Smarter Decisions,
Better Care

UpToDate synthesizes the most recent medical information into evidence-based practical recommendations clinicians trust to make the right point-of-care decisions.

  • Rigorous editorial process: Evidence-based treatment recommendations
  • World-Renowned physician authors: over 5,100 physician authors and editors around the globe
  • Innovative technology: integrates into the workflow; access from EMRs

Choose from the list below to learn more about subscriptions for a:

Subscribers log in here

Thyrotropin (TSH)-secreting pituitary adenomas


Thyrotropin (TSH)-secreting pituitary adenomas are a rare cause of hyperthyroidism [1]. They account for less than 2 percent of all functioning pituitary tumors [2,3], and much less than 1 percent of all cases of hyperthyroidism. Nevertheless, the diagnosis should be considered in all hyperthyroid patients, especially those with a diffuse goiter and no extrathyroidal manifestations of Graves' disease.

This topic will review the clinical presentation, diagnosis, and treatment of TSH-secreting pituitary tumors. Other causes of hyperthyroidism are reviewed separately. (See "Disorders that cause hyperthyroidism" and "Diagnosis of hyperthyroidism".)


Thyrotropin (TSH)-secreting adenomas secrete biologically active TSH in a more or less autonomous fashion. Thus, TSH secretion usually does not increase much in response to thyrotropin-releasing hormone (TRH) and does not decrease much in response to exogenous thyroid hormone administration. The biological activity of the TSH that is secreted varies considerably; as a result, serum immunoreactive TSH concentrations range from normal (albeit inappropriately high in the presence of hyperthyroidism) to markedly elevated (>500 mU/L) [4].

Approximately 25 percent of the adenomas secrete one or more other pituitary hormones; about 15 percent secrete growth hormone, 10 percent secrete prolactin, and rare tumors secrete gonadotropins [4]. There have been no reported instances of cosecretion of corticotropin (ACTH) and TSH.

Adenomas secreting TSH and growth hormone are equally common in men and women, whereas cosecretion of TSH and prolactin is about five times more common in women than in men. Hyperprolactinemia is not always due to tumor secretion of prolactin; in some patients, it is caused by compression of the pituitary stalk and interruption of tonic hypothalamic inhibition of prolactin secretion. (See "Causes of hyperprolactinemia", section on 'Decreased dopaminergic inhibition of prolactin secretion'.)


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2014. | This topic last updated: Jan 24, 2014.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2014 UpToDate, Inc.
  1. Ónnestam L, Berinder K, Burman P, et al. National incidence and prevalence of TSH-secreting pituitary adenomas in Sweden. J Clin Endocrinol Metab 2013; 98:626.
  2. Socin HV, Chanson P, Delemer B, et al. The changing spectrum of TSH-secreting pituitary adenomas: diagnosis and management in 43 patients. Eur J Endocrinol 2003; 148:433.
  3. Beck-Peccoz P, Persani L, Mannavola D, Campi I. Pituitary tumours: TSH-secreting adenomas. Best Pract Res Clin Endocrinol Metab 2009; 23:597.
  4. Beck-Peccoz P, Brucker-Davis F, Persani L, et al. Thyrotropin-secreting pituitary tumors. Endocr Rev 1996; 17:610.
  5. Delhase M, Vergani P, Malur A, et al. Pit-1/GHF-1 expression in pituitary adenomas: further analogy between human adenomas and rat SMtTW tumours. J Mol Endocrinol 1993; 11:129.
  6. Sanno N, Teramoto A, Matsuno A, et al. Clinical and immunohistochemical studies on TSH-secreting pituitary adenoma: its multihormonality and expression of Pit-1. Mod Pathol 1994; 7:893.
  7. Pellegrini I, Barlier A, Gunz G, et al. Pit-1 gene expression in the human pituitary and pituitary adenomas. J Clin Endocrinol Metab 1994; 79:189.
  8. Ando S, Sarlis NJ, Krishnan J, et al. Aberrant alternative splicing of thyroid hormone receptor in a TSH-secreting pituitary tumor is a mechanism for hormone resistance. Mol Endocrinol 2001; 15:1529.
  9. Ando S, Sarlis NJ, Oldfield EH, Yen PM. Somatic mutation of TRbeta can cause a defect in negative regulation of TSH in a TSH-secreting pituitary tumor. J Clin Endocrinol Metab 2001; 86:5572.
  10. Tagami T, Usui T, Shimatsu A, et al. Aberrant expression of thyroid hormone receptor beta isoform may cause inappropriate secretion of TSH in a TSH-secreting pituitary adenoma. J Clin Endocrinol Metab 2011; 96:E948.
  11. Dong Q, Brucker-Davis F, Weintraub BD, et al. Screening of candidate oncogenes in human thyrotroph tumors: absence of activating mutations of the G alpha q, G alpha 11, G alpha s, or thyrotropin-releasing hormone receptor genes. J Clin Endocrinol Metab 1996; 81:1134.
  12. Brucker-Davis F, Oldfield EH, Skarulis MC, et al. Thyrotropin-secreting pituitary tumors: diagnostic criteria, thyroid hormone sensitivity, and treatment outcome in 25 patients followed at the National Institutes of Health. J Clin Endocrinol Metab 1999; 84:476.
  13. Beckers A, Abs R, Mahler C, et al. Thyrotropin-secreting pituitary adenomas: report of seven cases. J Clin Endocrinol Metab 1991; 72:477.
  14. Refetoff S, Weiss RE, Usala SJ. The syndromes of resistance to thyroid hormone. Endocr Rev 1993; 14:348.
  15. Hall WA, Luciano MG, Doppman JL, et al. Pituitary magnetic resonance imaging in normal human volunteers: occult adenomas in the general population. Ann Intern Med 1994; 120:817.
  16. Bogazzi F, Manetti L, Tomisti L, et al. Thyroid color flow Doppler sonography: an adjunctive tool for differentiating patients with inappropriate thyrotropin (TSH) secretion due to TSH-secreting pituitary adenoma or resistance to thyroid hormone. Thyroid 2006; 16:989.
  17. Lamberts SW, Krenning EP, Reubi JC. The role of somatostatin and its analogs in the diagnosis and treatment of tumors. Endocr Rev 1991; 12:450.
  18. Cooper DS, Wenig BM. Hyperthyroidism caused by an ectopic TSH-secreting pituitary tumor. Thyroid 1996; 6:337.
  19. Pasquini E, Faustini-Fustini M, Sciarretta V, et al. Ectopic TSH-secreting pituitary adenoma of the vomerosphenoidal junction. Eur J Endocrinol 2003; 148:253.
  20. Kasliwal MK, Gupta A, Sharma MS. Single low dose adjuvant γ knife radiosurgery for thyrotropin secreting pituitary adenoma. Acta Neurochir (Wien) 2012; 154:665.
  21. Mulinda JR, Hasinski S, Rose LI. Successful therapy for a mixed thyrotropin-and prolactin-secreting pituitary macroadenoma with cabergoline. Endocr Pract 1999; 5:76.
  22. Camacho P, Mazzone T. Thyrotropin-secreting pituitary adenoma responsive to bromocriptine therapy. Endocr Pract 1999; 5:257.
  23. Kienitz T, Quinkler M, Strasburger CJ, Ventz M. Long-term management in five cases of TSH-secreting pituitary adenomas: a single center study and review of the literature. Eur J Endocrinol 2007; 157:39.
  24. Kuhn JM, Arlot S, Lefebvre H, et al. Evaluation of the treatment of thyrotropin-secreting pituitary adenomas with a slow release formulation of the somatostatin analog lanreotide. J Clin Endocrinol Metab 2000; 85:1487.
  25. Meas T, Sobngwi E, Vexiau P, Boudou P. An unusual somatotropin and thyreotropin secreting pituitary adenoma efficiently controlled by Octreotide and Pegvisomant. Ann Endocrinol (Paris) 2006; 67:249.
  26. Yoshihara A, Isozaki O, Hizuka N, et al. Expression of type 5 somatostatin receptor in TSH-secreting pituitary adenomas: a possible marker for predicting long-term response to octreotide therapy. Endocr J 2007; 54:133.
  27. Horiguchi K, Yamada M, Umezawa R, et al. Somatostatin receptor subtypes mRNA in TSH-secreting pituitary adenomas: a case showing a dramatic reduction in tumor size during short octreotide treatment. Endocr J 2007; 54:371.
  28. Brown RL, Muzzafar T, Wollman R, Weiss RE. A pituitary carcinoma secreting TSH and prolactin: a non-secreting adenoma gone awry. Eur J Endocrinol 2006; 154:639.