促甲状腺激素腺瘤的诊断和治疗  

Diagnosis and Treatment of Thyrotropin-secreting Pituitary Adenomas

作　　者：卞留贯[1] 孙青芳[1] 姜晓华[2] 叶蕾[2] 李云峰[1] 王卫庆[2] 宁光[2] 

机构地区：[1]上海交通大学医学院附属瑞金医院神经外科,上海200025 [2]上海交通大学医学院附属瑞金医院内分泌科,上海200025

出　　处：《中国神经肿瘤杂志》2013年第4期217-220,共4页Chinese Journal of Neuro-Oncology

摘　　要：背景与目的：促甲状腺激素（thyroidstimulatinghomone，TSH）腺瘤是一种罕见的垂体腺瘤，可导致中枢性甲亢．早期常被误诊为原发性甲亢。本文旨在探讨促甲状腺激素腺瘤的早期诊断和治疗。方法：回顾分析瑞金医院神经外科手术的TSH腺瘤患者19例（均来自本院内分泌科），所有患者的血清游离甲状腺激素水平均升高，同时TSH正常（11例）或升高（8例），14例患者行生长抑素抑制试验均被抑制（抑制率超过50％）；10例患者行TRH兴奋试验，3例有反应；垂体MRI平扫＋增强，未见明显肿瘤1例，微腺瘤9例，1-2cm6例，〉2cm的3例：18例选择经单鼻孔经蝶手术，1例经颅手术。结果：术后缓解18例，1例术后6个月复发，1例缓解病例术后3个月死于基底动脉动脉瘤引起的蛛网膜下腔出血。结论：TSH腺瘤的血清学特点为升高的甲状腺激素伴TSH不被抑制，须联合多项检查才能正确诊断；多学科联合可使患者获得早期诊断和治疗，从而提高TSH腺瘤的治疗缓解率．OBJECTIVE： Thyrotropin-secreting pituitary adenomas （TSH-omas） are rare tumor. In the current study, we aimed to explore the early diagnosis and treatment of thyrotropin-secreting pituitary adenomas. METHODS： We retrospectivly analyzed 19 patients with TSH-omas （all from the Department of Endocrinology）, which were surgically managed in the Department of Neurosurgery in Rui-Jin Hospital. All these patients had elevated free thyroid hormone, with TSH level normal （in 11 cases） or rise （in 8 cases）. TSH was suppressed to more than 50% in 14 cases in which somatostatin suppression test was carried out. TRH stimulating test was performed in 10 cases, 3 were with positive response and 7 without response, respectively. Pituitary MRI with enhancement was performed in all cases, with negative in 1 case, microadenoma in 9 cases, 1-2cm size of adenoma in 6 cases and more than 2cm in 3 cases, respectively. Surgery were performed in all patients （18 patients underwent transsphenoidal operation and one with craniotomy）. RESULTS： Eighteen cases had biochemical remission after operation, with one case recurrence at 6 months after operation and one died of SAH caused by rupture of basilar artery aneurysm.CONCLUSIONS： TSH- omas were characterized by high levels of circulating free thyroid hormones in the presence of non-suppressed serum TSH concentrations. Muhiple tests, including dynamic tests, facilitated early and correct diagnosis. Multiple disciplinary can help to increase the rate of early diagnosis and surgical remission.

关 键 词：促甲状腺激素腺瘤 诊断 动态试验 经蝶手术 

分 类 号：R739.41[医药卫生—肿瘤]