J Neurosurg 121:1462–1473, 2014 1462 J Neurosurg / Volume 121 / December 2014 ©AANS, 2014 T hyroTropin (TSH)-secreting pituitary adenomas are rare tumors that account for less than 2% of all pituitary adenomas. 1,27 Development of ultrasen- sitive measurement methods combined with advanced Clinicopathological characteristics and therapeutic outcomes in thyrotropin-secreting pituitary adenomas: a single-center study of 90 cases Clinical article Shozo Y amada, m.d., Ph.d., 1,2 Noriaki Fukuhara, m.d., 1 keNtaro horiguchi, m.d., Ph.d., 1 mitSuo Y amaguchi-okada, m.d., Ph.d., 1 hiroShi NiShioka, m.d., Ph.d., 1,2 akira takeShita, m.d., Ph.d., 2,3 Y aSuhiro takeuchi, m.d., Ph.d., 2,3 JuNko ito, m.d., 4 aNd Naoko iNoShita, m.d., Ph.d. 5 Departments of 1 Hypothalamic and Pituitary Surgery, 3 Endocrinology, 4 Pediatrics, and 5 Pathology, Toranomon Hospital; and 2 Okinaka Memorial Institute for Medical Research, Tokyo, Japan Object. 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)–secreting pituitary adenomas. Methods. The authors retrospectively reviewed clinical, pathological, and treatment characteristics of 90 con- secutive 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 11–74 years). Results. Sixteen tumors (18%) were microadenomas and 74 (82%) were macroadenomas. Microadenomas were signifcantly more frequent in the more recent half of our case series (12 of 45 cases) (p = 0.0274). Cavernous sinus invasion was confrmed in 21 patients (23%). In 67 cases (74%), the tumors were frm elastic or hard in consistency. Acromegaly and hyperprolactinemia were observed, respectively, in 14 (16%) and 11 (12%) of the 90 cases. Euthy- roidism 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 signifcant indepen- dent 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. Conclusions. TSH-secreting adenomas, particularly those in the microadenoma stage, have increased in fre- quency 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. (http://thejns.org/doi/abs/10.3171/2014.7.JNS1471) keY WordS • hyperthyroidism • somatostatin analogs • pituitary surgery • syndrome of inappropriate TSH secretion • transsphenoidal surgery • thyrotropin-secreting pituitary adenoma Abbreviations used in this paper: ACTH = adrenocorticotropic hormone; ADH = antidiuretic hormone; FSH = follicle stimulat- ing hormone; FT3 = free triiodothyronine; FT4 = free thyroxine; GH = growth hormone; IGF-1 = insulin-like growth factor 1; IQR = interquartile range; LH = luteinizing hormone; PRL = prolactin; SITSH = syndrome of inappropriate TSH secretion; TRH = thyro- tropin-releasing hormone; TSH = thyrotropin (thyroid stimulating hormone). This article contains some figures that are displayed in color online but in black-and-white in the print edition.