垂体促甲状腺素分泌瘤20例临床分析

A clinical analysis of thyrotropin-secreting pituitary adenomas in 20 patients

目的 通过分析垂体促甲状腺素（TSH）分泌瘤的临床和影像学资料,了解其临床特点、治疗手段及治疗后的临床转归.方法 分析复旦大学附属华山医院2006年至2013年住院的20例垂体TSH分泌瘤患者的临床表现、激素水平、影像学检查以及治疗后的随访结果.结果 20例患者的年龄为（40.0±14.5）岁,病程1个月～15年.13例（65％）患者表现为甲状腺毒症及甲状腺肿,9例（45％）患者出现颅内占位压迫所致的临床表现.所有患者均具备游离T3、游离T4升高伴TSH不被抑制以及影像学垂体瘤征象.20例患者经手术、生长抑素类似物、放射治疗等综合治疗后,18例患者甲状腺功能恢复正常,肿瘤缩小且稳定,1例患者复发,1例患者失访.结论 垂体TSH分泌瘤患者主要表现为甲状腺毒症及垂体瘤征象,临床以手术和生长抑素类似物为一线治疗,辅以放射治疗,预后较佳.

Objective To explore the clinical characteristics of thyrotropin-secreting pituitary adenomas.Methods A total of 20 patients with thyrotropin-secreting pituitary adenomas hospitalized in Shanghai Huashan Hospital from 2006 to 2013 were enrolled in the study.The clinical features,hormone levels,imaging findings,treatment and follow-up data were reviewed and analyzed.Results Most of the patients were young and middle-aged with （40.0 ± 14.5） years old.The disease duration varied from 1 month to 15 years.Among them,13 cases （65 %） presented with thyrotoxicosis and/or thyroid goiters and 9 （45%） presented with symptoms of intracranial compression.All patients had unsuppressed levels of thyroid stimulating hormone （TSH） with elevated levels of thyroid hormones.Pituitary lesions were found in all patients by neuroimaging.Pituitary adenomectomy,and/or somatostatin analogs and/or radiotherapy were applied in all patients after definitive diagnosis.Restored euthyroidism and shrinked pituitary adenomas with no progression were observed in 18 patients.Relapse was found in 1 patient and another patient was lost to follow up.Conclusions Thyrotropin-secreting pituitary adenomas mainly present with thyrotoxicosis and/or pituitary tumor.Comprehensive therapy,including adenomectomy,somatostatin analogues and radiotherapy,is often needed for the management.