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Clinical outcome and evidence of high rate post-surgical anterior hypopituitarism in a cohort of TSH-secreting adenoma patients: Might somatostatin analogs have a role as first-line therapy?
- Source :
-
Pituitary [Pituitary] 2015 Oct; Vol. 18 (5), pp. 583-91. - Publication Year :
- 2015
-
Abstract
- Purpose: Thyrotropin-secreting pituitary adenomas (TSHomas) represent a rare subtype of pituitary tumors. Neurosurgery (NCH) is still considered the first-line therapy. In this study we aimed to investigate the outcome of different treatment modalities, including first line somatostatin analogs (SSA) treatment, with a specific focus on neurosurgery-related complications.<br />Methods: We retrospectively evaluated thirteen patients diagnosed for TSHomas (9 M; age range 27-61). Ten patients had a magnetic resonance evidence of macroadenoma, three with slight visual field impairment. In the majority of patients, thyroid ultrasonography showed the presence of goiter and/or increased gland vascularization. Median TSH value at diagnosis was 3.29 mU/L (normal ranges 0.2-4.2 mIU/L), with median fT4 2.52 ng/dL (0.9-1.7 ng/dL).<br />Results: Three patients (two microadenoma) were primarily treated with NCH and achieved disease remission, whereas ten patients (nine macroadenomas) were initially treated with SSA. Despite the optimal biochemical response observed during medical treatment in most patients (mean TSH decrease -72%), only two stayed on medical therapy alone, achieving stable biochemical control at the end of the follow-up. The remaining patients (n = 7) underwent NCH later on during their clinical history, followed by radiotherapy or adjuvant SSA treatment in two cases. Noteworthy, five of them developed hypopituitarism. All patients reached a biochemical control, after a multimodal therapeutic approach.<br />Conclusions: Neurosurgery ultimately led to complete disease remission or to biochemical control in majority of patients, whereas resulting in a considerable percentage of post-operative complications (mainly hypopituitarism, 50%). In the light of the optimal results unanimously reported for medical treatment with SSA, our experience suggests that a careful evaluation of risk/benefit ratio should be taken into consideration when directing the treatment approach in patients with TSHoma.
- Subjects :
- Adenoma blood
Adenoma metabolism
Adenoma pathology
Adult
Antineoplastic Agents adverse effects
Biomarkers, Tumor blood
Chemotherapy, Adjuvant
Female
France
Humans
Hypopituitarism diagnosis
Italy
Male
Middle Aged
Patient Selection
Pituitary Irradiation
Pituitary Neoplasms blood
Pituitary Neoplasms metabolism
Pituitary Neoplasms pathology
Radiotherapy, Adjuvant
Retrospective Studies
Risk Factors
Somatostatin adverse effects
Somatostatin analogs & derivatives
Thyrotropin blood
Time Factors
Treatment Outcome
Adenoma therapy
Antineoplastic Agents therapeutic use
Biomarkers, Tumor metabolism
Hypophysectomy adverse effects
Hypopituitarism etiology
Pituitary Neoplasms therapy
Somatostatin therapeutic use
Thyrotropin metabolism
Subjects
Details
- Language :
- English
- ISSN :
- 1573-7403
- Volume :
- 18
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Pituitary
- Publication Type :
- Academic Journal
- Accession number :
- 25326851
- Full Text :
- https://doi.org/10.1007/s11102-014-0611-8