垂体促甲状腺激素瘤的临床特点分析和治疗

Clinical features and treatment of thyrotropin-secreting pituitary adenomas

目的探讨垂体促甲状腺激素瘤(垂体TSH瘤)导致中枢性甲亢的临床特点及治疗,为临床治疗提供参考。方法回顾性分析5例垂体TSH瘤患者的临床和实验室检查资料,5例均有不同程度的高代谢症状伴或不伴鞍区占位效应,且血清FT4、FT3水平升高,TSH升高或正常,均经垂体磁共振(平扫+增强)检查为大腺瘤。结果 4例行经鼻蝶神经内镜鞍区占位切除术,1例行开颅垂体瘤切除术,术后病理证实均为垂体腺瘤,免疫组化TSH阳性。结论甲亢患者血清TSH不被抑制时要警惕有无垂体TSH瘤的可能,需及时行垂体磁共振检查,若发现垂体腺瘤尽早手术治疗。

Objective To investigate the clinical features and treatment of central hyperthyroidism due to thyrotropin-secreting pituitary adenomas(TSH adenomas). Methods The clinical and laboratory findings and treatment from 5 cases of TSH adenoma were retrospectively analyzed. The main presenting symptoms were hypermetabolism with or without symptoms due to sellar region tumor. They all had high levels of serum FT4 and FT3 with the high or normal level of TSH. MRI showed pituitary macro-adenomas in all patients. Results Four cases had transspheniodal surgery, and one case had transcranial surgery. Histopathological examination showed thyrotropin-secreting pituitary adenoma in all cases, and immunohistochemical analysis showed TSH positive immunoreactivity. Conclusion Attention should be paid to the hyperthyroidism patients with non-suppressed serum level of TSH. MRI examination is helpful in diagnosis of pituitary adenoma. The initial therapeutic approach is to remove the tumor mass surgically.