目的总结甲状腺激素抵抗综合征(syndrome of resistance to thyroid hormone,RTH)和垂体促甲状腺激素瘤(thyrotropin-secreting pituitary adenoma,TSH瘤)的病例特点,分析奥曲肽抑制试验和大剂量地塞米松抑制试验对鉴别二者的临床应用价...目的总结甲状腺激素抵抗综合征(syndrome of resistance to thyroid hormone,RTH)和垂体促甲状腺激素瘤(thyrotropin-secreting pituitary adenoma,TSH瘤)的病例特点,分析奥曲肽抑制试验和大剂量地塞米松抑制试验对鉴别二者的临床应用价值,以此提高这两种疾病的诊疗水平。方法纳入2010年10月至2021年12月于湘雅医院住院期间临床诊断为RTH和TSH瘤患者22例,分析总结两种疾病各自的临床特点以及分别对不同试验的反应性。结果(1)TSH瘤患者的瘤体相较于RTH并发垂体瘤患者更大,在影像学上多表现为视交叉受压(P<0.05)。(2)在奥曲肽抑制试验中,RTH患者促甲状腺激素(TSH)抑制率比TSH瘤患者更低(P<0.05);在大剂量地塞米松抑制试验中,RTH患者TSH抑制率比TSH瘤患者更高(P<0.05)。(3)采用受试者工作特征(ROC)曲线计算TSH抑制率,结果显示奥曲肽抑制试验的灵敏度为91.9%,特异度为55.6%,此时TSH抑制率临界值为64.24%;大剂量地塞米松抑制试验的灵敏度为54.4%,特异度为89.0%,此时TSH抑制率临界值为65.73%。两种试验联合的灵敏度为77.8%,特异度为90.9%,具有更好的诊断价值(P<0.05)。结论联合奥曲肽抑制试验和大剂量地塞米松抑制试验对鉴别RTH与TSH瘤有一定的临床价值。TSH瘤比RTH并发垂体瘤更具占位效应和侵袭性。展开更多
Thyroid-stimulating hormone(TSH)-secreting pituitary adenoma is a rare type in all pituitary tumors.Recently we treated a TSH-secreting pituitary tumor in our hospital.The patient had been treated for hyperthyroidism,...Thyroid-stimulating hormone(TSH)-secreting pituitary adenoma is a rare type in all pituitary tumors.Recently we treated a TSH-secreting pituitary tumor in our hospital.The patient had been treated for hyperthyroidism,in which methimazole had been prescribed for 10 years,but the symptoms had not been alleviated.MRI imaging demonstrated the typical features of a sellar tumor,and the diameter was approximately 2.7 cm.Based on the laboratory studies:T3 at 6.27 nmol/L,T4 at 260.10 nmol/L,FT3 at 17.22 pmol/L,FT4 at 76.06 pmol/L,TSH at 9.93 Mu/L,the patient was diagnosed with a TSH-secreting pituitary tumor and central hyperthyroidism.After the patient was given octreotide for one week,he received resection of tumor via single-nostril transsphenoidal approach.After discharge,the patient received the radiation therapy two courses about 20 days.Through the comprehensive treatment of surgery,radiotherapy and drugs,the patient received a satisfactory result.展开更多
文摘目的总结甲状腺激素抵抗综合征(syndrome of resistance to thyroid hormone,RTH)和垂体促甲状腺激素瘤(thyrotropin-secreting pituitary adenoma,TSH瘤)的病例特点,分析奥曲肽抑制试验和大剂量地塞米松抑制试验对鉴别二者的临床应用价值,以此提高这两种疾病的诊疗水平。方法纳入2010年10月至2021年12月于湘雅医院住院期间临床诊断为RTH和TSH瘤患者22例,分析总结两种疾病各自的临床特点以及分别对不同试验的反应性。结果(1)TSH瘤患者的瘤体相较于RTH并发垂体瘤患者更大,在影像学上多表现为视交叉受压(P<0.05)。(2)在奥曲肽抑制试验中,RTH患者促甲状腺激素(TSH)抑制率比TSH瘤患者更低(P<0.05);在大剂量地塞米松抑制试验中,RTH患者TSH抑制率比TSH瘤患者更高(P<0.05)。(3)采用受试者工作特征(ROC)曲线计算TSH抑制率,结果显示奥曲肽抑制试验的灵敏度为91.9%,特异度为55.6%,此时TSH抑制率临界值为64.24%;大剂量地塞米松抑制试验的灵敏度为54.4%,特异度为89.0%,此时TSH抑制率临界值为65.73%。两种试验联合的灵敏度为77.8%,特异度为90.9%,具有更好的诊断价值(P<0.05)。结论联合奥曲肽抑制试验和大剂量地塞米松抑制试验对鉴别RTH与TSH瘤有一定的临床价值。TSH瘤比RTH并发垂体瘤更具占位效应和侵袭性。
文摘Thyroid-stimulating hormone(TSH)-secreting pituitary adenoma is a rare type in all pituitary tumors.Recently we treated a TSH-secreting pituitary tumor in our hospital.The patient had been treated for hyperthyroidism,in which methimazole had been prescribed for 10 years,but the symptoms had not been alleviated.MRI imaging demonstrated the typical features of a sellar tumor,and the diameter was approximately 2.7 cm.Based on the laboratory studies:T3 at 6.27 nmol/L,T4 at 260.10 nmol/L,FT3 at 17.22 pmol/L,FT4 at 76.06 pmol/L,TSH at 9.93 Mu/L,the patient was diagnosed with a TSH-secreting pituitary tumor and central hyperthyroidism.After the patient was given octreotide for one week,he received resection of tumor via single-nostril transsphenoidal approach.After discharge,the patient received the radiation therapy two courses about 20 days.Through the comprehensive treatment of surgery,radiotherapy and drugs,the patient received a satisfactory result.
