1Department of Neurosurgery, Yonsei University College of Medicine, Seoul.
2Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul.
J Neurosurg. 2020 Mar 13;134(3):794-800. doi: 10.3171/2020.1.JNS192787. Print 2021 Mar 1.
Thyroid-stimulating hormone (TSH)-secreting pituitary adenoma (TSHoma) is a rare type of pituitary adenoma; thus, little is known about TSHomas. The purpose of this study was to analyze clinical characteristics and therapeutic outcomes of TSHomas based on a single-center experience. The authors also searched for reliable preoperative and early postoperative factors that could predict long-term endocrinological remission.
The clinical, radiological, and pathological characteristics and surgical and endocrinological outcomes of 31 consecutive cases of TSHomas that were surgically treated between 2005 and 2017 were reviewed retrospectively. Preoperative factors were evaluated for their ability to predict long-term remission by comparing remission and nonremission groups. TSH and free thyroxine levels were measured at 2, 6, 12, 18, and 24 hours after surgery to determine whether they could predict long-term remission.
Gross-total removal of tumor was achieved in 28 patients (90.3%), and 26 patients (83.9%) achieved endocrinological remission by surgery alone based on long-term endocrinological follow-up (median 50 months, range 32-81 months). The majority of the tumors were solid (21/31, 67.7%), and en bloc resection was possible in 16 patients (51.6%). Larger tumor size and tumor invasion into cavernous sinus and sphenoid sinus were strong predictors of lower rates of endocrinological remission. Immediate postoperative TSH level at 12 hours after surgery was the strongest predictor, with a 0.62 μIU/mL cutoff. Postoperative complications included CSF rhinorrhea in one patient and epistaxis in another patient, who underwent additional surgical treatment for the complications.
Tumor size and extent are major prognostic factors for both extent of resection and endocrinological remission. The consistency of TSHomas was more likely to be solid, which makes extracapsular dissection more feasible. Long-term remission of TSHomas could be predicted even during the early postoperative period.
促甲状腺激素（TSH）分泌性垂体腺瘤（TSH 瘤）是一种罕见的垂体腺瘤；因此，对 TSH 瘤知之甚少。本研究的目的是基于单中心经验分析 TSH 瘤的临床特征和治疗结果。作者还寻找了可靠的术前和术后早期因素，可以预测长期内分泌缓解。
回顾性分析了 2005 年至 2017 年间手术治疗的 31 例连续 TSH 瘤患者的临床、放射影像学和病理学特征以及手术和内分泌学结果。通过比较缓解组和非缓解组，评估术前因素对长期缓解的预测能力。术后 2、6、12、18 和 24 小时测量 TSH 和游离甲状腺素水平，以确定它们是否可以预测长期缓解。
28 例患者（90.3%）实现了肿瘤全切除，26 例患者（83.9%）仅通过手术获得了内分泌缓解，基于长期内分泌随访（中位数 50 个月，范围 32-81 个月）。大多数肿瘤为实性（21/31，67.7%），16 例患者（51.6%）可行整块切除。肿瘤较大且侵袭海绵窦和蝶窦是内分泌缓解率较低的强烈预测因素。术后 12 小时即时 TSH 水平是最强的预测因素，截断值为 0.62μIU/mL。术后并发症包括 1 例患者出现脑脊液鼻漏，另 1 例患者出现鼻出血，这 2 例患者均因并发症而行额外手术治疗。
肿瘤大小和范围是影响切除范围和内分泌缓解的主要预后因素。TSH 瘤的一致性更可能是实性的，这使得囊外解剖更加可行。即使在术后早期，也可以预测 TSH 瘤的长期缓解。
