原发性甲状腺功能减低症与垂体腺瘤的鉴别诊断

目的探讨原发性甲状腺功能减低致垂体增生的临床特点和诊治方法,避免误诊。方法9例患者各经X线平片、CT、MRI等影像检查发现鞍内鞍上占位性病变,但因影像学及临床特点不典型,经内分泌检查、骨龄检查等确诊为原发性甲状腺功能减低导致垂体增生,遂采用激素替代治疗。结果9例患者均口服甲状腺片治疗,随访4~18个月,内分泌检查除TSH仍高于正常,其余均恢复正常,症状均有不同程度减轻,其中2例患者复查MRI发现病变明显缩小。结论原发甲状腺功能减低,易误诊为垂体腺瘤,应进行内分泌检查、骨龄检查等明确诊断,治疗采用激素替代治疗。

Differential diagnosis of primary hypothyroidism and pituitary adenoma

Objective To study the clinical characteristics and diagnostic methods of pituitary hyperplasia caused by primary hypothyroidism in order to avoid its misdiagnosis. Methods Sella area occupying lesion, found in 9 patients by X-ray radiograph, CT and MRI, was diagnosed as pituitary hyperplasia caused by primary hypothyroidism, by endocrine function test and bone age examination, and treated with thyroxine replacement therapy. Results The 9 patients were treated with thyroxine replacement therapy and followed up for 4-18months. The endocrine function test was normal except for TSH. The symptoms were improved at different extents. MRI showed that the size of lesion became obviously smaller in 2 patients. Conclusion Since primary hypothyroidism can be easily misdiagnosed as pituitary adenoma, its diagnosis should be established based on endocrine function test and bone age examination and treated with thyroxine replacement therapy.