Adults with thyroid-stimulating hormone-secreting pituitary adenomas have a greater chance of biochemical remission after undergoing adjuvant treatment compared with neoadjuvant therapies, according to findings published in Pituitary.
“The correct diagnosis and an early treatment [of TSH-secreting pituitary adenomas] are imperative because of the higher risk of mortality and morbidity in patients with untreated hyperthyroidism,” Giulia Cossu, MD, of the department of neurosurgery at Lausanne University Hospital in Switzerland, and colleagues wrote. “The surgical treatment is considered the mainstay of treatment and the transsphenoidal approach is considered the gold standard.”
Cossu, along with Mahmoud Messerer, MD, MSc, FEBNS, also of the department of neurosurgery at Lausanne University Hospital, and colleagues conducted an independent review of 23 articles published after 1990 that included patients with TSH-secreting pituitary adenomas who underwent surgery by itself or in combination with adjuvant or neoadjuvant therapy. Each report was required to include postoperative outcomes, including biochemical remission and radiological extent of resection.
Identified adenomas were classified as micro if they were less than 10 mm and macro if they were 10 mm or more. Biochemical remission was confirmed when thyroid hormone and TSH levels normalized or reached low levels.
Across the entire collection of included articles, there were 536 patients (52% women; mean age, 45 years). Among them, 67% had clinical hyperthyroidism and 90% had biochemical hyperthyroidism. In addition, macroadenomas were present in 79.6% of patients and microadenomas were present in 22%, which was up from the 11% identified in a 2000 report (P = .04), the researchers wrote.
After surgery, 69.7% of patients achieved biochemical remission (95% CI, 61.1-78.4) and 54.1% achieved gross total resection (95% CI, 41.2-66.9). More patients with microadenomas reached gross total resection (87%; 95% CI, 76.6-96.7) compared with patients with macroadenomas (49%; 95% CI, 32-66).
Although there were no significant differences in postoperative outcomes for patients who underwent neoadjuvant treatment, either with somatostatin receptor ligands or dopamine agonists, the researchers discovered that adjuvant radiotherapy led to biochemical remission in 65.9% of patients (95% CI, 48-83.8) and adjuvant medical therapies led to biochemical remission in 76% of patients (95% CI, 63.1-88.4). Combining these results, adjuvant therapy of any kind led to biochemical remission in 67% of patients (95% CI, 50.4-83.6). In addition, 85.8% of patients (95% CI, 80.7-90.8) achieved biochemical remission after long-term follow-up of more than 24 months when treated with either adjuvant method, according to the study.
“The number of patients diagnosed with [TSH-secreting pituitary adenomas] has tripled in the last decade, and our knowledge about this rare pathology is improving, thanks to an increase in the number of publications dealing with this subject,” the researchers wrote. “Larger surgical series and longer follow-up periods should prove useful to determine the factors predicting a long-term remission.” – by Phil Neuffer
Disclosures: The authors report no relevant financial disclosures.