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 imagingandhormonal profile,9%developed pituitary deficiencies,and3% 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 in37%of patients within 2 years, whereas32%of patients developednewpituitary 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.

Thyrotropin-secreting pituitary adenomas : outcome of pituitary surgery and irradiation / E. Malchiodi, E. Profka, E. Ferrante, E. Sala, E. Verrua, I. Campi, A.G. Lania, M. Arosio, M. Locatelli, P. Mortini, M. Losa, E. Motti, P.L.M. Beck Peccoz, A. Spada, G. Mantovani. - In: THE JOURNAL OF CLINICAL ENDOCRINOLOGY AND METABOLISM. - ISSN 0021-972X. - 99:6(2014 Jun), pp. 2069-2076.

Thyrotropin-secreting pituitary adenomas : outcome of pituitary surgery and irradiation

E. Malchiodi
Primo
;
E. Profka
Secondo
;
E. Ferrante;E. Sala;E. Verrua;I. Campi;A.G. Lania;M. Arosio;M. Locatelli;E. Motti;P.L.M. Beck Peccoz;A. Spada;G. Mantovani
Ultimo
2014

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 imagingandhormonal profile,9%developed pituitary deficiencies,and3% 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 in37%of patients within 2 years, whereas32%of patients developednewpituitary 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.
Adult; Aged; Combined Modality Therapy; Cranial Irradiation; Female; Follow-Up Studies; Humans; Male; Middle Aged; Neurosurgical Procedures; Retrospective Studies; Thyrotropin; Treatment Outcome; Young Adult; Adenoma; Pituitary Neoplasms; Biochemistry; Clinical Biochemistry; Endocrinology; Biochemistry (medical); Endocrinology, Diabetes and Metabolism
Settore MED/13 - Endocrinologia
Settore MED/27 - Neurochirurgia
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/253460
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