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ACTH-secreting pituitary microadenomas are associated with a higher prevalence of central hypothyroidism compared to other microadenoma types.

Abstract：

CONTEXT:Unlike pituitary macroadenomas, microadenomas (micros) are not commonly associated with hypopituitarism. In clinical practice, we have observed that patients with ACTH-secreting micros have a higher than expected prevalence of central hypothyroidism (HT), and we speculated that this effect might be because of glucocorticoid-induced suppression of the hypothalamic-pituitary-thyroid axis. OBJECTIVE:To determine whether there is a difference in the prevalence of central HT among ACTH micros compared to other types of microadenoma, and if so, to investigate whether this is directly related to the degree of hypercortisolism. DESIGN, SETTING AND PATIENTS:Retrospective study of 149 newly diagnosed patients with pituitary micros: 34 ACTH-secreting, 72 prolactin-secreting (PRLomas) and 43 clinically nonfunctioning adenomas (NFAs). MAIN OUTCOMES MEASURES:Prevalence of central HT, correlation between normalized free T4 or TSH vs normalized urinary free cortisol (UFC) or salivary cortisol. RESULTS:The prevalence of central HT was significantly higher in the ACTH compared to the non-ACTH adenomas: 18% (ACTH), 1% (PRL) and 0% (NFAs). The mean normalized free T4 was lower in the ACTH micros compared to the non-ACTH micros (1·29 ± 0·06 vs 1·50 ± 0·23, P = 0·0001). There was no correlation between the degree of hypercortisolism, as reflected by 24-h urine free cortisol and salivary cortisol, and free T4 or TSH levels among the ACTH adenomas. Similarly, there were no differences in mean UFC or salivary cortisol between ACTH adenomas with and without central HT. Following transsphenoidal adenomectomy, central HT recovered in three of six patients with ACTH micros. CONCLUSIONS:These findings suggest that patients with ACTH-secreting microadenomas should always, at a minimum, undergo testing for central HT. However, given the potential for recovery of thyroid function following cure of Cushing disease, we recommend withholding thyroid hormone replacement until after pituitary surgery.

journal_name

Clin Endocrinol (Oxf)

journal_title

Clinical endocrinology

authors

Mathioudakis N,Thapa S,Wand GS,Salvatori R

doi

10.1111/j.1365-2265.2012.04442.x

subject

Has Abstract

pub_date

2012-12-01 00:00:00

pages

871-6

issue

eissn

0300-0664

issn

1365-2265

journal_volume

pub_type

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ACTH-secreting pituitary microadenomas are associated with a higher prevalence of central hypothyroidism compared to other microadenoma types.