MRI-demonstrable regression of a pituitary mass in a case of primary hypothyroidism after a week of acute thyroid hormone therapy.
MRI-demonstrable regression of a pituitary mass in a case of primary hypothyroidism after a week of acute thyroid hormone therapy.
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原发性甲状腺功能减退症患者接受急性甲状腺激素治疗一周后，MRI 可显示垂体肿块消退。
DOI：
10.1210/jcem.82.3.3796
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发表时间：
1997
期刊：
影响因子：
--
通讯作者：
M. Skarulis
中科院分区：
文献类型：
--
作者：
N. Sarlis;F. Brucker;J. Doppman;M. Skarulis
虽然磁共振成像（MRI）在原发性甲状腺功能减退症中垂体增生的特征已经被描述过，但急性甲状腺激素（TH）治疗后增生消退所需的时间范围尚未明确。1例26岁女性在入院前11年行131I消融术。间断性左甲状腺素（LT4）治疗依从性差导致她的三碘甲状腺原氨酸（T3）和甲状腺素（T4）的血清促甲状腺激素（TSH）水平过高。对患者进行检查以排除分泌tsh的垂体腺瘤或对TH的抵抗。入院时，患者的临床特征和甲状腺功能检查，以及促甲状腺素释放激素（TRH）和急性T3抑制试验均支持深度原发性甲状腺功能减退。MRI显示垂体对称肿大，具有明显的大腺瘤形态学特征。患者开始大剂量TH治疗，6天后重新扫描。后续扫描显示脑下垂体明显萎缩。4周后血清T4、TSH均在正常范围内，此时复查垂体MRI示正常腺体。本病例是第一个记录长期原发性甲状腺功能减退患者在急性甲状腺激素治疗一周内垂体增生显著缩小的病例。单独的MRI不能可靠地区分tsh分泌垂体腺瘤和甲状腺功能减退引起的垂体增生。动态内分泌测试和重复垂体MRI后短暂的甲状腺激素试验可以提供一个明确的诊断类似的情况。
Although magnetic resonance imaging (MRI) characteristics of pituitary gland hyperplasia in primary hypothyroidism have been previously described, the time span necessary for the regression of the hyperplasia in response to acute thyroid hormone (TH) therapy has not been defined. A 26-yr-old woman underwent 131I ablation 11 yr before admission. Intermittent poor compliance to levothyroxine (LT4) therapy led to inappropriately high serum thyroid-stimulating hormone (TSH) for her triiodothyronine (T3) and thyroxine (T4) levels. The patient was investigated to rule out TSH-secreting pituitary adenoma or resistance to TH. On admission, the patient's clinical features and thyroid function tests, as well as thyrotropin-releasing hormone (TRH) and acute T3 suppression tests, were in favor of profound primary hypothyroidism. MRI revealed symmetrical enlargement of the pituitary gland with distinct morphological characteristics of a macroadenoma. The patient began high-dose TH therapy and was rescanned six days later. The follow-up scan revealed a dramatic shrinkage of the pituitary gland. Four weeks later, serum T4 and TSH were within the normal range, and repeat MRI scan of the pituitary at that time showed a normal gland. This case is the first to document dramatic shrinkage of pituitary hyperplasia in long-standing primary hypothyroidism within one week of acute TH therapy. MRI alone is unable to reliably differentiate between a TSH-secreting pituitary adenoma and hypothyroidism-induced pituitary hyperplasia. Dynamic endocrine testing as well as repeat pituitary MRI after a brief TH trial may provide a firm diagnosis in similar cases.