垂体柄阻断综合征患者促甲状腺激素水平的临床研究

Clinical study of thyroid stimulating hormone status in patients with pituitary stalk interruption syndrome

目的分析垂体柄阻断综合征(PSIS)患者的促甲状腺激素(TSH)水平。方法回顾性分析2013年1月至2018年1月郑州大学第一附属医院73例PSIS患者和52例Sheehan综合征(SS)患者的临床资料。结果PSIS患者年龄小于SS患者年龄[(22.3±8.4)岁比(46.8±10.6)岁],P<0.05。两组患者中枢性甲状腺功能减退症的患病率分别为74.0%和67.3%。54例甲状腺功能减退PSIS患者中11例(20.4%)出现TSH升高,而35例甲状腺功能减退SS患者无TSH升高。与SS患者比较,PSIS患者的TSH水平升高[(4.85±2.85)μIU/L比(1.85±1.34)μIU/L,P<0.05]。与甲状腺功能减退的SS患者比较,甲状腺功能减退PSIS患者的游离甲状腺素和TSH水平均升高[(5.74±1.07)pmol/L比(3.76±1.80)pmol/L,(4.50±2.31)μIU/L比(1.94±1.80)μIU/L,P均<0.05]。TSH水平与垂体柄状态和垂体前叶高度无明显相关性。结论PSIS是新发现的中枢性甲状腺功能减退症的原因。PSIS患者TSH升高的比例和幅度高于其他引起中枢性甲状腺功能减退症的下丘脑-垂体疾病。

Objective To analyze the thyroid stimulating hormone(TSH)levels in patients with pituitary stalk interruption syndrome(PSIS).Methods The clinical data of 73 patients with PSIS and 52 patients with Sheehan syndrome(SS)in the First Affiliated Hospital of Zhengzhou University from January 2013 to January 2018 were retrospectively analyzed.Results The age of PSIS patients was(22.3±8.4)years,lower than the(46.8±10.6)years of SS patients(P<0.05).The incidence of central hypothyroidism of PSIS patients and SS patients was 74.0%and 67.3%,respectively.TSH elevation was noticed in 11 cases of the 54 hypothyroid PSIS patients(20.4%),but not in the 35 hypothyroid SS patients.Compared with SS patients,the TSH level of PSIS patients was significantly increased,(4.85±2.85)μIU/L vs.(1.85±1.34)μIU/L,P<0.05.Compared with SS patients with hypothyroidism,the FT4 and TSH levels were elevated in patients with hypothyroidism,(5.74±1.07)pmol/l vs.(3.76±1.80)pmol/l,(4.50±2.31)μIU/L vs.(1.94±1.80)μIU/L,P all<0.05.There was no significant correlation of TSH level with pituitary stalk status or anterior pituitary height.Conclusions PSIS is the newly discovered cause of central hypothyroidism.The proportion and magnitude of elevated TSH in patients with PSIS is higher than other hypothalamic-pituitary diseases that can cause central hypothyroidism.