Iglesias P, Díez J J
Department of Endocrinology, Hospital General de Segovia, Madrid, Spain.
J Endocrinol Invest. 1998 Dec;21(11):775-8. doi: 10.1007/BF03348045.
Thyrotropin (TSH)-secreting pituitary adenomas are the less frequent form of presentation of pituitary tumors. Selective transsphenoidal surgical resection of the tumor is the treatment of choice. Given that native somatostatin inhibits TSH secretion, treatment with somatostatin analogues has been recently employed in patients with unresectable tumors or after surgery. We report on the case of a 58 year-old man with a TSH-secreting pituitary adenoma who was treated with octreotide for long-term before neurosurgery. The patient was referred to us because of a pituitary mass on CT scanning. Hormonal evaluation resulted in hyperthyroidism with high serum TSH concentrations. Serum alpha subunit concentration was elevated and TSH response to exogenous TRH stimulation was absent. Magnetic resonance imaging of the hypothalamic-pituitary area confirmed the presence of a pituitary mass (2.0 by 1.8 by 1.7 cm). Acutely administered subcutaneous octreotide (100 microg) was followed by a reduction of the serum TSH concentrations. Therefore, the patient received octreotide, 100 microg three times daily for 12 months. At first month after beginning therapy serum TSH, free thyroxine, total triiodothyronine, and alpha subunit concentrations were normalized and persisted into the normal range for the next 11 months. On the other hand, a shrinkage of the tumor mass (1.6 by 1.7 by 1.4 cm) was noted after 6 months of octreotide therapy, however, its volume did not modify in the following next months. Then, the tumor was removed by transsphenoidal surgery and the diagnosis was confirmed by immunohistochemical staining. This case demonstrates that long-term treatment with octreotide gave rise to a normalization of the thyroid function and a reduction of the tumor volume before surgery. This clinical observation suggests that octreotide therapy might be useful in preparation for pituitary surgery in patients with TSH-secreting pituitary adenomas.
促甲状腺素（TSH）分泌型垂体腺瘤是垂体肿瘤中较不常见的表现形式。肿瘤的选择性经蝶窦手术切除是首选治疗方法。鉴于天然生长抑素可抑制TSH分泌，生长抑素类似物治疗最近已应用于无法切除的肿瘤患者或术后患者。我们报告了一例58岁分泌TSH的垂体腺瘤男性患者，在神经外科手术前接受奥曲肽长期治疗的病例。该患者因CT扫描发现垂体肿块而转诊至我们处。激素评估显示甲状腺功能亢进，血清TSH浓度升高。血清α亚基浓度升高，且对促甲状腺激素释放激素（TRH）刺激无TSH反应。下丘脑 - 垂体区域的磁共振成像证实存在垂体肿块（2.0×1.8×1.7厘米）。急性皮下注射奥曲肽（100微克）后血清TSH浓度降低。因此，该患者接受奥曲肽，每日三次，每次100微克，共12个月。开始治疗后的第一个月，血清TSH、游离甲状腺素、总三碘甲状腺原氨酸和α亚基浓度恢复正常，并在接下来的11个月内一直保持在正常范围内。另一方面，奥曲肽治疗6个月后发现肿瘤肿块缩小（1.6×1.7×1.4厘米），然而，在接下来的几个月中其体积未再改变。然后，通过经蝶窦手术切除肿瘤，并通过免疫组织化学染色确诊。该病例表明，奥曲肽长期治疗可使甲状腺功能正常化，并在手术前减小肿瘤体积。这一临床观察结果表明，奥曲肽治疗可能有助于分泌TSH的垂体腺瘤患者的垂体手术准备。
