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Updated: May 2, 2026
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Thyrotropin-secreting pituitary adenomas: outcome of pituitary surgery and irradiation
Elena Malchiodi1, Eriselda Profka, Emanuele Ferrante
1Departments of Clinical Sciences and Community Health (E.M., E.P., E.F., E.S., E.V., I.C., M.A., P.B.P., A.S., G.M.), Neurological Sciences (E.M.) and BIOMETRA Department (A.G.L.), University of Milan; Endocrinology and Diabetology Unit (E.M., E.P., E.F., E.S., E.V., I.C., P.B.P., A.S., G.M.) and Unit of Neurosurgery (M.L.), Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, 20112 Milan, Italy; Istituto Clinico Humanitas IRCCS (A.G.L.), 20089 Rozzano, Italy; Unit of Endocrine Diseases and Diabetology (M.A.), San Giuseppe Hospital, Multimedica Group, 20123 Milan, Italy; Pituitary Unit, Department of Neurosurgery (P.M., M.L.), Istituto Scientifico San Raffaele, Università Vita-Salute, 20132 Milan, Italy; and GVM Care and Research, Maria Cecilia Hospital (E.M.), 48010 Cotignola, Italy.
Objective:
Our objective was to describe the effects of surgery and radiotherapy on hormonal control and tumor mass in short- and long-term follow-up of TSH-secreting pituitary adenomas (TSHomas).
Methods:
This was a retrospective multicenter study.
Results:
We collected data of 70 TSHomas (70% macroadenomas). The mean follow-up was 64.4 (range 3-324) months. Overall, 97% of patients were treated with surgery; in 27% of them radiotherapy was associated. After surgery, 75% of patients normalized thyroid function, 58% normalized both pituitary imaging and hormonal profile, 9% developed pituitary deficiencies, and 3% had tumor or hormonal recurrence, all within the first 2 years after surgery. Presurgical medical treatment did not significantly improve surgical outcome (63% vs 57%). Radiotherapy controlled hypersecretion in 37% of patients within 2 years, whereas 32% of patients developed new pituitary deficiencies from 18 to 96 months from treatment. At last follow-up, 80% of patients normalized thyroid function, whereas 20% were currently on medical treatment: 85% with somatostatin analog (SSA) alone and 15% with SSA combined with methimazole. Subjects who achieved disease control had surgery as the only treatment in 80% of cases and surgery combined with irradiation in 20%.
Conclusions:
Surgery remains the first-choice treatment for TSHoma. If surgery is successful, recurrence is rare. When surgery is unsuccessful or contraindicated, SSA and radiotherapy are effective in controlling hyperthyroidism and tumor growth in the majority of patients. The effects of radiotherapy on TSH secretion and tumor mass are greater within the first years after treatment, whereas pituitary deficiencies may occur several years later.
