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促甲状腺激素型垂体腺瘤的临床诊疗特点
引用本文:幸兵,任祖渊,苏长保,王任直,杨义,马文斌,李永宁,连小兰,戴为信,顾峰. 促甲状腺激素型垂体腺瘤的临床诊疗特点[J]. 中华外科杂志, 2011, 49(1): 546-550. DOI: 10.3760/cma.j.issn.0529-5815.2011.06.018
作者姓名:幸兵  任祖渊  苏长保  王任直  杨义  马文斌  李永宁  连小兰  戴为信  顾峰
作者单位:北京协和医学院,卫生部内分泌重点实验室,北京协和医院神经外科,中国医学科学院,100730;北京协和医学院,卫生部内分泌重点实验室,北京协和医院内分泌科,中国医学科学院,100730;
摘    要:目的 研究促甲状腺激素(TSH)型垂体腺瘤的临床诊断和治疗特点.方法 回顾性分析2001年1月至2008年12月收治的19例TSH型垂体腺瘤患者的临床资料.男性14例,女性5例;年龄20~70岁,平均40.5岁;病程1~228个月,平均55个月.15例患者因甲状腺功能亢进(甲亢)症状就诊,其中12例被误诊为原发性甲亢并口服抗甲亢药物治疗,另3例入院后很快确诊.4例患者因头痛和视力视野障碍等肿瘤占位效应就诊.在12例误诊患者中,2例行131I放射性核素治疗,1例行甲状腺大部分切除.所有患者均行经蝶垂体腺瘤切除术.结果 病理均为垂体腺瘤,免疫组化TSH阳性17例,阴性2例,生长激素阳性2例,泌乳素阳性1例,促肾上腺皮质激素阳性1例.术后MRI显示肿瘤全切除15例,肿瘤残留4例.随访时间6个月~7年,平均3.6年.术后3个月内甲状腺激素水平各项均正常13例,其中2例3个月后复查TSH再次升高,但MRI未见肿瘤复发,行垂体放疗后甲状腺各项激素均正常.手术治愈率11/19,手术加放疗治愈率13/19.结论 对合并TSH升高的甲亢患者的筛查是提高TSH型垂体腺瘤的早期诊断的关键.治疗采用以手术治疗为主,垂体放疗和生长抑素为辅的治疗方法.

关 键 词:垂体肿瘤   促甲状腺素   诊断   经蝶手术   放疗   

Thyroid-stimulating hormone pituitary adenomas: clinical characteristics, diagnosis and treatment
XING Bing,REN Zu-yuan,SU Chang-bao,WANG Ren-zhi,YANG Yi,MA Wen-bin,LI Yong-ning,LIAN Xiao-lan,DAI Wei-xin,GU Feng. Thyroid-stimulating hormone pituitary adenomas: clinical characteristics, diagnosis and treatment[J]. Chinese Journal of Surgery, 2011, 49(1): 546-550. DOI: 10.3760/cma.j.issn.0529-5815.2011.06.018
Authors:XING Bing  REN Zu-yuan  SU Chang-bao  WANG Ren-zhi  YANG Yi  MA Wen-bin  LI Yong-ning  LIAN Xiao-lan  DAI Wei-xin  GU Feng
Abstract:Objective To study the clinical characteristics, diagnosis and surgical effects of thyroid-stimulating hormone pituitary adenomas (TSH-omas). Methods The clinical data of 19 patients (14 female and 5 male) with TSH-omas were analyzed retrospectively in this study from January 2001 to December 2008. The patients ranged from 20 to 70 years old ( average 40. 5 years old) and had disease histories from 1 to 228 months (average 55 months). Among these patients, 15 of them complained of thyrotoxicosis symptoms, while the other 4 patients' symptoms were associated with headache and/or visual disturbance caused by the tumor mass effect. Initially, 12 of the 15 patients with thyrotoxicosis symptoms were misdiagnosed with Grave's disease. As a result 2 of them received 131Iodine, and one received subtotal thyroidectomy. All of these patients underwent transsphenoidal microsurgery. Results Average follow-up period was 3. 6 years (6 months-7 years). Pathological analysis of the surgical specimen showed pituitary adenoma in all patients, immunohistostains were positive for TSH in 17 cases, negative for TSH in 2,positive for growth hormone in 2, positive for prolactin in 1, and positive for adrenocorticotrophic hormone in 1. Postoperative MRI revealed that the tumors in 15 patients were removed totally, though 4 patients still had residual tumors. The thyroid hormone level tests suggested that 13 patients could be considered normal 3 months after their tumors were removed, though 2 of patients with normal postoperative MRI and thyroid hormones showed increased levels of TSH. For these 2 patients, tumors did not recur and their thyroid hormone levels returned to normal after pituitary radiotherapy. The cure rate was 11/19 after surgery and 13/19 after surgery plus pituitary radiotherapy. Conclusions The screening test for hyperthyroidism patients with high TSH levels is a key point to improve the accuracy rate in early diagnoses of TSH-omas. The transsphenoidal microsurgery is first choice to treat TSH-omas, while pituitary radiotherapy and somatostatin analogs are beneficially adjunctive therapies.
Keywords:Pituitary neoplasmsThyrotropinDiagnosisTranssphenoidal microsurgeryRadiotherapy
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