Long-term surgical outcome in 16 patients with thyrotropin pituitary adenoma
Long-term surgical outcome in 16 patients with thyrotropin pituitary adenoma
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DOI：
10.3171/jns.2000.93.2.0194
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发表时间：
2000-08-01
影响因子：
4.1
通讯作者：
Osamura, RY
中科院分区：
文献类型：
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作者：
Sanno, N;Teramoto, A;Osamura, RY
Object.垂体促甲状腺激素腺瘤是一种罕见的内分泌系统病变。虽然引进超敏放射免疫测定促甲状腺激素能够识别这种激素的不适当分泌，上述病变仍然是罕见的，大多数神经外科医生不熟悉。以前曾有报道，促甲状腺激素分泌腺瘤的手术治疗比其他功能性腺瘤更困难，因为前者的体积大，侵袭性强。然而，手术后的长期结果尚未得到很好的记录。作者报告了16例促甲状腺激素腺瘤的手术系列和长期随访结果。1983年至1999年间，16例年龄在23岁至62岁之间的患者（12例女性和4例男性）接受了经蝶窦促甲状腺激素腺瘤切除术。这些患者都有促甲状腺激素分泌异常综合征（SITS）伴垂体肿块病变。其中4名患者既往接受过甲状腺次全切除术和/或放射性碘甲状腺消融术，11名患者接受过抗甲状腺药物治疗。影像学检查显示大腺瘤14例，其中10例有海绵窦侵犯。13例（81.2%）肿瘤呈异常纤维化，质地坚硬。术前给予奥曲肽可有效降低血清促甲状腺激素水平，并使肿瘤缩小。进行了经蝶窦手术，未发生并发症。16例患者中有10例（62.5%）实现了手术缓解，14例（87.5%）通过联合额外的放射或药物治疗实现了完全缓解。在另外两名患者中，由于肿瘤位于海绵窦，SITS持续存在。因此，给予放疗和/或抗甲状腺治疗。在平均7.5年（范围11个月至15.8年）的随访期内，磁共振成像上没有观察到肿瘤复发，而在两名患者中发现了SITS复发，没有肿瘤再生长。此外，在另外两名患者中，尽管手术后SITS缓解，但仍发现并存原发性甲状腺功能亢进症。对于促甲状腺激素分泌型垂体腺瘤，如果在肿瘤变大之前进行手术，经蝶手术可以获得良好的长期预后。根据作者的经验，促甲状腺素分泌腺瘤是纤维性的，坚硬的，这使得手术很难达到缓解。此外，即使肿瘤切除效果满意，有时也会因原发性甲状腺功能亢进而导致SITS复发或甲状腺功能亢进症状。值得强调的是，手术后仔细的随访是必要的，特别是对于术前有长期甲亢病史的患者。
Object. Thyrotropin-secreting pituitary adenomas are rare lesions of the endocrinological system. Although introduction of a hypersensitive radioimmunoassay for thyrotropin enables the recognition of inappropriate secretion of this hormone, the aforementioned lesions remain uncommon and unfamiliar to most neurosurgeons. It has been reported previously that surgical cure of thyrotropin-secreting adenomas is more difficult than in other functional adenomas because of the large size and invasive features of the former. However, the long-term outcome after surgery has not been well documented. The authors report on a surgical series of 16 patients with thyrotropin adenoma and the results of longterm follow up.Methods. Sixteen patients ages 23 to 62 years (12 women and four men) underwent transsphenoidal removal of thyrotropin adenomas between 1983 and 1999. These patients had the syndrome of inappropriate thyrotropin secretion (SITS) with pituitary mass lesions. Four of the patients had undergone previous subtotal thyroidectomy and/or radioiodine thyroid ablation, and 11 had been treated with antithyroid medication. Radiological investigations demonstrated macroadenomas in 14 patients, and 10 of those had cavernous sinus invasion. Surgical findings showed unusually fibrous and firm tumors in 13 (81.2%) of 16 patients. Preoperative octreotide administration was revealed to be effective for serum thyrotropin reduction as well as tumor shrinkage. Transsphenoidal surgery was performed with no morbidity resulting. Surgical remission was achieved in 10 (62.5%) of 16 patients, and total remission was achieved in 14 patients (87.5%) with a combination of additional radiation or medical therapy. In the other two patients, SITS persisted because of tumor rests in the cavernous sinus. Therefore, radiation and/or antithyroid therapy was administered. In the mean follow-up period of 7.5 years (range 11 months-15.8 years), no recurrence of tumor was observed on magnetic resonance images, whereas recurrence of SITS was found in two patients with no tumor regrowth. In addition, coexistent primary hyperthyroidism was found in two other patients despite remission of SITS after surgery.Conclusions. Transsphenoidal surgery can achieve a good long-term outcome in patients with thyrotropin-secreting pituitary adenomas if surgery is performed before these become larger, invasive tumors. In the authors' experience, thyrotropin-secreting adenomas are fibrous and firm, which makes it difficult to achieve surgical remission. In addition, even satisfactory resection of the tumor sometimes results in recurrence of SITS or hyperthyroid symptoms due to coexistent primary hyperthyroidism. It is emphasized that a careful follow-up review is necessary after surgery, especially in patients with a long preoperative history of hyperthyroidism.