{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T08:26:35Z","timestamp":1793262395284,"version":"4.5.0"},"reference-count":21,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2012,11,9]],"date-time":"2012-11-09T00:00:00Z","timestamp":1352419200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinical Endocrinology"],"published-print":{"date-parts":[[2012,12]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Context<\/jats:title><jats:p>Unlike pituitary macroadenomas, microadenomas (micros) are not commonly associated with hypopituitarism. In clinical practice, we have observed that patients with <jats:styled-content style=\"fixed-case\">ACTH<\/jats:styled-content>\u2010secreting micros have a higher than expected prevalence of central hypothyroidism (<jats:styled-content style=\"fixed-case\">HT<\/jats:styled-content>), and we speculated that this effect might be because of glucocorticoid\u2010induced suppression of the hypothalamic\u2013pituitary\u2013thyroid axis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To determine whether there is a difference in the prevalence of central <jats:styled-content style=\"fixed-case\">HT<\/jats:styled-content> among <jats:styled-content style=\"fixed-case\">ACTH<\/jats:styled-content> micros compared to other types of microadenoma, and if so, to investigate whether this is directly related to the degree of hypercortisolism.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design, setting and patients<\/jats:title><jats:p>Retrospective study of 149 newly diagnosed patients with pituitary micros: 34 <jats:styled-content style=\"fixed-case\">ACTH<\/jats:styled-content>\u2010secreting, 72 prolactin\u2010secreting (<jats:styled-content style=\"fixed-case\">PRL<\/jats:styled-content>omas) and 43 clinically nonfunctioning adenomas (<jats:styled-content style=\"fixed-case\">NFA<\/jats:styled-content>s).<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcomes measures<\/jats:title><jats:p>Prevalence of central <jats:styled-content style=\"fixed-case\">HT<\/jats:styled-content>, correlation between normalized free <jats:styled-content style=\"fixed-case\">T<\/jats:styled-content>4 or <jats:styled-content style=\"fixed-case\">TSH <\/jats:styled-content><jats:italic>vs<\/jats:italic> normalized urinary free cortisol (<jats:styled-content style=\"fixed-case\">UFC<\/jats:styled-content>) or salivary cortisol.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The prevalence of central <jats:styled-content style=\"fixed-case\">HT<\/jats:styled-content> was significantly higher in the <jats:styled-content style=\"fixed-case\">ACTH<\/jats:styled-content> compared to the non\u2010<jats:styled-content style=\"fixed-case\">ACTH<\/jats:styled-content> adenomas: 18% (<jats:styled-content style=\"fixed-case\">ACTH<\/jats:styled-content>), 1% (<jats:styled-content style=\"fixed-case\">PRL<\/jats:styled-content>) and 0% (<jats:styled-content style=\"fixed-case\">NFA<\/jats:styled-content>s). The mean normalized free <jats:styled-content style=\"fixed-case\">T<\/jats:styled-content>4 was lower in the <jats:styled-content style=\"fixed-case\">ACTH<\/jats:styled-content> micros compared to the non\u2010<jats:styled-content style=\"fixed-case\">ACTH<\/jats:styled-content> micros (1\u00b729\u00a0\u00b1\u00a00\u00b706 <jats:italic>vs<\/jats:italic> 1\u00b750\u00a0\u00b1\u00a00\u00b723, <jats:italic>P<\/jats:italic>\u00a0=\u00a00\u00b70001). There was no correlation between the degree of hypercortisolism, as reflected by 24\u2010h urine free cortisol and salivary cortisol, and free <jats:styled-content style=\"fixed-case\">T<\/jats:styled-content>4 or <jats:styled-content style=\"fixed-case\">TSH<\/jats:styled-content> levels among the <jats:styled-content style=\"fixed-case\">ACTH<\/jats:styled-content> adenomas. Similarly, there were no differences in mean <jats:styled-content style=\"fixed-case\">UFC<\/jats:styled-content> or salivary cortisol between <jats:styled-content style=\"fixed-case\">ACTH<\/jats:styled-content> adenomas with and without central <jats:styled-content style=\"fixed-case\">HT<\/jats:styled-content>. Following transsphenoidal adenomectomy, central <jats:styled-content style=\"fixed-case\">HT<\/jats:styled-content> recovered in three of six patients with <jats:styled-content style=\"fixed-case\">ACTH<\/jats:styled-content> micros.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>These findings suggest that patients with <jats:styled-content style=\"fixed-case\">ACTH<\/jats:styled-content>\u2010secreting microadenomas should always, at a minimum, undergo testing for central <jats:styled-content style=\"fixed-case\">HT<\/jats:styled-content>. However, given the potential for recovery of thyroid function following cure of <jats:styled-content style=\"fixed-case\">C<\/jats:styled-content>ushing disease, we recommend withholding thyroid hormone replacement until after pituitary surgery.<\/jats:p><\/jats:sec>","DOI":"10.1111\/j.1365-2265.2012.04442.x","type":"journal-article","created":{"date-parts":[[2012,5,15]],"date-time":"2012-05-15T14:50:58Z","timestamp":1337093458000},"page":"871-876","source":"Crossref","is-referenced-by-count":27,"title":["<scp>ACTH<\/scp>\u2010secreting pituitary microadenomas are associated with a higher prevalence of central hypothyroidism compared to other microadenoma types"],"prefix":"10.1111","volume":"77","author":[{"given":"Nestoras","family":"Mathioudakis","sequence":"first","affiliation":[{"name":"Division of Endocrinology Department of Medicine The Johns Hopkins University School of Medicine Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sritika","family":"Thapa","sequence":"additional","affiliation":[{"name":"Division of Endocrinology Department of Medicine The Johns Hopkins University School of Medicine Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary S.","family":"Wand","sequence":"additional","affiliation":[{"name":"Division of Endocrinology Department of Medicine The Johns Hopkins University School of Medicine Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Salvatori","sequence":"additional","affiliation":[{"name":"Division of Endocrinology Department of Medicine The Johns Hopkins University School of Medicine Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2012,11,9]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2010-1048"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.85.5.1789"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1590\/S0004-27302009000100006"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.2008.03201.x"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1530\/eje.1.02298"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1742-1241.2010.02537.x"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.beem.2009.08.003"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1172\/JCI106411"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1172\/JCI106176"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.82.11.3700"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1210\/jcem-41-5-911"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2004-1430"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-09-0580"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.85.11.4039"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1210\/jcem-53-1-165"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11102-010-0285-9"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2362.2010.02395.x"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1530\/eje.0.1460389"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/B978-0-12-380926-1.10013-6"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2265.2000.00994.x"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.beem.2011.07.003"}],"container-title":["Clinical Endocrinology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fj.1365-2265.2012.04442.x","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/j.1365-2265.2012.04442.x","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,31]],"date-time":"2023-10-31T13:54:08Z","timestamp":1698760448000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/j.1365-2265.2012.04442.x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2012,11,9]]},"references-count":21,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2012,12]]}},"alternative-id":["10.1111\/j.1365-2265.2012.04442.x"],"URL":"https:\/\/doi.org\/10.1111\/j.1365-2265.2012.04442.x","archive":["Portico"],"relation":{},"ISSN":["0300-0664","1365-2265"],"issn-type":[{"value":"0300-0664","type":"print"},{"value":"1365-2265","type":"electronic"}],"subject":[],"published":{"date-parts":[[2012,11,9]]}}}