垂体促甲状腺素腺瘤的诊断和处理

目的探讨垂体促甲状腺素(TSH)腺瘤的临床特点及治疗方法。方法垂体TSH腺瘤患者4例,男1例,女3例,年龄25-47岁,中位病程7.5年,延误诊断4.2年。4例患者均有不同程度的甲状腺增大和甲亢症状,血浆FT3、FT4、T3、T4增高,3例患者TSH增高。1例对促甲状腺激素释放激素(TRH)激发试验有反应。头部鞍区MRI检查显示3例为大腺瘤,1例为微腺瘤。确诊后4例患者行经鼻-蝶窦入路垂体瘤切除术,其中1例术后辅以放疗。结果术后病理均证实为垂体腺瘤。随访至今(术后约5-7年),鞍区MRI检查未见肿瘤复发,甲状腺激素水平基本控制在正常范围。结论垂体TSH腺瘤发病率极低,甲亢患者血清TSH水平不被抑制时应警惕垂体TSH腺瘤的存在;鞍区影像学检查有助于垂体TSH腺瘤的早期诊断和治疗。

Diagnosis and management of pituitary thyrotropin-secreting adenoma

Objective To investigate the clinical features and treatment of pituitary thyrotropin-secreting(TSH) adenoma.Methods Data of four patients(1 male,3 females) with TSH were analyzed retrospectively,who were 29 years old in avarage with a mean history of 7.5 years.The mean duration of misdiagnosis was 4.2 years.The patients had the diffuse goitre and hyperthyroidism with high levels of plasma free T3,free T4,total T3 and total T4.Plasma TSH was abnormally increased in 3 cases.Two patients were responsive to thyrotropin releasing hormone(TRH) test.MRI showed 2 macro-adenomas and 2 micro-adenomas.All patients had transspheniodal surgery,of whom one had additional postoperative radiotherapy.Results The pituitary TSH adenomas in 4 cases were diagnosed pathologically.The patients have been followed up for 5 to 7 years with thyroid hormones in the normal ranges and without any tumor showed on MRI in all cases.Conclusion The morbidity of pituitary TSH adenoma is wery low.Attention shold be paid to the hyperthyroidism patients with higher plasma level of TSH,in whom MRI examination is helpful in early diagnosis and management.