The outcome of TSHoma from a tertiary care institute in India

Aditya Dutta; Nimisha Jain; Ashutosh Rai; Rahul Gupta; Sivashanmugam Dhandapani; Anil Bhansali; Bishan Das Radotra; Chirag Kamal Ahuja; Pinaki Dutta

doi:10.25259/SNI_877_2020

The outcome of TSHoma from a tertiary care institute in India

Surg Neurol Int. 2021 Apr 14:12:161. doi: 10.25259/SNI_877_2020. eCollection 2021.

Authors

Aditya Dutta¹, Nimisha Jain¹, Ashutosh Rai¹, Rahul Gupta¹, Sivashanmugam Dhandapani², Anil Bhansali¹, Bishan Das Radotra³, Chirag Kamal Ahuja⁴, Pinaki Dutta¹

Affiliations

¹ Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
² Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
³ Department of Histopathology Post Graduate Institute of Medical Education and Research, Chandigarh, India.
⁴ Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

Abstract

Background: Thyroid-stimulating hormone (TSH)-secreting pituitary adenoma (TSHoma) is the rarest functioning pituitary adenoma.

Methods: A retrospective analysis of eight patients of TSHomas to highlight the presentations, diagnostic challenges, and treatment outcomes.

Results: Median age at diagnosis was 42 years, median latency to diagnosis was 2.5 years, and thyrotoxic and compressive symptoms were the most common presenting symptoms. At presentation, three cases were plurihormonal, six cases were on medical treatment including thyroxine, and two cases were incidentally discovered. Imaging revealed macroadenoma in all cases. Seven cases underwent pituitary surgery, after which three achieved remission. Another case entered remission after adjunctive radiotherapy. Thyrotropin (TSH) immunostaining was demonstrated in six out of seven adenomas.

Conclusion: TSHoma is a rare functioning pituitary tumor with both silent and symptomatic presentations. Diagnosis can be established with biochemical and imaging features, even without dynamic tests.

Keywords: Non-suppressed thyroid-stimulating hormone; Secondary hyperthyroidism; Thyroid-stimulating hormone-secreting pituitary adenoma.