Thyroid Stimulating Hormone Secreting Pituitary Adenoma
Özet
This text provides a comprehensive overview of Thyroid-Stimulating Hormone secreting pituitary adenomas (TSHomas), a rare form of central hyperthyroidism representing less than 1% of all pituitary tumors. Characterized by autonomous TSH secretion that stimulates the overproduction of free thyroxine (fT4) and triiodothyronine (fT3), TSHomas typically present with typical hyperthyroidism symptoms, goiter, and occasionally visual fields defects or headaches due to mass effect. The diagnosis is based on elevated free thyroid hormones with non-suppressed TSH levels, alongside dynamic testing like the TRH stimulation test and pituitary MRI. While the majority are pure TSH-secreting macroadenomas, mixed secretion with growth hormone or prolactin occurs in about 20-25% of cases. Transsphenoidal surgery is the primary treatment modality, achieving high remission rates in microadenomas, though macroadenomas often require adjunctive therapy due to cavernous sinus invasion. Medical management with somatostatin analogs is utilized preoperatively or for residual disease to achieve euthyroidism, while dopamine agonists are reserved for mixed or somatostatin-resistant tumors. Radiotherapy serves as an effective option for invasive or persistent cases. Long-term follow-up is critical due to recurrence risks and an increased incidence of differentiated thyroid cancer.
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