垂体促甲状腺激素腺瘤的诊疗策略  

Diagnosis and treatment strategies of pituitary thyroid stimulating hormone adenomas

作　　者：于浩 郭孛 裴京 童慧昕 李钰婕 梁琳琅 Yu Hao;Guo Bei;Pei Jing;Tong Hui-Xin;Li Yu-Jie;Liang Lin-Lang(Department of Endocrinology,General Hospital of Northern Theater Command,Shenyang,Liaoning 110016,China)

机构地区：[1]北部战区总医院内分泌科,辽宁沈阳110016

出　　处：《解放军医学杂志》2024年第11期1251-1258,共8页Medical Journal of Chinese People's Liberation Army

基　　金：辽宁省科技计划项目(2022-MS-048)。

摘　　要：垂体促甲状腺激素(TSH)腺瘤是一种罕见的垂体疾病,在垂体腺瘤中占比不足2%;临床表现主要为轻中度的甲状腺功能亢进症状、其他垂体前叶激素分泌障碍以及垂体肿瘤占位效应引起的相应症状。垂体TSH腺瘤需与原发性甲亢(Graves病)、甲状腺激素抵抗综合征(RTH)相鉴别,误诊可导致肿瘤增长,加重病情。目前,借助于灵敏的实验室检查、影像学检查及针对性的功能试验,可较为准确地诊断垂体TSH腺瘤,其治疗首选手术切除,在无法手术或手术失败等情况下,可选择放射治疗或药物治疗。长效生长抑素类似物可有效缩小肿瘤体积,并减少TSH的分泌,从而使游离甲状腺素(FT4)和游离三碘甲腺原氨酸(FT3)水平恢复正常。早期识别并给予有效治疗对垂体TSH腺瘤患者意义重大。本文从垂体TSH腺瘤的流行病学、病理学特点、筛查对象、临床表现、辅助检查、诊断及治疗、随访与评估等方面进行阐述,旨在为垂体TSH腺瘤的临床诊治提供指导。Pituitary thyroid-stimulating hormone(TSH)adenomas is a rare pituitary disorder,accounting for less than 2%of pituitary adenomas.The clinical manifestations primarily include mild to moderate symptoms of hyperthyroidism,corresponding symptoms caused by other anterior pituitary hormone secretion disorders,and symptoms resulting from the mass effect of pituitary tumors.Pituitary TSH adenomas need to be differentiated from primary hyperthyroidism(Graves'disease)and resistance to thyroid hormone(RTH),as misdiagnosis can lead to tumor growth and aggravation of the condition.Currently,with the help of sensitive laboratory tests,imaging examinations,and targeted functional tests,pituitary TSH adenomas can be diagnosed relatively accurately.The preferred treatment is surgical resection. In cases where surgery is not feasible or unsuccessful, radiotherapy or medical therapycan be considered. Long-acting somatostatin analogs can effectively reduce tumor volume and decrease TSH secretion, therebynormalizing free 3,5,3',5'-tetraiodothyronine (FT4) and free 3,5,3'-triiodothyronine (FT3). Early identification and effective treatmentare significant for patients with pituitary TSH adenomas. This review summarizes the epidemiology, pathological characteristics,screening objects, clinical manifestations, auxiliary examinations, diagnosis and treatment, follow-up and evaluation of pituitary TSHadenoma, aiming to provide guidance for the clinical diagnosis and treatment of this condition.

关 键 词：垂体促甲状腺激素腺瘤 甲状腺激素抵抗症 甲状腺毒症 诊断 治疗 

分 类 号：R584[医药卫生—内分泌]