垂体TSH细胞腺瘤致中枢性甲状腺功能亢进的诊断和处理

目的 前瞻性研究分析7例垂体促甲状腺激素(thyroid-stimulating hormone，TSH)腺瘤所致中枢性甲状腺功能亢进患的临床资料：方法 男性6例，女性1例，平均年龄42．7岁，平均病程3．1年，平均延误诊断1．5年。7例均有不同程度的甲状腺增大和甲状腺功能亢进症状，4例有视野缺损。7例均有血浆游离T3、游离T4、T3和T4增高，TSH不被抑制，其中，4例TSH增高，3例TSH正常；3例行促甲状腺释放激素(thyrotropin releasing hormone，TRH)试验、2例无反应，1例有反应。7例均行蝶鞍MRI检查，均为垂体大腺瘤和巨大腺瘤，直径2～5cm；7例对海绵窦均有不同程度的挤压或包绕，2例侵犯蝶窦。7例均行经口鼻蝶窦显微外科垂体腺瘤切除术，其中，1例术前外院曾行γ-刀治疗，1例行二期开颅垂体腺瘤切除术，3例术后辅以放疗：结果 术后病理均为垂体TSH细胞腺瘤。随访3个月～1年，甲状腺功能正常5例，蝶鞍MRI检查末见肿瘤6例。结论 垂体TSH细胞腺瘤首选手术治疗，术后密切随访甲状腺功能和影像学检查，若发现异常，及时辅以放疗。早期诊断和治疗是预后的关键。

Diagnosis and management of central hyperthyroidism due to thyrotropin-secreting pituitary adenomas

Objective Prospectively analyze 7 cases of central hyperthyroidism due to thyrotropin-secreting pituitary adenoma. Methods Among the 7 patients, 6 were male and 1 was female. Mean age was 42.7 yrs old and mean history was 3. 1 years. The mean duration of misdiagnosis was 1.5 yrs. They all had the diffuse goitre and hyperthyroidism, accompanied by visual field defect in 4 patients. They all had high level of plasma free T3, free T4,total T3 and total T4 with detectable thyroid-stimulating hormone (TSH). Among them, the level of plasma TSH was high in 4 patients, normal in 3 patients. Three patients had thyrotropin releasing hormone(TRH) test. Two patierns had no response, and one had normal response. MRI showed macro- or giant pituitary adenomas in all the patients.They all had different degree of compression to cavernous sinus. Two patients had invasion to sphenoid sinus. All had transspheuiodal surgery. One had secondary transcranial surgery. Three patients had additional postoperative radiotherapy. One had γ-knife treatment previously. Results Pathology showed thyrotropin-secreting pituitary adenoma. Postoperative follow-up was 3 months to 1 yr. Hyperthyroidism disappeared in 5 patients. MRI showed no tumor left in 6 patients. Conclusion To these patients, pituitary surgery is first choice. Postoperative follow-up is very important. If hyperthyroidism is found, radiotherapy should be considered. Early diagnosis and rnanag ement are the key to prognosis.