TSH-SECRETING PITUITARY-ADENOMA, CURRENT MANAGEMENT AND REVIEW

The neurosurgical literature contains little information about the cur rent management of patients with thyroid-stimulating hormone (TSH)-sec reting pituitary adenomas or about the usefulness of the somatostatin analogue octreotide in such cases. While TSH-secreting pituitary adeno mas are rare, our review and illustrative case demonstrate the effecti veness of pretreating patients with octreotide therapy not only to red uce tumor size prior to surgical resection but also to increase the po ssibility of clinical remission. A 52-year-old male presented with sig ns and symptoms of hyperthyroidism and elevated TSH, thyroxine, and tr iiodothyronine. Magnetic resonance imaging revealed a pituitary macroa denoma with extension into suprasellar cistern. The patient was treate d with octreotide for 6 months prior to surgery. Approximately 3 month s after initiation of octreotide therapy, the patient exhibited excell ent biochemical and clinical response. Tumor shrinkage of nearly 50% w as associated with resolution of suprasellar extension and optic nerve compression. Subsequent transsphenoidal surgery for resection of resi dual adenoma was followed by symptomatic and hormonal remission withou t the need for reinstitution of octreotide therapy. Pretreatment with octreotide for TSH-secreting pituitary adenomas has a beneficial effec t on disease symptoms and reduces tumor mass. We suggest that patients with these rare tumors can be managed with a combination of octreotid e therapy and subsequent surgical removal or residual tumor. Although this combination treatment helps to faciliate clinical remission, only short-term follow-up has been reported and thus the optimal managemen t of these patients remains to be determined.