Tirotropin salgılayan adenoma tedavisinde oktreotid kullanımının yeri: İki olgu sunumu ve literatürün gözden geçirilmesi

Octreotide treatment in TSH-secreting adenomas: Report of two cases and review of the literature

Arif YÖNEM, Murat ASLAN, Bekir ÇAKIR, Metin ÖZATA, Çağlayan ÖZDEMİR, Yüksel DERE, Mustafa KUTLU

Özet

Bu yazimizda hipofizde tiroidi stimtlle edici ho- adenomu (TSHoma) bulunan iki olguyu ve bunlara uy-guladigimiz oktreotid tedavisinin sonuclanni i,u,nuyoruz. Ilk olguda klasik hipertiroidizm semptomlan vegu-atr varken, ikinci olguda asil semptom basagnsi olup hipertiroidizm semptomlan daha az agirhkta idi vegu-atr mevcut degildi. Her iki olgunun da tiroid hormon dilzeyleri yilksek, buna karsihk TSH duzeyleri baskilan-mamisti. Olgulartn TSH duzeyleri T3 supresyonundan ve TRH stimillasyonundan etkilenmedi.TSH a-subuni-ti bir olguda normal iken, digerinde yiiksek bulundu. Her iki olgunun baska bir hormonal bozuklugu yoktu. Magnetik rezonans goruntuleme ve somatostatin reseptor sintigrafisi He olgunun birinde hipofizde mikroade-nom (6x7 mm), digerinde makroadenom (14x18 mm) boyutunda TSH salgilayan tumor tesbit edildi. Her iki otguyagilnde 3 kez 100 jig dozda ba§layip, tedricen arttinlarak 600pg/giln doza cikanlan somatostatin ana-logu (oktreotid-Sandostatin) tedavisiyaklasik alti ay sureyle uygulandi. Hastalann semptomlannda azalma ol-makla beraber, bu azalma belirgin olgilde degildi. Tedavinin baslangicmda tiroid hormon ve TSH duzeylerin-de dilsme olmakla beraber bu dilgme sureklilik gostermedi. Buna karsihk hipofizdeki tumor boyutunda alti ay-hk tedavinin sonunda anlamh bir degisme olmadi. Oktreotit tedavisinin bitiminde olgunun birine (makroade-nomlu) hipofizer cerrahi uygulandi, digeri ise takiplere gelmedi. Sonuc olarah, oktreotidin TSHom'ada biyokim-yasal belirleyicileri azaltmada bir olcude etkili olsa bile, tumor boyutunda anlamh bir kugulme saglamadigi-ni gozledik.

Abstract

We presented two cases with thyrotropin-secreting adenoma and the effectiveness of octreotide treatment on the¬ir TSH and thyroid hormone levels and tumor size. The first case presented with symptoms and signs such as tremor, palpitations, sweeting, suggestive of hyperthyroidism, but the other presented predominantly with he¬adache and had no thyroid enlargement on physical exam. Thyroid hormone levels in both cases were incre¬ased but TSH levels not suppressed, indicating inappropriate secretion of TSH. Also, TSH levels did not change after T3 and TRH administration, which also contributed to the assumption of inappropriate TSH secretion. One case had no increase in. alpha subunit level but the other had an increased level of alpha subunit. Both mag¬netic-resonance imaging and somatostatin receptor scintigraphy revealed that there were a microadenoma (the first case; 6x7 mm in diameter) and a macroadenoma (the second case; 14x18 mm in diameter). -Both cases were placed on therapy with somatostatin analog (octreotide-Sandostatin). Somatostatin analog was initially given at a dose of 300 pig daily, and then increased gradually up to 600 pig per day. There were some reductions in the levels of TSH and thyroid hormones at first. But the reductions did not persist with ongoing therapy after 6 months period. In addition, there was no change in tumor size with this therapy at the end. As a consequence, we conclude that the somatostatin analog, octreotide, treatment may not be an effective means of reducing tumor size in the pituitary TSHomas though it may be used to reduce TSH and thyroid hormones temporarily.