摘要
目的分析垂体促甲状腺激素分泌瘤(TSH-oma)的发病特点、鉴别诊断及诊疗方案,以提高对该病临床诊断及治疗措施的认知水平。方法分析1例TSH-oma的诊治过程,并复习相关文献。结果 TSH-oma患者的甲状腺功能提示游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)升高,促甲状腺激素(sTSH)不适应地升高,生长抑制试验为阳性,影像学特征可发现垂体有占位,术后病理提示TSH阳性。切除肿瘤后,促甲状腺激素恢复正常,垂体MRI无复发征象。结论 TSH-oma是临床以甲状腺毒症为首发,FT3、FT4水平增高伴有不适当sTSH正常或增高为特点的一种垂体糖蛋白激素分泌瘤。对于合并FT3、FT4水平升高,TSH正常或升高的患者,应警惕合并TSH-oma的可能。早期诊断、早期治疗是改善预后的关键,治疗上首选手术治疗,辅以放疗及药物治疗。
Objective To analyze the clinical features,differential diagnosis and treatment of thyrotropin-secreting pituitary adenomas(TSH-oma),and to improve doctors'awareness of clinical diagnosis and therapeutic method of this disease.Methods The diagnosis and treatment procedures of 1 case of TSH-oma were analyzed,and the related literatures were reviewed.Results This patient had increased levels of free triiodothyronine(FT3)and free thyroxine(FT4)with inappropriate TSH secretion and positive growth inhibition test result.Pituitary MR revealed a macro-adenoma and postoperative pathology showed TSH-positive pituitary adenoma.After the tumor was resected,TSH returned to normal level and no recurrence was observed.Conclusion TSH-oma is a kind of glycoprotein hormone-secreting pituitary tumor,which is characterized by thyrotoxicosis with high levels of FT3 and FT4 and inappropriate TSH secretion.Therefore,TSH-oma should be considered in patients with increased levels of FT3 and FT4 and normal or elevated levels of TSH.The key to successful management of TSH-oma is early diagnosis and treatment,and the preferred treatment is surgery supplemented with radiotherapy and medication.
作者
曾祥霞
汪娇
胡凯翔
徐积兄
ZENG Xiang-xia;WANG Jiao;HU Kai-xiang;XU Ji-xiong(Department of Endocrinology,the First Affiliated Hospital of Nanchang University,Nanchang 330006,China)
出处
《南昌大学学报（医学版）》
CAS
2017年第6期101-106,共6页
Journal of Nanchang University：Medical Sciences
基金
国家自然科学基金(81460018)
关键词
垂体促甲状腺激素分泌瘤
诊断
鉴别
治疗
thyrotropin-secreting pituitary adenoma
diagnosis
differential diagnosis
treatment
