TSH-secreting pituitary adenomas
- Roy E Weiss, MD, PhD
Roy E Weiss, MD, PhD
- Professor and Chairman
- The University of Miami Miller School of Medicine
- Samuel Refetoff, MD
Samuel Refetoff, MD
- Professor of Medicine, Pediatrics, and Committee on Genetics
- University of Chicago
Thyroid-stimulating hormone (TSH)-secreting pituitary adenomas are a rare cause of hyperthyroidism . They account for 0.5 to 3 percent of all functioning pituitary tumors  and much less than 1 percent of all cases of hyperthyroidism. The incidence in Sweden is calculated to be 2.8 per 1 million, in which 0.85 per million had disease . 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".)
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) .
Most TSH-secreting adenomas secrete only TSH. However, approximately 20 to 25 percent of the adenomas secrete one or more other pituitary hormones, predominantly growth hormone or prolactin . There have been no reported instances of co-secretion of adrenocorticotropic hormone (ACTH) and TSH.
Adenomas secreting TSH and growth hormone are equally common in men and women, whereas co-secretion of TSH and prolactin is approximately 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'.)
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- CLINICAL PRESENTATION
- Symptoms and signs
- Thyroid function tests
- Alpha subunit
- Imaging studies
- Differential diagnosis
- - Assay interference
- - Resistance to thyroid hormone
- - Long-standing primary hypothyroidism
- Diagnostic evaluation
- - Medical therapy
- Restore euthyroidism prior to neurosurgery
- Reduce tumor size prior to neurosurgery
- Primary treatment
- - Surgery
- Criteria for cure
- Residual disease
- - Somatostatin analogs
- - Pituitary irradiation
- - Thyroidectomy
- Long-term monitoring
- SUMMARY AND RECOMMENDATIONS