Sen Harun Emre, Ceylan Ecem Cemre, Atayev Sazak, Sozen Mehmet, Bayrak Busra Yaprak, Cetinarslan Berrin, Anik Yonca, Icli Arife Dilek, Cabuk Burak, Anik Ihsan, Ceylan Savas
Department of Neurosurgery and Pituitary Research Center, Kocaeli University, School of Medicine, Kocaeli, Turkey.
Department of Endocrinology, Kocaeli University, School of Medicine, Kocaeli, Turkey.
World Neurosurg. 2022 Nov;167:e1275-e1283. doi: 10.1016/j.wneu.2022.09.027. Epub 2022 Sep 9.
To analyze surgical outcomes and tumor characteristics of 49 patients with thyrotropin-secreting pituitary adenoma, a rare functional pituitary adenoma subtype with challenging surgery, who underwent endoscopic endonasal transsphenoidal surgery.
In this single-center study, clinical, radiological, surgical, and endocrinological data of 49 patients diagnosed with thyrotropin-secreting pituitary adenoma were retrospectively reviewed.
Mean tumor size was 21.12 mm (6 microadenomas, 41 macroadenomas, 2 giant adenomas). Cavernous sinus invasion was present in 12 (24.48%) patients. Tumor consistency was firm in 23 (46.93%) patients. Plurihormonal secretion characteristics were present in 9 patients (5 growth hormone + thyrotropin and 4 growth hormone + prolactin + thyrotropin). Mean follow-up duration was 51.73 months. Of the cases with firm tumors, 14 patients had a history of antithyroid drug use; there was no statistically significant correlation between the antithyroid medication and the firmness of the tumor. Gross total resection was achieved in 32 (65.30%) cases, near-total resection was achieved in 14 (28.57%) cases, and subtotal resection was achieved in 3 (6.12%) cases. The analysis showed that the negative effect of >2 cm tumor size and cavernous sinus invasion on resection rate was statistically significant (P < 0.001). Although early remission was achieved in 33 (67.34%) patients, 44 (89.79%) patients were in euthyroid state at >3 months' follow-up. Complications were 4 new-onset pituitary deficiencies, 3 cases of permanent diabetes insipidus, 1 thyrotoxic crisis, and 1 cerebrospinal fluid leak.
Endoscopic endonasal transsphenoidal surgery is the first-line treatment in thyrotropin-secreting pituitary adenoma and should be performed in a tertiary center. Gross total resection is the goal, and early diagnosis is essential for surgical success.
分析49例促甲状腺素分泌型垂体腺瘤患者的手术结果和肿瘤特征。促甲状腺素分泌型垂体腺瘤是一种罕见的功能性垂体腺瘤亚型，手术具有挑战性，这些患者均接受了鼻内镜经蝶窦手术。
在这项单中心研究中，对49例诊断为促甲状腺素分泌型垂体腺瘤患者的临床、影像学、手术和内分泌学数据进行了回顾性分析。
肿瘤平均大小为21.12 mm（6例微腺瘤，41例大腺瘤，2例巨大腺瘤）。12例（24.48%）患者存在海绵窦侵袭。23例（46.93%）患者肿瘤质地硬。9例患者存在多激素分泌特征（5例生长激素+促甲状腺素，4例生长激素+催乳素+促甲状腺素）。平均随访时间为51.73个月。在肿瘤质地硬的病例中，14例患者有抗甲状腺药物使用史；抗甲状腺药物与肿瘤质地硬之间无统计学显著相关性。32例（65.30%）患者实现了肿瘤全切除，14例（28.57%）患者实现了近全切除，3例（6.12%）患者实现了次全切除。分析表明，肿瘤大小>2 cm和海绵窦侵袭对切除率的负面影响具有统计学显著性（P<0.001）。虽然33例（67.34%）患者实现了早期缓解，但在随访>3个月时，44例（89.79%）患者处于甲状腺功能正常状态。并发症包括4例新发垂体功能减退、3例永久性尿崩症、1例甲状腺危象和1例脑脊液漏。
鼻内镜经蝶窦手术是促甲状腺素分泌型垂体腺瘤的一线治疗方法，应在三级中心进行。肿瘤全切除是目标，早期诊断对手术成功至关重要。
