Diagnosis and management of central hyperthyroidism due to thyrotropin-secreting pituitary adenomas

doi:10.3969/j.issn.1671-2897.2003.04.006

Abstract：Objective Prospectively analyze 7 cases of central hyperthyroidism due to thyrotropin-secreting pituitary adenoma. Methods Among the 7 patients, 6 were male and 1 was female. Mean age was 42.7 yrs old and mean history was 3. 1 years. The mean duration of misdiagnosis was 1.5 yrs. They all had the diffuse goitre and hyperthyroidism, accompanied by visual field defect in 4 patients. They all had high level of plasma free T3, free T4,total T3 and total T4 with detectable thyroid-stimulating hormone (TSH). Among them, the level of plasma TSH was high in 4 patients, normal in 3 patients. Three patients had thyrotropin releasing hormone(TRH) test. Two patierns had no response, and one had normal response. MRI showed macro- or giant pituitary adenomas in all the patients.They all had different degree of compression to cavernous sinus. Two patients had invasion to sphenoid sinus. All had transspheuiodal surgery. One had secondary transcranial surgery. Three patients had additional postoperative radiotherapy. One had γ-knife treatment previously. Results Pathology showed thyrotropin-secreting pituitary adenoma. Postoperative follow-up was 3 months to 1 yr. Hyperthyroidism disappeared in 5 patients. MRI showed no tumor left in 6 patients. Conclusion To these patients, pituitary surgery is first choice. Postoperative follow-up is very important. If hyperthyroidism is found, radiotherapy should be considered. Early diagnosis and rnanag ement are the key to prognosis.