原发性甲状腺功能减退致垂体增生的临床特点及治疗(附15例报道)  

Clinical characteristics and treatment of pituitary hyperplasia caused by primary hypothyroidism:a report of 15 cases

作　　者：刘鹏飞[1] 朱旭强[1] 董阳[1] 孙剑瑞[1] 陈若琨[1] Liu Pengfei;Zhu Xuqiang;Dong Yang;Sun Jianrui;Chen Ruokun(Department of Neurosurgery,the First Affiliated Hospital,Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院神经外科,郑州450052

出　　处：《中华神经外科杂志》2023年第8期804-807,共4页Chinese Journal of Neurosurgery

摘　　要：目的探讨原发性甲状腺功能减退(甲减)致垂体增生的临床特点及治疗效果。方法回顾性分析2015年6月至2021年5月郑州大学第一附属医院神经外科收治的15例原发性甲减致垂体增生患者的临床资料。收集患者的临床症状、实验室检查及影像学资料。15例患者均给予口服左甲状腺素钠治疗,维持剂量为50~150μg/d;1例发育迟缓的10岁患儿同时应用生长激素2年。通过电话或门诊随访患者症状、内分泌及鞍区MRI检查结果。结果15例患者的主要表现为甲减症状(乏力、畏寒、头痛、浮肿等);其中5例儿童患者均存在生长发育迟缓。内分泌检查提示甲状腺激素水平降低,促甲状腺素均>100μIU/ml,催乳素水平不同程度升高(30.33~137.00ng/ml);3例儿童患者的生长激素水平正常,但胰岛素样生长因子水平均明显低于正常。鞍区MRI提示病变多呈等T1、等T2信号,后方可见呈条状短T1信号的垂体后叶,增强后病变多强化均匀,中央隆起,两侧对称,垂体高度为(13.7±3.2)mm(10.0~21.0mm)。15例患者的中位随访时间为35个月(12~63个月)。15例患者治疗1个月后症状和内分泌检查均逐渐恢复正常。10例患者完成影像学随访,中位随访时间为4.5个月(1~18个月);鞍区MRI结果提示治疗后垂体高度为(6.6±2.3)mm(3.4~12.0mm),较治疗前下降(t=15.35,P<0.001)。结论原发性甲减致垂体增生的临床表现、内分泌检查及MRI表现具有一定的特征性,经甲状腺素替代治疗后预后良好,应注意与垂体腺瘤鉴别,避免手术治疗。Objective To investigate the clinical characteristics and treatment outcomes of pituitary hyperplasia caused by primary hypothyroidism.Methods The clinical data of 15 patients with pituitary hyperplasia caused by primary hypothyroidism admitted to the Department of Neurosurgery of the First Affiliated Hospital of Zhengzhou University from June 2015 to May 2021 were retrospectively analyzed.The clinical symptoms,laboratory tests and imaging data of the patients were collected.All 15 patients were treated with oral levothyroxine sodium at a maintenance dose of 50-150μg/d;a 10-year-old child with developmental delay was also given growth hormone for 2 years.The symptoms,endocrine and MRI findings of the sellar region were followed up by telephone or outpatient service.Results Fifty patients mainly presented with symptoms of hypothyroidism(fatigue,chills,headache,swelling,etc.).Among them,5 children had growth retardation.Endocrine examination showed that the level of thyroid hormone decreased,and the thyrotropin was>100μIU/ml,and the prolactin level increased to varying degrees(30.33-137.00 ng/ml).The growth hormone levels of 3 adolescent patients were normal,but insulin-like growth factor levels were significantly lower than normal.MRI of the sellar region showed that the lesions were mostly iso-T1 and iso-T2 signals,and the posterior lobe of the pituitary gland with short T1 signals in stripes could be seen behind.The upper smooth edge of the lesions showed symmetric hill-shaped projection.The height of the pituitary was 13.7±3.2 mm(range:10.0-21.0 mm).The median follow-up time of 15 patients was 35 months(range:12-63 months).Symptoms and endocrine examinations of 15 patients gradually returned to normal fter one month of treatment.Ten patients completed imaging follow-up,and the median follow-up time was 4.5 months(range:1-18 months).MRI results of the sellar region indicated that the pituitary gland height after treatment was 6.6±2.3 mm(range:3.4-12.0 mm),which was decreased compared with that before treatme

关 键 词：甲状腺功能减退症 垂体疾病 增生 发育障碍 药物疗法 

分 类 号：R581.2[医药卫生—内分泌] R584[医药卫生—内科学]