{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T23:00:06Z","timestamp":1792710006495,"version":"4.5.0"},"reference-count":38,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2014,12]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>The aim of this study was to analyze clinicopathological characteristics and treatment outcomes in a large single-center clinical series of cases of thyrotropin (TSH)\u2013secreting pituitary adenomas.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>The authors retrospectively reviewed clinical, pathological, and treatment characteristics of 90 consecutive cases of TSH-secreting pituitary adenomas treated with transsphenoidal surgery between December 1991 and May 2013. The patient group included 47 females and 43 males (median age 42 years, range 11\u201374 years).<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Sixteen tumors (18%) were microadenomas and 74 (82%) were macroadenomas. Microadenomas were significantly more frequent in the more recent half of our case series (12 of 45 cases) (p = 0.0274). Cavernous sinus invasion was confirmed in 21 patients (23%). In 67 cases (74%), the tumors were firm elastic or hard in consistency. Acromegaly and hyperprolactinemia were observed, respectively, in 14 (16%) and 11 (12%) of the 90 cases. Euthyroidism was achieved in 40 (83%) of 48 patients and tumor shrinkage was found in 24 (55%) of 44 patients following preoperative somatostatin analog treatment. Conventional transsphenoidal surgery, extended transsphenoidal surgery, and a simultaneous combined supra- and infrasellar approach were performed in 85, 2, and 3 patients, respectively. Total removal with endocrinological remission was achieved in 76 (84%) of 90 patients, including all 16 (100%) patients with microadenomas, 60 (81%) of the 74 with macroadenomas, and 8 (38%) of the 21 with cavernous sinus invasion. None of these 76 patients experienced tumor recurrence during a median follow-up period of 2.8 years. Stratifying by Knosp grade, total removal with endocrinological remission was achieved in 34 of 36 patients with Knosp Grade 0 tumors, all 24 of those with Grade 1 tumors, 12 of the 14 with Grade 2 tumors, 6 of the 8 with Grade 3 tumors, and none of the 8 with Grade 4 tumors. Cavernous sinus invasion and tumor size were significant independent predictors of surgical outcome. Immunoreactivity for growth hormone, prolactin, or both hormones was present in 32, 9, and 24 patients, respectively. The Ki-67 labeling index was less than 3% in 71 (97%) of 73 tumors for which it was obtained and 3% or more in 2. Postsurgery pituitary dysfunction was found in 15 patients (17%) and delayed hyponatremia was seen in 9.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>TSH-secreting adenomas, particularly those in the microadenoma stage, have increased in frequency over the past 5 years. The high surgical success rate achieved in this series is due to relatively early diagnosis and relatively small tumor size. In addition, the surgical strategies used, such as extracapsular removal of hard or solid adenomas, aggressive resction of tumors with cavernous sinus invasion, or extended transsphenoidal surgery or a simultaneous combined approach for large\/giant multilobulated adenomas, also may improve remission rate with a minimal incidence of complications.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2014.7.jns1471","type":"journal-article","created":{"date-parts":[[2014,9,19]],"date-time":"2014-09-19T14:00:12Z","timestamp":1411135212000},"page":"1462-1473","source":"Crossref","is-referenced-by-count":120,"title":["Clinicopathological characteristics and therapeutic outcomes in thyrotropin-secreting pituitary adenomas: a single-center study of 90 cases"],"prefix":"10.3171","volume":"121","author":[{"given":"Shozo","family":"Yamada","sequence":"first","affiliation":[{"name":"Departments of Hypothalamic and Pituitary Surgery,"},{"name":"Okinaka Memorial Institute for Medical Research, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noriaki","family":"Fukuhara","sequence":"additional","affiliation":[{"name":"Departments of Hypothalamic and Pituitary Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kentaro","family":"Horiguchi","sequence":"additional","affiliation":[{"name":"Departments of Hypothalamic and Pituitary Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitsuo","family":"Yamaguchi-Okada","sequence":"additional","affiliation":[{"name":"Departments of Hypothalamic and Pituitary Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroshi","family":"Nishioka","sequence":"additional","affiliation":[{"name":"Departments of Hypothalamic and Pituitary Surgery,"},{"name":"Okinaka Memorial Institute for Medical Research, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akira","family":"Takeshita","sequence":"additional","affiliation":[{"name":"Okinaka Memorial Institute for Medical Research, Tokyo, Japan"},{"name":"Endocrinology,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasuhiro","family":"Takeuchi","sequence":"additional","affiliation":[{"name":"Okinaka Memorial Institute for Medical Research, Tokyo, Japan"},{"name":"Endocrinology,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junko","family":"Ito","sequence":"additional","affiliation":[{"name":"Pediatrics, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naoko","family":"Inoshita","sequence":"additional","affiliation":[{"name":"Pathology, Toranomon Hospital, and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-jns1471","series-title":"Endocr Rev","first-page":"610","article-title":"Thyrotropin-secreting pituitary tumors","volume":"17","author":"Beck-Peccoz","year":"1996"},{"key":"b2-jns1471","series-title":"Pituitary","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1023\/A:1022360414062","article-title":"Medical management of thyrotropin-secreting pituitary adenomas","volume":"5","author":"Beck-Peccoz","year":"2002"},{"key":"b3-jns1471","series-title":"Thyroid Disease Manager","article-title":"Thyrotropin-secreting pituitary adenomas","author":"Beck-Peccoz"},{"key":"b4-jns1471","series-title":"Best Pract Res Clin Endocrinol Metab","doi-asserted-by":"publisher","first-page":"597","DOI":"10.1016\/j.beem.2009.05.006","article-title":"Pituitary tumours: TSH-secreting adenomas","volume":"23","author":"Beck-Peccoz","year":"2009"},{"key":"b5-jns1471","series-title":"Eur J Endocrinol","first-page":"519","article-title":"Mono-and plurihormonal thyrotropic pituitary adenomas: pathological, hormonal and clinical studies in 12 patients","volume":"140","author":"Bertholon-Gr\u00e9goire","year":"1999"},{"key":"b6-jns1471","series-title":"J Clin Endocrinol Metab","doi-asserted-by":"publisher","first-page":"476","DOI":"10.1210\/jcem.84.2.5505","article-title":"Thyrotropin-secreting pituitary tumors: diagnostic criteria, thyroid hormone sensitivity, and treatment outcome in 25 patients followed at the National Institutes of Health","volume":"84","author":"Brucker-Davis","year":"1999"},{"key":"b7-jns1471","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"17","DOI":"10.3171\/JNS\/2008\/109\/7\/0017","article-title":"Thyroidstimulating hormone pituitary adenomas","volume":"109","author":"Clarke","year":"2008"},{"key":"b8-jns1471","series-title":"Neurol Res","doi-asserted-by":"publisher","first-page":"1060","DOI":"10.1179\/016164110X12670144737855","article-title":"Labeling index in pituitary adenomas evaluated by means of MIB-1: is there a prognostic role? A critical review","volume":"32","author":"de Aguiar","year":"2010"},{"key":"b9-jns1471","series-title":"Intern Med J","doi-asserted-by":"publisher","first-page":"214","DOI":"10.1111\/j.1445-5994.2009.02107.x","article-title":"Clinical and biochemical characteristics of patients with thyroid-stimulating hormone-secreting pituitary adenomas from one New Zealand centre","volume":"40","author":"Elston","year":"2010"},{"key":"b10-jns1471","series-title":"Endocr Pathol","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1007\/BF02739875","article-title":"Basic fibroblast growth factor expression by two prolactin and thyrotropin-producing pituitary adenomas","volume":"6","author":"Ezzat","year":"1995"},{"key":"b11-jns1471","series-title":"Pituitary","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1007\/s11102-010-0271-2","article-title":"In vivo and in vitro response to octreotide LAR in a TSH-secreting adenoma: characterization of somatostatin receptor expression and role of subtype 5","volume":"14","author":"Gatto","year":"2011"},{"key":"b12-jns1471","series-title":"J Clin Endocrinol Metab","doi-asserted-by":"publisher","first-page":"3141","DOI":"10.1210\/jc.2009-2670","article-title":"A consensus on criteria for cure of acromegaly","volume":"95","author":"Giustina","year":"2010"},{"key":"b13-jns1471","series-title":"Endocr J","doi-asserted-by":"publisher","first-page":"371","DOI":"10.1507\/endocrj.K06-177","article-title":"Somatostatin receptor subtypes mRNA in TSH-secreting pituitary adenomas: a case showing a dramatic reduction in tumor size during short octreotide treatment","volume":"54","author":"Horiguchi","year":"2007"},{"key":"b14-jns1471","series-title":"J Japan Thyroid Assoc","first-page":"129","article-title":"A misleading case of thyroid hormone resistance in a 15-year-old girl who underwent transsphenoidal surgery as a TSH-secreting pituitary microadenoma (authors' trans)","volume":"4","author":"Kamitani","year":"2013"},{"key":"b15-jns1471","series-title":"Curr Opin Endocrinol Diabetes Obes","doi-asserted-by":"publisher","first-page":"359","DOI":"10.1097\/MED.0b013e3283060a56","article-title":"Basic science and clinical research advances in the pituitary transcription factors: Pit-1 and Prop-1","volume":"15","author":"Kerr","year":"2008"},{"key":"b16-jns1471","series-title":"Neurosurgery","first-page":"610","article-title":"Pituitary adenomas with invasion of the cavernous sinus space: a magnetic resonance imaging classification compared with surgical findings","volume":"33","author":"Knosp","year":"1993"},{"key":"b17-jns1471","series-title":"Pituitary","doi-asserted-by":"publisher","first-page":"313","DOI":"10.1007\/s11102-006-0411-x","article-title":"TSH adenomas","volume":"9","author":"Laws","year":"2006"},{"key":"b18-jns1471","series-title":"Minerva Endocrinol","first-page":"329","article-title":"Thyrotropin-secreting pituitary adenomas: biological and molecular features, diagnosis and therapy","volume":"33","author":"Losa","year":"2008"},{"key":"b19-jns1471","series-title":"Pituitary","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1023\/A:1009987530852","article-title":"Surgical management of thyrotropin-secreting pituitary adenomas","volume":"2","author":"Losa","year":"1999"},{"key":"b20-jns1471","series-title":"J Comput Assist Tomogr","doi-asserted-by":"publisher","first-page":"519","DOI":"10.1097\/00004728-199207000-00004","article-title":"Volume of pituitary macroadenomas: assessment by MRI","volume":"16","author":"Lundin","year":"1992"},{"key":"b21-jns1471","series-title":"Horm Res","first-page":"257","article-title":"A plurihormonal TSH-producing pituitary tumor of monoclonal origin in a patient with hypothyroidism","volume":"59","author":"Ma","year":"2003"},{"key":"b22-jns1471","series-title":"J Endocrinol Invest","doi-asserted-by":"publisher","first-page":"773","DOI":"10.1007\/BF03346535","article-title":"Clinical aspects and therapeutic outcome in thyrotropin-secreting pituitary adenomas: a single center experience","volume":"32","author":"Macchia","year":"2009"},{"key":"b23-jns1471","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"521","DOI":"10.3171\/jns.1993.79.4.0521","article-title":"Thyrotropin-producing pituitary adenomas","volume":"79","author":"Mindermann","year":"1993"},{"key":"b24-jns1471","series-title":"Pituitary","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1007\/s11102-007-0020-3","article-title":"TSH-secreting pituitary adenomas: followup of 11 cases and review of the literature","volume":"10","author":"Ness-Abramof","year":"2007"},{"key":"b25-jns1471","series-title":"World Neurosurg","doi-asserted-by":"publisher","first-page":"533","DOI":"10.1016\/j.wneu.2011.07.013","article-title":"Simultaneous combined supra-infrasellar approach for giant\/large multilobulated pituitary adenomas","volume":"77","author":"Nishioka","year":"2012"},{"key":"b26-jns1471","series-title":"Neurol Med Chir (Tokyo)","doi-asserted-by":"publisher","first-page":"311","DOI":"10.2176\/nmc.48.311","article-title":"Biochemical cure of acromegaly after transsphenoidal surgery despite residual tumor on magnetic resonance imaging: case report","volume":"48","author":"Nishioka","year":"2008"},{"key":"b27-jns1471","series-title":"J Clin Endocrinol Metab","doi-asserted-by":"publisher","first-page":"626","DOI":"10.1210\/jc.2012-3362","article-title":"National incidence and prevalence of TSH-secreting pituitary adenomas in Sweden","volume":"98","author":"\u00d3nnestam","year":"2013"},{"key":"b28-jns1471","series-title":"Best Pract Res Clin Endocrinol Metab","doi-asserted-by":"publisher","first-page":"277","DOI":"10.1016\/j.beem.2007.03.005","article-title":"Syndromes of reduced sensitivity to thyroid hormone: genetic defects in hormone receptors, cell transporters and deiodination","volume":"21","author":"Refetoff","year":"2007"},{"key":"b29-jns1471","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"194","DOI":"10.3171\/jns.2000.93.2.0194","article-title":"Long-term surgical outcome in 16 patients with thyrotropin pituitary adenoma","volume":"93","author":"Sanno","year":"2000"},{"key":"b30-jns1471","series-title":"J Neurooncol","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1023\/A:1012917701756","article-title":"Thyrotropin-secreting pituitary adenomas. Clinical and biological heterogeneity and current treatment","volume":"54","author":"Sanno","year":"2001"},{"key":"b31-jns1471","series-title":"Endocr J","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1507\/endocrj.46.113","article-title":"Treatment of thyrotropin-secreting pituitary adenomas with octreotide","volume":"46","author":"Shimatsu","year":"1999"},{"key":"b32-jns1471","series-title":"Eur J Endocrinol","doi-asserted-by":"publisher","first-page":"433","DOI":"10.1530\/eje.0.1480433","article-title":"The changing spectrum of TSH-secreting pituitary adenomas: diagnosis and management in 43 patients","volume":"148","author":"Socin","year":"2003"},{"key":"b33-jns1471","series-title":"Br J Neurosurg","doi-asserted-by":"publisher","first-page":"507","DOI":"10.1080\/02688690400012459a","article-title":"Complications after transsphenoidal surgery: our experience and a review of the literature","volume":"18","author":"Sudhakar","year":"2004"},{"key":"b34-jns1471","series-title":"Thyroid","doi-asserted-by":"publisher","first-page":"1001","DOI":"10.1089\/thy.2000.10.1001","article-title":"Treatment of a thyrotropinoma with octreotide-LAR in a patient with multiple endocrine neoplasia-1","volume":"10","author":"Taylor","year":"2000"},{"key":"b35-jns1471","series-title":"Clin Endocrinol (Oxf)","doi-asserted-by":"publisher","first-page":"395","DOI":"10.1111\/cen.12290","article-title":"A long-term follow-up study of eighteen patients with thyrotrophin-secreting pituitary adenomas","volume":"80","author":"van Varsseveld","year":"2014"},{"key":"b36-jns1471","series-title":"Endocr Pathol","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1007\/s12022-009-9094-y","article-title":"Clinicopathological characterization of TSHproducing adenomas: special reference to TSH-immunoreactive but clinically non-functioning adenomas","volume":"20","author":"Wang","year":"2009"},{"key":"b37-jns1471","series-title":"Eur J Endocrinol","doi-asserted-by":"publisher","first-page":"873","DOI":"10.1530\/EJE-11-0657","article-title":"GH deficiency in patients after cure of acromegaly by surgery alone","volume":"165","author":"Yamada","year":"2011"},{"key":"b38-jns1471","series-title":"Wien Klin Wochenschr","doi-asserted-by":"publisher","first-page":"678","DOI":"10.1007\/s00508-012-0216-z","article-title":"Thyrotropin-secreting pituitary adenomas: diagnosis and management of patients from one Chinese center","volume":"124","author":"Zhao","year":"2012"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/121\/6\/article-p1462.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/121\/6\/article-p1462.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/121\/6\/article-p1462.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,7,25]],"date-time":"2022-07-25T00:15:05Z","timestamp":1658708105000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/121\/6\/article-p1462.xml"}},"subtitle":["Clinical article"],"short-title":[],"issued":{"date-parts":[[2014,12]]},"references-count":38,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.3171\/2014.7.jns1471","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,12]]}}}