误诊为原发性甲状腺功能亢进症的垂体促甲状腺激素瘤

Thyroid-stimulating Hormone Pituitary Adenomas Easily Misdiagnosed as Primary Hyperthyroidism

目的探讨垂体促甲状腺激素瘤的临床特点及诊治方法。方法回顾性分析2例垂体促甲状腺激素瘤误诊病例资料。结果 2例术前表现为甲状腺增大和(或)甲状腺毒症体征,甲状腺功能检查示游离三碘甲状腺原氨酸、游离甲状腺素升高,例1促甲状腺激素升高,初步诊断为原发性甲状腺功能亢进症(甲亢)。后行影像学检查发现垂体占位性病变,经手术病理检查及免疫组织化学染色确诊为垂体促甲状腺激素瘤。术后给予糖皮质激素替代治疗,随访1年甲状腺激素均维持正常水平。结论垂体促甲状腺激素瘤临床罕见,易误诊为甲亢,结合症状体征、内分泌学检查及影像学检查结果可初步诊断,确诊仍需依靠病理检查。

Objective To investigate the clinical features, diagnosis and treatment of thyroid-stimulating hormone pituitary adenomas.Methods The clinical date of 2 misdiagnosed cases of thyroid-stimulating hormone pituitary adenomas were reviewed.Results Both of 2 cases had thyromegaly and （or） thyrotoxicosis in the preoperative, and thyroid hormone level in free triiodothyronine and free thyroxine increased.Thyroid-stimulating hormone（TSH） level increased in case 1 and reduced in case 2, which can be diagnosed as primary hyperthyroidism preliminarily.Later, the pituitary occupying lesions was found by imaging examination.Thyroid-stimulating hormone pituitary adenomas was confirmed by surgical pathological examination and immunohistochemical staining.After the operation, with a treatment of providing glucocorticoids to patients for supplement and thyroid hormone was maintained at a normal level during the 1 year follow-up.Conclusion thyroid-stimulating hormone pituitary adenomas is clinically rare and easy to be misdiagnosed.It can be diagnosed preliminarily after comprehensive results of clinical signs and symptoms, endocrine examination and imaging examination, however, confirming the diagnosis has to be based on pathological examination.At present, resection by surgery is the best treatment of the disease.