{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,7]],"date-time":"2026-02-07T23:19:58Z","timestamp":1770506398717,"version":"3.49.0"},"reference-count":33,"publisher":"Georg Thieme Verlag KG","issue":"01","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Horm Metab Res"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Thyrotropin (thyroid-stimulating hormone)-secreting pituitary adenomas are a rare\n                    cause of hyperthyroidism that frequently presents diagnostic and therapeutic\n                    challenges. This study characterizes the clinical, biochemical, radiological,\n                    and histopathological features of thyrotropin-secreting pituitary adenomas,\n                    evaluates long-term outcomes, and identifies factors influencing remission and\n                    recurrence. We retrospectively analysed 12 patients with thyrotropin-secreting\n                    pituitary adenomas treated between January 2003 and February 2025 at a tertiary\n                    endocrine referral centre. Clinical presentation, hormonal profiles, imaging\n                    characteristics, histopathology, management, and follow-up were reviewed.\n                    Diagnostic criteria included inappropriately normal or elevated\n                    thyroid-stimulating hormone levels with increased free thyroid hormones and\n                    pituitary imaging confirming an adenoma. Remission was defined as clinical and\n                    biochemical normalization without ongoing therapy. Subgroup analysis examined\n                    the impact of diagnostic delay on tumour size, invasiveness, and outcome. The\n                    cohort comprised nine men (75%) and three women (25%) with a mean age at\n                    diagnosis of 47.8\u00b117.2 years. Excluding one multiple endocrine neoplasia type 1\n                    case with early detection, the mean diagnostic delay was 42.5 months (range:\n                    4\u2013156). Magnetic resonance imaging revealed macroadenomas in 75% of patients and\n                    Knosp grade 3\u20134 invasion in 41.7%. Longer diagnostic delay was correlated with\n                    significantly larger tumours (17.9\u00b13.6 mm vs 9.8\u00b11.0 mm; p=0.004). All\n                    patients underwent surgery; 50% achieved remission, while 33.3% required\n                    additional therapy (somatostatin analogues and\/or radiotherapy). At a median\n                    7.8-year follow-up, 66.7% remained in sustained remission. No patient\n                    experienced thyroid storm; transient postoperative hypothyroidism occurred in\n                    25%. Thyrotropin-secreting pituitary adenomas often present with heterogeneous\n                    and misleading biochemical profiles leading to diagnostic delay, larger and more\n                    invasive tumours, and a greater need for multimodal therapy. Early recognition\n                    of discordant thyroid function tests\u2014elevated free T3\/T4 with non-suppressed\n                    thyroid-stimulating hormone\u2014is critical to avoid unnecessary thyroid ablation\n                    and improve surgical outcomes.<\/jats:p>","DOI":"10.1055\/a-2762-7986","type":"journal-article","created":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T00:22:51Z","timestamp":1764807771000},"page":"23-33","source":"Crossref","is-referenced-by-count":0,"title":["Delay in Diagnosis of Thyroid-Stimulating Hormone-Secreting Pituitary\n                    Adenomas: Clinical and Endocrinological Profiles from a Retrospective Cohort\n                    Study"],"prefix":"10.1055","volume":"58","author":[{"given":"Stylianos","family":"Kopanos","sequence":"additional","affiliation":[{"name":"Academic Department of Endocrinology, Diabetes and Infectiology,\n                    Klinikum Bielefeld, Medical School and University Medical Centre East\n                    Westphalia-Lippe Bielefeld University, Bielefeld, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ulrich Johannes","family":"Knappe","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johannes Wesling Klinikum\n                    Minden, Medical Centre Ruhr University Bochum, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreas Sebastian","family":"Moeller","sequence":"additional","affiliation":[{"name":"Academic Department of Endocrinology, Diabetes and Infectiology,\n                    Klinikum Bielefeld, Medical School and University Medical Centre East\n                    Westphalia-Lippe Bielefeld University, Bielefeld, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sandra Nicole","family":"Scheel","sequence":"additional","affiliation":[{"name":"Academic Department of Endocrinology, Diabetes and Infectiology,\n                    Klinikum Bielefeld, Medical School and University Medical Centre East\n                    Westphalia-Lippe Bielefeld University, Bielefeld, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joachim","family":"Feldkamp","sequence":"additional","affiliation":[{"name":"Academic Department of Endocrinology, Diabetes and Infectiology,\n                    Klinikum Bielefeld, Medical School and University Medical Centre East\n                    Westphalia-Lippe Bielefeld University, Bielefeld, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2026,1,21]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"1401","DOI":"10.1007\/s40618-019-01066-x","article-title":"A 2019 update on TSH-secreting pituitary adenomas","volume":"42","author":"P Beck-Peccoz","year":"2019","journal-title":"J Endocrinol Invest"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"161","DOI":"10.25259\/SNI_877_2020","article-title":"The outcome of TSHoma from a tertiary care institute in India","volume":"12","author":"A Dutta","year":"2021","journal-title":"Surg Neurol Int"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1002\/brb3.2081","article-title":"Yang Z yu, Zhang Y ping, et al. TSH adenoma and syndrome of resistance to\n                    thyroid hormones-Two cases report of syndrome of inappropriate secretion of\n                    thyrotropin","volume":"11","author":"F Deng","year":"2021","journal-title":"Brain Behav"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"771","DOI":"10.3389\/fendo.2021.771673","article-title":"Clinical and Therapeutic Characteristics of Pituitary TSH-Secreting Adenoma in\n                    Adolescent-Onset Patients: Six Case Studies and Literature Review","volume":"12","author":"Y Yang","year":"2021","journal-title":"Front Endocrinol"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1007\/BF03401412","article-title":"TSH-secreting pituitary adenomas treated by gamma knife radiosurgery: our case\n                    experience and a review of the literature","volume":"15","author":"Z Mouslech","year":"2016","journal-title":"Horm Athens Greece"},{"key":"ref6","first-page":"58","article-title":"Progress in the Pathogenesis, Diagnosis, and Treatment of TSH-Secreting\n                    Pituitary Neuroendocrine Tumor","volume":"11","author":"P Luo","year":"2020","journal-title":"Front Endocrinol"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"1219","DOI":"10.1007\/s00701-017-3105-4","article-title":"Surgical treatment and outcome of TSH-producing pituitary adenomas","volume":"159","author":"R Rotermund","year":"2017","journal-title":"Acta Neurochir (Wien)"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1007\/s12020-016-0863-3","article-title":"Thyrotropin-secreting pituitary adenomas: epidemiology, diagnosis, and\n                    management","volume":"52","author":"F G Amlashi","year":"2016","journal-title":"Endocrine"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"936","DOI":"10.4103\/0366-6999.204098","article-title":"Short-term Preoperative Octreotide for Thyrotropin-secreting Pituitary\n                    Adenoma","volume":"130","author":"H J Fang","year":"2017","journal-title":"Chin Med J (Engl)"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1507\/endocrj.EJ14-0118","article-title":"Short-term preoperative octreotide treatment for TSH-secreting pituitary\n                    adenoma","volume":"62","author":"N Fukuhara","year":"2015","journal-title":"Endocr J"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1507\/endocrj.EJ20-0707","article-title":"Preoperative and long-term efficacy and safety of lanreotide autogel in patients\n                    with thyrotropin-secreting pituitary adenoma: a multicenter, single-arm, phase 3\n                    study in Japan","volume":"68","author":"A Shimatsu","year":"2021","journal-title":"Endocr J"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"R65","DOI":"10.1530\/EJE-21-0162","article-title":"ENDOCRINE TUMOURS: Thyrotropin-secreting pituitary adenoma: a structured review\n                    of 535 adult cases","volume":"185","author":"C De Herdt","year":"2021","journal-title":"Eur J Endocrinol"},{"key":"ref13","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1007\/s12020-023-03480-x","article-title":"A reference center study in thyrotropin-secreting pituitary adenomas:\n                    clinicopathological, therapeutic and long-term follow-up outcomes","volume":"82","author":"M S\u00f6zen","year":"2023","journal-title":"Endocrine"},{"key":"ref14","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1007\/s12022-022-09708-2","article-title":"Overview of the 2022 WHO Classification of Neuroendocrine Neoplasms","volume":"33","author":"G Rindi","year":"2022","journal-title":"Endocr Pathol"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"R183","DOI":"10.1530\/EJE-16-1029","article-title":"DIAGNOSIS OF ENDOCRINE DISEASE: Diagnostic approach to TSH-producing pituitary\n                    adenoma","volume":"177","author":"A Tj\u00f6rnstrand","year":"2017","journal-title":"Eur J Endocrinol"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1186\/s12911-022-02031-0","article-title":"Moving toward a standardized diagnostic statement of pituitary adenoma using an\n                    information extraction model: a real-world study based on electronic medical\n                    records","volume":"22","author":"J Zhou","year":"2022","journal-title":"BMC Med Inform Decis Mak"},{"key":"ref17","doi-asserted-by":"crossref","first-page":"1462","DOI":"10.3171\/2014.7.JNS1471","article-title":"Clinicopathological characteristics and therapeutic outcomes in\n                    thyrotropin-secreting pituitary adenomas: A single-center study of 90 cases","volume":"121","author":"S Yamada","year":"2014","journal-title":"J Neurosurg"},{"key":"ref18","first-page":"1029","article-title":"Combination of transsphenoidal endoscopic surgery and presurgical somatostatin\n                    analogs in thyrotropin (TSH)-secreting pituitary adenomas: Treatment outcome and\n                    long-term remission at a single pituitary center","volume":"13","author":"J Liu","year":"2022","journal-title":"Front Endocrinol"},{"key":"ref19","first-page":"1","article-title":"Clinical characteristics and outcomes of patients with TSH-secreting pituitary\n                    adenoma and Graves\u2019 disease \u2013 a case report and systematic review","volume":"17","author":"A A Khan","year":"2024","journal-title":"Thyroid Res"},{"key":"ref20","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1186\/s12902-021-00839-x","article-title":"A challenging TSH\/GH co-secreting pituitary adenoma with concomitant thyroid\n                    cancer; a case report and literature review","volume":"21","author":"J H Yoon","year":"2021","journal-title":"BMC Endocr Disord"},{"key":"ref21","doi-asserted-by":"crossref","first-page":"807","DOI":"10.3389\/fonc.2021.807040","article-title":"Radiological Knosp, Revised-Knosp, and Hardy\u2013Wilson Classifications for the\n                    Prediction of Surgical Outcomes in the Endoscopic Endonasal Surgery of Pituitary\n                    Adenomas: Study of 228 Cases","volume":"11","author":"M Araujo-Castro","year":"2022","journal-title":"Front Oncol"},{"key":"ref22","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1007\/s11102-014-0611-8","article-title":"Clinical outcome and evidence of high rate post-surgical anterior\n                    hypopituitarism in a cohort of TSH-secreting adenoma patients: Might\n                    somatostatin analogs have a role as first-line therapy?","volume":"18","author":"F Gatto","year":"2015","journal-title":"Pituitary"},{"key":"ref23","doi-asserted-by":"crossref","first-page":"1923","DOI":"10.1007\/s40618-023-02291-1","article-title":"Gamma knife radiosurgery is effective in patients with thyrotropin-secreting\n                    pituitary adenomas","volume":"47","author":"M Losa","year":"2024","journal-title":"J Endocrinol Invest"},{"key":"ref24","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1038\/s41574-023-00949-7","article-title":"Consensus guideline for the diagnosis and management of pituitary adenomas in\n                    childhood and adolescence: Part 2, specific diseases","volume":"20","author":"M Korbonits","year":"2024","journal-title":"Nat Rev Endocrinol"},{"key":"ref25","first-page":"270","article-title":"Gonadotropin-secreting and thyrotropin-secreting pituitary adenomas: A\n                    single-center experience","volume":"68","author":"M Karlekar","year":"2023","journal-title":"Arch Endocrinol Metab"},{"key":"ref26","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1136\/bcr-2022-251451","article-title":"Plurihormonal pituitary adenoma cosecreting ACTH and GH: a rare cause of\n                    Cushing\u2019s disease","volume":"15","author":"J Amir","year":"2022","journal-title":"BMJ Case Rep"},{"key":"ref27","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1007\/BF03346597","article-title":"Primary empty sella: Why and when to investigate hypothalamic-pituitary\n                    function","volume":"33","author":"A Giustina","year":"2010","journal-title":"J Endocrinol Invest"},{"key":"ref28","doi-asserted-by":"crossref","first-page":"678","DOI":"10.1007\/s00508-012-0216-z","article-title":"Thyrotropin-secreting pituitary adenomas: diagnosis and management of patients\n                    from one Chinese center","volume":"124","author":"W Zhao","year":"2012","journal-title":"Wien Klin Wochenschr"},{"key":"ref29","first-page":"615","article-title":"Thyrotropin-Secreting Pituitary Adenomas","author":"L Persani","year":"2025","journal-title":"The Pituitary"},{"key":"ref30","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1007\/s11102-020-01043-1","article-title":"Suprasellar pituitary adenomas: a 10-year experience in a single tertiary\n                    medical center and a literature review","volume":"23","author":"J Zhu","year":"2020","journal-title":"Pituitary"},{"key":"ref31","first-page":"672","article-title":"Clinically active pituitary tumors","volume":"65","author":"N Unger","year":"2024","journal-title":"Inn Med Heidelb Ger"},{"key":"ref32","doi-asserted-by":"crossref","first-page":"263","DOI":"10.2478\/enr-2019-0026","article-title":"The coexistence of infundibular pituicytoma and Cushing\u2019s disease due to\n                    pituitary adenoma: A case report","volume":"53","author":"E Gezer","year":"2019","journal-title":"Endocr Regul"},{"key":"ref33","doi-asserted-by":"crossref","first-page":"63","DOI":"10.14791\/btrt.2016.4.2.63","article-title":"Therapeutic Strategy for Cavernous Sinus-Invading Non-Functioning Pituitary\n                    Adenomas Based on the Modified Knosp Grading System","volume":"4","author":"J Hwang","year":"2016","journal-title":"Brain Tumor Res Treat"}],"container-title":["Hormone and Metabolic Research"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2762-7986.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T23:33:34Z","timestamp":1770420814000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2762-7986"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,3]]},"references-count":33,"journal-issue":{"issue":"01","published-online":{"date-parts":[[2026,2,6]]},"published-print":{"date-parts":[[2026,1]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2762-7986","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0018-5043","1439-4286"],"issn-type":[{"value":"0018-5043","type":"print"},{"value":"1439-4286","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,12,3]]},"published":{"date-parts":[[2025,12,3]]}}}