying pituitary disorders. The aim of this study was to examine cognitive functions in patients previously treated for NFA with or without radiotherapy. Design Verbal memory was assessed with the Dutch equivalent to the Rey Auditory Verbal Learning Test (15 Words Test, 15 WT). Executive functioning was examined using the Ruff Figural Fluency Test (RFFT). We compared our patient cohort with large reference populations representative of the Dutch population. Patients Eighty-four patients (62 +/- 10 years) who underwent transsphenoidal surgery 8.6 +/- 6.3 years earlier participated. Patients who underwent radiotherapy (n = 39) were compared to those who received surgery alone (n = 45). All patients were on stable hormonal replacement therapy. Results The total patient group scored significantly below the reference sample on all 15 WT z-scores (95%CI): short-term memory, -0.3 (-0.5 to -0.1); total memory, -0.8 (-1.1 to -0.5); learning score, -0.3 (-0.5 to -0.1); delayed memory, -0.8 (-1.1 to -0.5), all P

OBJECTIVE Results of trans-sphenoidal pituitary surgery, in terms of long-term cure, vary considerably between centres. Additional techniques, which can assist the neurosurgeon in deciding whether surgery is complete or not, might therefore be important. One such potential tool is the intra-operative measurement of GH and calculating the plasma half-life from the plasma samples obtained after the presumed complete resection of the adenoma. METHODS GH half-life was calculated from 5–10 min plasma samples after adenomectomy in 20 patients. GH was measured with a sensitive and rapid IFMA, and the results could be reported within 30 min, but were not used in this study for per-operative decisions. Cure was defined by a glucose suppressed plasma GH concentration below 1 mU/l (0.38 μg/l) during follow-up studies and a normal plasma IGFI concentration. RESULTS In 13 cured patients the plasma half-life was 22.2 ± 1.9 min (range 14–40.6). In three non-cured patients the plasma half-life could not be calculated, and in four other patients the plasma half-life was 35.8 ± 5.9 min (range 25.8–51 min). By applying 25 min as the upper normal limit for the GH plasma half-life, the sensitivity was 77%, specificity 100%, and positive predictive value 100%. CONCLUSION Per-operative plasma GH monitoring is a potentially useful tool for determining the completeness of trans-sphenoidal surgery in acromegaly.