促甲状腺激素垂体瘤病例报道并文献复习

Hyperthyroidism due to thyrotropin-secreting pituitary tumors

对2例促甲状腺激素（TSH）垂体瘤患者的临床资料进行回顾性分析，并进行文献复习。2例患者都存在甲状腺毒症，均有甲状腺激素水平增高同时不伴TSH抑制，1例大腺瘤患者存在视野缺损。2例患者在确诊之前均误诊为原发性甲状腺功能亢进而接受抗甲状腺药物治疗4-7年，1例患者还曾行甲状腺大部切除术。确诊后大腺瘤患者行垂体瘤手术联合垂体放射治疗，另1例为微腺瘤患者，行垂体放射治疗。术后随访，2例患者的甲状腺功能亢进均较前改善。甲状腺毒症患者血清TSH水平不被抑制时应警惕TSH垂体瘤的存在，鞍区影像学检查可以进一步明确诊断，早期诊断和手术联合放射治疗可以取得较好的治疗效果。

Two patients with thyrotropin-secreting pituitary tumors were reported. And their clinical characteristics were analyzed retrospectively. Patients were presented with thyrotoxieosis and one had visual field defect. Hyperthyroidism was determined in these patients by means of elevated total or free thyroid hormone levels while serum TSH levels were not lower than detect limits. They were previously considered as suffering from primary hyperthyroidism and were treated with antithyroid drug for 4 to 7 years, one of them subsequently underwent subtotal thyroidectomy. MRI showed pituitary macroadenomas in 1 patients who underwent transsphenoidal adenomectomy and followed by radiotherapy, while microadenomas in the other patient who was given radiotherapy. Thyrotropin-seereting pituitary adenoma should be considered in patients with elevated thyroid hormone and non-suppressed serum TSH level. Combined treatment with transsphenoidal adenomectomy and radiotherapy are the choice for thyrotropin-secreting pituitary tumors.