| ObjectiveTo explore the clinical characteristics of patients with thyrotropin-secreting pituitary adenomas(TSH-omas)in China.MethodsPart 1:The clinical features,laboratory variables,imaging and pathological results were retrospectively compared and analyzed of 26 cases with TSH-oma admitted in PLA General Hospital from Feb.2006 to Oct.2016 and 20 cases with TSH-oma admitted in Shanghai Huashan Hospital from Apr.2006 to Apr.2013.Part 2:All the articles related to TSH-omas were retrieved from the Chinese journal databases up to 2017.All reported cases were assessed in clinical features,imaging findings,treatment and prognosis by gender and tumor size.ResultsPart 1:The female ratio was slightly higher in patients of PLA General Hospital than in Huashan Hospital[(57.7%(15/26)vs 45.0%(9/20)],while the mean age was similar[39.5± 14.1(18?67 years)vs 40.0±14.5(17?74 years)].The most common chief complaint was thyrotoxicosis[73.1%(19/26)vs 55.0%(11/20)].The mean serum TSH levels in PLA General Hospital and in Huashan Hospital were 5.06(IQR 2.97-6.27)mU/L and 6.16(IQR 3.76-10.91)mU/L respectively,and patients with normal serum TSH levels were more common in PLA General Hospital than in Huashan Hospital[57.7%(15/26)vs 40.0%(8/20)].Microadenoma was more common in PLA General Hospital than in Huashan Hospital[34.62%(9/26)vs 20.0%(4/20)],while macroadenoma was more common in Huashan Hospital than in PLA General Hospital[20.0%(4/20)vs 7.7%(2/26)].Microadenoma was more common in female patients of the both groups[66.7%(6/9)vs 75%(3/4)],while macroadenoma was all found in male patients.Tumor invasion of surrounding tissue and structure was often found in macroadenoma.In terms of octreotide inhibition test,the range of 24h TSH inhibition rate was roughly the same in the two groups(37.39%?91.80%and 46.5%?94.1%,respectively).Mixed adenoma was rare among all the pathologically confirmed cases.In PLA General Hospitals,TSH immunoreactive negative neoplastic cells were found in 3 of 8 cases,and octreotide scanning showed negative in 2 of 12 cases.Part 2:(1)153 patients with TSH-omas were analyzed.TSH-omas can be diagnosed in all ages(12?81 years old,average 41.9± 13.8 years old)with no gender difference(male:female=84:69).The rate of misdiagnosis fell from 84.6%(11/13)to 50.6%(39/77)in the last 10 years.In 92(60.1%)cases,the level of TSH was elevated[median 1.57×ULN(upper limits of normal)].There was no significant correlation between TSH and thyroid hormone.The most common hormones combined with TSH were growth hormone(GH)and prolactin(PRL)(11.1%and 9.7%,respectively).37 cases underwent octreotide suppression test of which the inhibitory rates ranged from 26.2%to 94.9%(median 71.79%).Macro-adenomas are more common despite of the increasing detection rate of micro-adenomas.Although TSHomas usually invade surrounding tissues,they hardly cause pituitary apoplexy.Surgery or y-knife was performed in 132(86.3%)cases.Immunohistochemistry showed that 87(52.9%)of 46 were pure TSH adenomas and 32(36.8%)cases were mixed adenomas.GH and PRL were most common(75.0%and 56.3%respectively)in the mixed adenomas.Negative immunohistochemistry for TSH was found in 9 cases(10.3%).In the follow-up,the restoring rates of thyroid hormone and TSH level were 77.0%(87/113)and 81.4%(92/113)respectively.(2)123 cases were analyzed by gender(male:female = 70:53).There was no significant difference in the pathogenesis,misdiagnosis,age,chief complaint,thyroid enlargement by gender.There was no significant difference between male and female in the proportion of elevated TSH level(57.1%vs 52.8%,P=0.634)and the multiple of ULN of TSH level[1.11(0.81-1.57)vs 1.04(0.56-2.18),P= 0.754].The multiple of ULN of FT3 and fT4 level in male was higher than that in female {[1.75(1.27-2.23)vs 1.43(1.15-1.63),P=0.016]and[1.51(1.10-1.83)vs 1.27(1.09-1.45),and P= 0.037]respectively}.There was no significant correlation between TSH and FT3 level,TSH and fT4 level by gender.The micro-adenomas were more common in female than that in male[34%(18/53)vs 14.3%(10/70),P= 0.017].The rate of operation in male was higher than that in female(87.1%vs 71.7%,P= 0.032).(3)153 cases were analyzed by tumor size.The patients with larger tumor were younger[(47.8±13.0,41.0±13.4 and 36.0±13.2)years]and more frequently men(37.5%,61.9%and 71.4%).Comparison of the course,the rate of misdiagnosis and goiter in patients with different size adenomas showed no significant difference.Although there were no statistically significant difference between proportions of elevated TSH level in three groups,the multiples of ULN of TSH level in groups of macro-adenoma and giant-adenoma are significantly higher than that in the micro-adenoma group[0.63(0.47-1.28)vs 0.47(0.83-1.94)vs 1.03(0.64-2.29),P = 0.014).There were no statistically significant difference in multiples of ULN of FT3 or FT4 level between three groups.The operation rate in groups of macro-adenoma or giant-adenoma is significantly higher than that in micro-adenoma group(63.6%vs.89.6%vs.83.3%,P = 0.003).Conclusion1.Patients with TSH-omas in the two hospitals show similarities but also some significant differences in the clinical features.Overall,the Chineses with TSH-omas are diagnosed without gender difference.The mean age at diagnosis is significantly younger than that in European data.Microadenoma and macroadenoma are more common in female and in male respectively.Serum TSH levels can be normal in patients with TSH-omas.Immunostaining and/or octreotide scanning for TSH can be negative.2.Most Chinese patients are diagnosed around the third-fifth decade of life.Male patients are more likely had macro-adenomas and higher levels of free thyroid hormone.Nevertheless,FT3/FT4 had nothing to do with the tumor size.Be aware of the presence of large adenomas regardless of TSH level.Pituitary apoplexy is rare in invasive macro-adenomas.Immunostaining for TSH can be negative.The most common mixed positive immunostaining is TSH with GH/PRL.However,a positive immunostaining for some pituitary hormone does not necessarily correlates with its hypersecretion. |
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