甲状腺激素抵抗综合征与垂体促甲状腺激素瘤的临床特点分析及鉴别诊断  

Syndrome of resistance to thyroid hormone and thyrotropin-secreting pituitary adenoma:Case series study

作　　者：刘隆福 彭宁 蒋铁建[1] Liu Longfu;Peng Ning;Jiang Tiejian(Department of Endocrinology,Xiangya Hospital of Central South University,Changsha 410005,China;Department of Endocrinology,Xiangyang Central Hospital,Affiliated Hospital of Hubei University of Arts and Science,Xiangyang 441000,China)

机构地区：[1]中南大学湘雅医院内分泌科,长沙410005 [2]湖北文理学院附属医院,襄阳市中心医院内分泌科,襄阳441000

出　　处：《中华内分泌代谢杂志》2022年第12期1057-1062,共6页Chinese Journal of Endocrinology and Metabolism

摘　　要：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。Objective To outline clinical features in syndrome of resistance to thyroid hormone(RTH)and thyrotropin-secreting pituitary adenoma(TSH adenoma)based on a case series,and to assess the value of octreotide suppression test and high-dose dexamethasone suppression test(HDDST)in differentiating the two diseases.Methods A total of 22 cases with RTH and TSH adenoma clinically diagnosed in Xiangya Hospital of Central South University from October 2010 to December 2021 were retrieved.The clinical characteristics of the two diseases and results to different tests were analyzed and summarized.Results(1)The tumors in TSH adenoma patients were larger than those with RTH complicated with pituitary mass,which presented chiasmatic compression on images(P<0.05).(2)In octreotide suppression test,thyrotropin(TSH)inhibition rate in RTH patients was lower than that in TSH adenoma patients(P<0.05).In HDDST,TSH inhibition rate was higher in patients with RTH than in patients with TSH adenoma(P<0.05).(3)The TSH inhibition rate was calculated by receiver operating characteristic(ROC)curve.The sensitivity and specificity of octreotide suppression test were 91.9%and 55.6%,respectively,and the threshold value of TSH inhibition rate was 64.24%.The sensitivity and specificity of HDDST were 54.4%and 89.0%,respectively,and the threshold value of TSH inhibition rate was 65.73%.The combined sensitivity and specificity of the two tests were 77.8%and 90.9%,indicating better diagnostic value(P<0.05).Conclusions The combination of octreotide suppression test and HDDST is of clinical value in differentiating RTH from TSH adenoma.TSH adenoma is more aggressive than that of pituitary adenoma with RTH.

关 键 词：甲状腺激素抵抗综合征 垂体促甲状腺激素瘤 奥曲肽抑制试验 大剂量地塞米松抑制试验 

分 类 号：R736.4[医药卫生—肿瘤]