摘要
目的分析TSH瘤的临床特点和诊治经验。方法对2006年1月至2011年9月在本院确诊治疗的16例垂体TSH分泌瘤患者的临床表现、实验室检查以及辅助检查和手术治疗效果进行分析。结果（1）男性9例，女性7例，年龄（51．63±13．23）岁。就诊原因为甲状腺毒症症状占87．5％（14／16），仅2例分别困视物障碍和体检发现甲状腺功能异常。16例患者均无突眼、杵状指、胫前黏液性水肿。（2）血清FL和FT，水平均高于正常，血清TSH（4．37±2．77）μIU／ml，25％（4／16）的患者同时合并血清甲状腺球蛋白抗体和（或）甲状腺过氧化物酶抗体阳性，促甲状腺素受体抗体全部阴性。9例行TRH兴奋试验：3例有反应（TSH高峰较基线L升5．45～9．20μIU／m1）．6例无反应（TSH高峰较基线上升-0．01～3．15μIU／ml）。11例患者行生长抑素试验：TSH平均被抑制到基线的27．15％（5．19％～99．15％）。有2例患者分别合并血清催乳素和胰岛素样生长因子I升高。垂体MRI显示垂体占位15例，其中微腺瘤10例，垂体大腺瘤5例；1例患者垂体未见异常，但见鼻腔内占位。（3）11例患者行手术治疗：9例行经蝶垂体瘤手术．1例干亍经额垂体瘤手术，1例行内镜下鼻中隔肿瘤手术。术后病理均为垂体腺瘤（11／11）。结论TSH不被抑制的甲状腺毒症需警惕TSH瘤，联合多种动态功能试验更有助于本病的早期诊断；另外在定性诊断符合TSH瘤。
Objective To analyze clillical characteristics and diagnostic experience on thyrotropinoma （TSHoma）. Methods Clinical characteristics, laboratory findings, diagnostic experience, and surgical outcome were summarized from 16 cases of TSHoma in our hospital from January 2006 to September 2011. Results （ 1 ） Among 16 cases （ 9 male,7 female） aged （ 51.63 ±13.23 ） years, 14 （ 87.5 % ） cases presented with hyperthyroidism and 2 were diagnosed by physical examination. None of them had exophthalmos, aeropachy, or pretibial myxedema. （ 2 ） Serum FT4 and FT3 levels were all above normal range with serum TSH （4.37± 2.77 ） μIU/ml. There were 25% （4/16） cases with positive serum thyroglobulin antibody and/or thyroid peroxidase antibody, none with positive TSH receptor antibody. TRH stimulating test was performed in 9 cases, 3 were with positive response （ peak TSH level increased by 5.45-9. 20 μIU/ml compared with basellne） , and 6 without response （ peak TSH level increased hy -0.01-3.15 μIU/ml compared with baseline）. TSH was suppressed to 27.15% （5.19% -99. 15% ） of the haseline in 11 eases in which somatostatin suppression test was carried out. Prolactin and insulin-like growth factor- I levels were increased in 2 cases. MRI performed in 15 patients showed 10 cases of microadenomas and 5 cases of pituitary adenoma. A mass in nasal cavity was found in one case, where no mass was found in the pituitary. （ 3 ） Surgcl7 was made in 11 eases （ 9 patients underwent transsphenoidal operation, one craniotomy, and one underwent operation via endoscopic nasal septum ）. All patients （11/11） were proved to yield pituitary adenoma pathologically. Conclusion Thyrotropinoma should be considered in hyperthyroidism with unsuppressed TSH level, and dynamic tests facilitated early diagnosis. Ectopic thyrotropinoma should be considered when normal pituitary morphology was shown by MRI.
出处
《中华内分泌代谢杂志》
CAS
CSCD
北大核心
2012年第9期729-733,共5页
Chinese Journal of Endocrinology and Metabolism
作者简介
王卫庆．Email：wqingw@hotmail．com
