Frédéric Illouz1, Philippe Chanson2,3, Emmanuel Sonnet4, Thierry Brue5, Amandine Ferriere6,7,8, Marie-Laure Raffin Sanson9,10, Marie-Christine Vantyghem11,12, Gérald Raverot13,14,15, Mathilde Munier16, Patrice Rodien17, Claire Briet18. 1. Centre de Référence des Maladies Rares de la Thyroïde et des Récepteurs Hormonaux TRH, Centre de Référence des Maladies Rares de l'Hypophyse HYPO, Service d'Endocrinologie, Diabétologie et Nutrition, CHU d'Angers, Angers Cedex, France. 2. Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l'Hypophyse HYPO, Le Kremlin-Bicêtre, France. 3. UMR S-1185, Fac Med Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France. 4. Service d'Endocrinologie Diabétologie Nutrition, CHU de BREST, BREST Cedex, France. 5. Assistance Publique-Hôpitaux de Marseille (AP-HM), Service d'Endocrinologie, Hôpital de la Conception, Centre de Référence des Maladies Rares de l'Hypophyse HYPO, Institut National de la Santé et de la Recherche Médicale (INSERM), Marseille, France. 6. Service d'Endocrinologie, Diabétologie et Nutrition, Hôpital Haut Lévêque, CHU Bordeaux, Pessac, France. 7. INSERM, Neurocentre Magendie, Physiopathologie de la Plasticité Neuronale, Bordeaux, France. 8. Université de Bordeaux, Neurocentre Magendie, Physiopathologie de la Plasticité Neuronale, Bordeaux, France. 9. Service d'Endocrinologie et Nutrition, CHU Ambroise-Paré, AP-HP, Boulogne-Billancourt, France. 10. Inserm U1173, Université Versailles-Saint-Quentin, Montigny-Le-Bretonneux, France. 11. Service d'Endocrinologie et Métabolisme, CHU Lille, Lille, France. 12. UMR 1190 Translational Research in Diabetes INSERM, Lille, France. 13. Université de Lyon, Lyon1, Lyon, France. 14. Inserm U1052, CNRS UMR5286, Cancer Research Center of Lyon, Lyon, France. 15. Fédération d'Endocrinologie, Centre de Référence des Maladies Rares de l'Hypophyse HYPO, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron Cedex, France. 16. Centre de Référence des Maladies rares de la Thyroïde et des Récepteurs Hormonaux, Institut MITOVASC, Université d'Angers, Angers, France. 17. Centre de Référence des Maladies Rares de la Thyroïde et des Récepteurs Hormonaux TRH, Centre de Référence des Maladies Rares de l'Hypophyse HYPO Service d'Endocrinologie, Diabétologie et Nutrition, CHU d'Angers, Institut MITOVASC, Université d'Angers, Angers, France. 18. Centre de Référence des Maladies Rares de la Thyroïde et des Récepteurs Hormonaux TRH Centre de Référence des Maladies Rares de l'Hypophyse HYPO Service d'Endocrinologie, Diabétologie et Nutrition, CHU d'Angers, Institut MITOVASC, Université d'Angers, Angers, France.
Abstract
OBJECTIVE: Somatostatin receptor ligands (SRL) are useful to control central hyperthyroidism in patients with thyrotropin-secreting pituitary adenoma (TSH pituitary adenoma). The aim of this study was to describe the frequency of thyrotropin deficiency (TSH deficiency) in patients with TSH pituitary adenoma treated by SRL. DESIGN: Retrospective study. METHODS: Patients with central hyperthyroidism due to TSH pituitary adenoma treated by short or long-acting SRL were retrospectively included. TSH deficiency was defined by a low FT4 associated with non-elevated TSH concentrations during SRL therapy. We analysed the frequency of TSH deficiency and the characteristics of patients with or without TSH deficiency. RESULTS: Forty-six patients were included. SRL were used as the first-line therapy in 21 of 46 patients (46%). Central hyperthyroidism was controlled in 36 of 46 patients (78%). TSH deficiency appeared in 7 of 46 patients (15%) after a median time of 4 weeks (4-7) and for a median duration of 3 months (2.5-3). The TSH deficiency occurred after one to three injections of long-acting SRL used as first-line therapy in 6/7 cases. There were no differences in terms of clinical and hormonal features, size of adenomas or doses of SRL between patients with or without TSH deficiency. CONCLUSIONS: SRL can induce TSH deficiency in patients with central hyperthyroidism due to TSH pituitary adenoma. Thyrotropic function should be assessed before the first three injections of SRL in order to track TSH deficiency and reduce the frequency of injections when control of thyrotoxicosis rather than tumour reduction is the aim of the treatment.
OBJECTIVE: Somatostatin receptor ligands (SRL) are useful to control central hyperthyroidism in patients with thyrotropin-secreting pituitary adenoma (TSH pituitary adenoma). The aim of this study was to describe the frequency of thyrotropin deficiency (TSH deficiency) in patients with TSH pituitary adenoma treated by SRL. DESIGN: Retrospective study. METHODS: Patients with central hyperthyroidism due to TSH pituitary adenoma treated by short or long-acting SRL were retrospectively included. TSH deficiency was defined by a low FT4 associated with non-elevated TSH concentrations during SRL therapy. We analysed the frequency of TSH deficiency and the characteristics of patients with or without TSH deficiency. RESULTS: Forty-six patients were included. SRL were used as the first-line therapy in 21 of 46 patients (46%). Central hyperthyroidism was controlled in 36 of 46 patients (78%). TSH deficiency appeared in 7 of 46 patients (15%) after a median time of 4 weeks (4-7) and for a median duration of 3 months (2.5-3). The TSH deficiency occurred after one to three injections of long-acting SRL used as first-line therapy in 6/7 cases. There were no differences in terms of clinical and hormonal features, size of adenomas or doses of SRL between patients with or without TSH deficiency. CONCLUSIONS: SRL can induce TSH deficiency in patients with central hyperthyroidism due to TSH pituitary adenoma. Thyrotropic function should be assessed before the first three injections of SRL in order to track TSH deficiency and reduce the frequency of injections when control of thyrotoxicosis rather than tumour reduction is the aim of the treatment.
Authors: Daniel Gillett; Russell Senanayake; James MacFarlane; Merel van der Meulen; Olympia Koulouri; Andrew S Powlson; Rosy Crawford; Bethany Gillett; Nick Bird; Sarah Heard; Angelos Kolias; Richard Mannion; Luigi Aloj; Iosif A Mendichovszky; Heok Cheow; Waiel A Bashari; Mark Gurnell Journal: EJNMMI Res Date: 2022-05-07 Impact factor: 3.434