分泌促甲状腺素及生长激素的垂体混合瘤临床特点及诊疗分析  

Clinical characteristics of pituitary adenoma co-secreting thyroid stimulating hormone and growth hormone and analysis of its diagnosis and treatment

作　　者：姜艳[1] 顾锋[1] 朱惠娟[1] 连小兰[1] 幸兵[2] 姚勇[2] 段炼[1] 阳洪波[1] 许莉军[1] 金自孟[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院内分泌科卫计委内分泌重点实验室,北京100730 [2]中国医学科学院北京协和医学院北京协和医院神经外科,北京100730

出　　处：《中国实用内科杂志》2016年第7期567-569,共3页Chinese Journal of Practical Internal Medicine

基　　金：国家临床重点专科建设项目(WBYZ 2011873)

摘　　要：目的分析分泌促甲状腺素（TSH）及生长激素（GH）垂体混合瘤的临床表现及诊治经验。方法对北京协和医院2010年1月至2015年4月确诊的8例TSH及GH垂体混合瘤患者的临床表现、实验室检查、辅助检查以及治疗进行分析。结果患者男：女=7：1，平均年龄（50．4±15．9）岁，平均病程（10．4±6．4）年。5例因面容改变等肢端肥大症表现，2例因心悸等甲状腺功能亢进症表现，1例因视力下降就诊。实验室检查：血游离三碘甲状腺原氨酸、游离甲状腺素水平升高，TSH平均值为（4．00±2．99）mu／L；GH葡萄糖抑制试验均不被抑制，血胰岛素样生长因子一1平均值（635．3±325．5）μg／L。垂体MRI均显示为垂体大腺瘤，平均直径（2．6±0．7）cm。6例经生长抑素类似物（SSA）治疗，3～4个月后行经蝶垂体瘤手术。另外2例既往做过垂体瘤手术，未再次手术。术后临床症状及生化指标未能完全缓解，6例采用放射治疗。结论TSH及GH垂体混合瘤起病隐匿，临床表现多样。垂体MRI表现为垂体大腺瘤，生长抑素类此物的术前应用有利于甲状腺功能控制正常．垂体瘤术后完全缓解率低．仍需采用放疗或药物治疗。Objective To analyze clinical characteristics and the diagnosis treatment of pituitary adenoma co-secreting thyroid stimulating hormone （TSH） and growth hormone （GH）. Methods Clinical characteristics, laboratory parameters and treatment of the 8 patients with pituitary adenoma co-secreting TSH and GH in Peking Union Medical College Hospital from Jan. 2010 to Apr. 2015 were analyzed retrospectively. Results Among 8 patients （M：F=7：1）, average age was 50.4±15.9 years and average course was 10.4＋6.4 years. 5/8 patients firstly presented with symptoms of acromegalj6 2/8 with hyperthyroidism and 1/8 with impaired vision. Their serum FT3 and FT4 levels were all above the normal range with serum TSH at 4.00±2.99 mU/L. Their serum IGF-1 elevated to 635.3±325.5 μg/L but serum GH levels were not suppressed in the glucose-GH suppression test. MRI showed all were pituitary macroadenomas with average diameter of 2.6±0.7 cm. 6/8 patients were treated with somatosatin analogue （SSA） before transsphenoidal microsurgery and 6/8 followed by pituitary radiotherapy. Conclusion pituitary adenoma co-secreting TSH and GH has overlapped manifestations of hyperthyroidism and acromegaly. MRI shows all of them are pituitary macroadenomas. Pre-operative SSA is beneficial before transsphenoidal microsurgery, while radiotherapy is an adjunctive therapy after surgery.

关 键 词：垂体瘤 促甲状腺激素 生长激素 生长抑素类似物 

分 类 号：R584[医药卫生—内分泌]