TSH 분비 뇌하수체 선종 환자들의 임상적, 생화학적 특징과 치료

Abstract

Background/Aims : Thyrotropin (TSH)-secreting pituitary adenoma (TSHoma) is rare and represents 1~2% of all pituitaryadenomas. TSHoma should be distinguished from the thyroid hormone resistance syndrome. Patients with TSHoma may bemisdiagnosed with primary hyperthyroidism and often receive inappropriate thyroid gland treatment.

Methods : We assessed the clinical characteristics of patients with TSHoma who presented to Severance Hospital at the YonseiUniversity College of Medicine, Seoul, Korea between 2005 and 2009.

Results : Of 484 patients who underwent pituitary tumor resection, eight (1.65%; five women and three men) were found to haveTSHoma. The mean age was 40.6±8.9 years at diagnosis (range, 28~55 years). The median duration from onset of symptoms todiagnosis was 17 months (range, 4~60 months). Four patients had overt symptoms of hyperthyroidism and two had visual fielddefect. Six patients had elevated free thyroxine (FT4) levels with elevated or inappropriately normal TSH levels, and two patientshad symptoms associated with Hashimoto’s thyroiditis. The serum levels of free α-subunit measured in two patients were elevated.Six of the tumors were macroadenomas (>10 mm) and two were microadenomas. Complete tumor removal was achieved in allpatients. Five patients had preoperative anterior pituitary dysfunction; three patients recovered from this after surgery. Threepatients were lost to follow up and five patients showed no evidence of recurrence or hyperthyroidism in the follow-up period(mean, 30.8 months, range, 3~57).

Conclusions : Early diagnosis and complete removal of the tumor mass may improve the neurological and endocrine deficits. (Korean J Med 2011;80:47-55)