Thyroid-stimulating Hormone (TSH) Adenomas

These are the least common of the overproduction syndromes. There have been only two cases in over 1,000 on the National Hospital pituitary database.

Clinical Features The diagnosis is made on raised TSH in the presence of hyperthyroidism. Pituitary-dependent TSH excess may also be associated with hypothyroidism. These patients have longstanding primary hypothyroidism, which induces hypersecretion of TSH, thy-rotroph hyperplasia and even adenoma.

Histology Thyrotroph adenomas are usually large chromophobe tumors with a sinusoidal architecture.

Treatment This is by surgical excision.

Gonadotrophic Adenomas Although a number of "non-functioning" tumors have gonadotroph expression on immunostaining, the tumors may release only the alpha subunit or have lost the ability to release the hormone. Although it has been suggested that they may be more common in hypogonadal individuals, there is no increase in frequency in menopausal women. Most authorities consider them to be clinically non-functioning tumors.

Clinical Features Although patients with gonadotroph adenomas occasionally present with signs or symptoms of gonadal dysfunction, most present with features of chiasmal compression. Clinically diagnosed gonadotroph tumors occur mainly in middle-aged males. In young women, gonadotrophin-secreting adenomas may masquerade as primary ovarian failure because chronically elevated serum gonadotro-phins reversibly inhibit ovarian function.

Histology Gonadotroph adenomas are usually chromophobic tumors with trabecular or papillary architecture and pseudo-rosette formation around blood vessels.

Treatment The treatment is surgical.

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