A Retrospective Study Of Surgical Treatment For Thyrotropin-Secreting Pituitary Adenoma

Objective:At present,transsphenoidal pituitary surgery remains first line therapy in the majority of patients with thyrotropinomas.And tumors with hard consistency might worsen surgical outcomes.This research focus on the texture of thyrotropinomas,and the change rule of postoperation hormone level.Methods:This study based on the retrospectively collected data of 15 cases of thyrotropinomas,which were treated in our hospital during 2007 to 2016,such as clinical data,MRI,surgery records,and perioperative hormone levels.By statistical methods,we conclude relevant factors of thyrotropinomas,tumor size,invasiveness,texture,and the change rule of postoperation hormone level.Results:There are 15 cases of thyrotropinomas in this study,which didn't show hypopituitarism preoperatively.However,after operation,there are 4 cases of hypopituitarism,including 3 cases of pituitary-adrenal axis,and 1 case of pituitary-thyroid axis as well as pituitary-adrenal axis.In the case of remission after surgery,14 patients remitted in the early period of postoperation,and 13 patients remitted in one month after the operation.The specific research results are as follows:1)Thyrotropin-secreting pituitary adenomas can be seen more in women than in men,and mostly in 40 to 60 years of age.2)As for tumor size,macroadenomes are rare,and macroadenomas count 47 %in this study,and microadenoma count 53%.Tumor size or tumor invasive has no significant correlation with tumor quality(p>0.05).3)In MRI,T1 WI tumor/alba signal ratio has no significant correlation with tumor quality(p>0.05).However,T2 WI tumor/alba signal ratio has negative correlation with tumor quality(p=0.003<0.05,t=-3.593),meaning that high T2 WI tumor/alba signal ratio refers to tumors with soft consistency.4)Postoperatively,transient hormone suppression is generally present in patients whose tumors were completely resected.TSH levels stay undetectable in the early period of postoperation,but recover one month later.Free T3 and free T4 levels keep decreasing until they become normal.Pituitary-adrenal axis are seen more in hypopituitarism than pituitary-thyroid axis.In one month after the operation,PTC,GH,LH,and FSH levels might recover normal(p>0.05),although they suffered suppression in the early period of postoperation.5)In patients who are treated by surgery,hypopituitarism has been reported up to 28.6 % of cases,in that there are more pituitary-adrenal axis.Tumor quality has positive correlation with hypopituitarism(p<0.05),meaning that tumors with harder consistency refer to more hypopituitarisms.Conclusion:Tumor texture has negative correlation with T2 WI tumor/alba signal ratio,and positive correlation with hypopituitarism.Postoperatively,transient hormone suppression is generally present in patients whose tumors were completely resected.TSH levels one month after surgery are highly predictive of successful outcomes.