Central Hypothyroidism Related to Pituitary Adenomas: Low Incidence of Central Hypothyroidism in Patients With Acromegaly
Central Hypothyroidism Related to Pituitary Adenomas: Low Incidence of Central Hypothyroidism in Patients With Acromegaly
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DOI：
10.1210/jc.2019-00466
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发表时间：
2019-10-01
影响因子：
5.8
通讯作者：
Yamada, Masanobu
中科院分区：
文献类型：
--
作者：
Takamizawa, Tetsuya;Horiguchi, Kazuhiko;Yamada, Masanobu
内容：中枢性甲状腺功能减退症（CeH）最常见的原因是垂体腺瘤，但其机制尚不清楚。目的：我们调查了未经治疗的垂体无功能和GH分泌腺瘤患者的血清甲状腺水平和GH/IGF-1。设计：这是一项回顾性横断面研究，收集了2007年至2016年期间群马大学和虎之门医院的病例。患者：分析了139例无功能垂体腺瘤（NFPA）和150例GH分泌型垂体腺瘤（GHPA）的临床资料，主要结果：分析了甲状腺水平、临床病理参数和GH/IGF-1的相关性。严重程度与肿瘤大小、年龄或性别无关，所有病例的TSH水平均正常。相比之下，只有8.7%的GHPA患者有CeH;大约一半的TSH水平正常，大约一半的TSH水平低。GHPA患者血清TSH水平显著低于NFPA患者，而游离T4（FT 4）和游离T3水平显著高于NFPA患者。此外，大约四分之一的GHPA患者具有正常的FT 4和低TSH水平。此外，血清FT 4水平和血清TSH水平分别与血清IGF-1水平呈正相关和负相关。此外，IGF-1水平在GHPA患者随着年龄的增长而下降。结论：（i）NFPA患者CeH的TSH水平在正常范围内。(ii)GHPA患者的CeH发生率较低，这可能是GH/IGF-1刺激甲状腺功能的结果。(iii)我们发现GHPA患者血清IGF-1水平呈年龄依赖性下降。
Context: The most frequent cause of central hypothyroidism (CeH) is pituitary adenomas, but the mechanisms remain unclear.Objective: We investigated serum thyroid levels and GH/IGF-1 in central hypothyroidism in untreated patients with pituitary nonfunctioning and GH-secreting adenomas.Design: This was a retrospective cross-sectional study of cases collected from Gunma University and Toranomon Hospitals between 2007 and 2016.Patients: One-hundred thirty-nine cases of nonfunctioning pituitary adenoma (NFPA) and 150 cases of GH-secreting pituitary adenoma (GHPA) were analyzed.Main Outcome Measures: The correlations between thyroid levels, several clinicopathological parameters, and GH/IGF-1 were examined.Results: Twenty-four percent of NFPA patients had CeH. The severity did not correlate with tumor size, age, or sex, and all cases had normal TSH levels. In contrast, only 8.7% of GHPA patients had CeH; approximately half had normal TSH levels and approximately half had low TSH levels. Serum TSH levels in GHPA patients were significantly lower and free T4 (FT4) and free T3 levels were higher than those in patients with NFPA. Furthermore, approximately one-fourth of GHPA patients had normal FT4 and low TSH levels. In addition, serum FT4 levels and serum TSH levels were positively and negatively correlated, respectively, with serum IGF-1 levels. Furthermore, IGF-1 levels in patients with GHPA decreased with age.Conclusions: (i) NFPA patients with CeH had TSH levels within a normal range. (ii) GHPA patients had a low incidence of CeH, which may be a result of stimulated thyroid function by GH/IGF-1. (iii) We found an age-dependent decrease in serum IGF-1 levels in patients with GHPA.