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Horm Metab Res
DOI: 10.1055/a-2762-7986
Original Article: Endocrine Care

Delay in Diagnosis in TSH-Secreting Pituitary Adenomas - Clinical and Endocrinological Profiles from a Retrospective Cohort Study

Authors

  • Stylianos Kopanos

    1   Academic Department of Endocrinology, Diabetes and Infectiology, Klinikum Bielefeld, Klinikum Bielefeld gemGmbH, Bielefeld, Germany (Ringgold ID: RIN14970)

  • Ulrich Johannes Knappe

    2   Department of Neurosurgery, Medical Centre Ruhr University Bochum, Germany, Johannes Wesling Klinikum Minden, Minden, Germany (Ringgold ID: RIN39631)

  • Andreas Sebastian Moeller

    3   Academic Department of Endocrinology, Diabetes and Infectiology, Klinikum Bielefeld, Medical School and University Medical Centre East Westphalia-Lippe Bielefeld University, Germany, Klinikum Bielefeld gemGmbH, Bielefeld, Germany (Ringgold ID: RIN14970)

  • Sandra Nicole Scheel

    3   Academic Department of Endocrinology, Diabetes and Infectiology, Klinikum Bielefeld, Medical School and University Medical Centre East Westphalia-Lippe Bielefeld University, Germany, Klinikum Bielefeld gemGmbH, Bielefeld, Germany (Ringgold ID: RIN14970)

  • Joachim Feldkamp

    4   Academic Department of Endocrinology, Diabetes and Infectiology, Klinikum Bielefeld, Medical School and University Medical Centre East Westphalia-Lippe Bielefeld University, Germany, Klinikum Bielefeld, Bielefeld, Germany
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Thyrotropin (TSH)-secreting pituitary adenomas (TSHomas) are rare causes of hyperthyroidism that frequently present diagnostic and therapeutic challenges. This study characterizes the clinical, biochemical, radiological, and histopathological features of TSHomas, evaluates long-term outcomes, and identifies factors influencing remission and recurrence. We retrospectively analysed 12 patients with TSHoma treated between January 2003 and February 2025 at a tertiary endocrine referral centre. Clinical presentation, hormonal profiles, imaging characteristics, histopathology, management, and follow-up were reviewed. Diagnostic criteria included inappropriately normal or elevated TSH levels with increased free thyroid hormones and pituitary imaging confirming an adenoma. Remission was defined as clinical and biochemical normalization without ongoing therapy. Subgroup analysis examined the impact of diagnostic delay on tumour size, invasiveness, and outcome. The cohort comprised 9 men (75%) and 3 women (25%) with a mean age at diagnosis of 47.8 ± 17.2 years. Excluding one MEN1 case with early detection, the mean diagnostic delay was 42.5 months (range 4–156). MRI revealed macroadenomas in 75% and Knosp grade 3–4 invasion in 41.7%. Longer diagnostic delay correlated with significantly larger tumours (17.9 ± 3.6 mm vs 9.8 ± 1.0 mm; p = 0.004). All patients underwent surgery; 50% achieved remission, while 33.3% required additional therapy (SSA and/or radiotherapy). At a median 7.8-year follow-up, 66.7% remained in sustained remission. No patient experienced thyroid storm; transient postoperative hypothyroidism occurred in 25%. TSHomas often present with heterogeneous and misleading biochemical profiles leading to diagnostic delay, larger and more invasive tumours, and greater need for multimodal therapy. Early recognition of discordant thyroid function tests—elevated free T3/T4 with non-suppressed TSH—is critical to avoid unnecessary thyroid ablation and to improve surgical outcomes.



Publication History

Received: 28 October 2025

Accepted after revision: 02 December 2025

Accepted Manuscript online:
03 December 2025

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