OBJECTIVE Thyroid-stimulating hormone (TSH)–secreting pituitary adenoma (TSHoma) is a rare type of pituitary adenoma; thus, little is known about TSHomas. The purpose of this study was to analyze clinical characteristics and therapeutic outcomes of TSHomas based on a single-center experience. The authors also searched for reliable preoperative and early postoperative factors that could predict long-term endocrinological remission. METHODS The clinical, radiological, and pathological characteristics and surgical and endocrinological outcomes of 31 consecutive cases of TSHomas that were surgically treated between 2005 and 2017 were reviewed retrospectively. Preoperative factors were evaluated for their ability to predict long-term remission by comparing remission and nonremission groups. TSH and free thyroxine levels were measured at 2, 6, 12, 18, and 24 hours after surgery to determine whether they could predict long-term remission. RESULTS Gross-total removal of tumor was achieved in 28 patients (90.3%), and 26 patients (83.9%) achieved endocrinological remission by surgery alone based on long-term endocrinological follow-up (median 50 months, range 32–81 months). The majority of the tumors were solid (21/31, 67.7%), and en bloc resection was possible in 16 patients (51.6%). Larger tumor size and tumor invasion into cavernous sinus and sphenoid sinus were strong predictors of lower rates of endocrinological remission. Immediate postoperative TSH level at 12 hours after surgery was the strongest predictor, with a 0.62 μIU/mL cutoff. Postoperative complications included CSF rhinorrhea in one patient and epistaxis in another patient, who underwent additional surgical treatment for the complications. CONCLUSIONS Tumor size and extent are major prognostic factors for both extent of resection and endocrinological remission. The consistency of TSHomas was more likely to be solid, which makes extracapsular dissection more feasible. Long-term remission of TSHomas could be predicted even during the early postoperative period.
Bibliographical noteFunding Information:
This study was funded by the Basic Science Research Program through the NRF of Korea (NRF-2018R1C1B5042687) from the Korean Ministry of Science; ICT and Future Planning (Eui Hyun Kim); and the “Dongwha” Faculty Research Assistance Program of Yonsei University College of Medicine (6-2018-0073) (Eui Hyun Kim). We thank Juyoon Park, RN, MPH, OCN; Min Kyeong Jang, RN, KOAPN, PhD; Sung Ja Kang, RN; Sujin Ryu, RN; and Yong Jun Jang, RN, for their tremendous effort in performing the endocrinological tests and data acquisition for such a long follow-up duration. We also express our sincere gratitude to Sinae Kim for the statistical advice.
©AANS 2021, except where prohibited by US copyright law
All Science Journal Classification (ASJC) codes
- Clinical Neurology