Transient Graves disease developing after surgery for Cushing disease.
Transient Graves disease developing after surgery for Cushing disease.
复制标题
库欣病手术后出现暂时性格雷夫斯病。
DOI：
10.1097/00000441-200203000-00009
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发表时间：
2002
影响因子：
3.1
通讯作者：
K. Yasuda
中科院分区：
文献类型：
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作者：
H. Morita;M. Isaji;T. Mune;H. Daido;Y. Isomura;H. Sarui;T. Tanahashi;N. Takeda;T. Ishizuka;K. Yasuda
一名49岁的男性，1976年26岁时被诊断为库欣病，在利血平联合脑下放射治疗13年后接受了Hardy手术。手术成功前及术后2周实验室检查，除促甲状腺激素(TSH)抑制外，其余均为正常，抗TSH受体抗体(TRAb)和抗TSH受体刺激抗体(TSAb)均为阴性。术后第15天停止糖皮质激素补充治疗，第48天重新开始，在此期间没有肾上腺危象的迹象。术后第140天观察到窦性心动过速、手指轻微震颤和甲状腺增大，大小约为拇指头部大小。甲亢患者血清TSAb和TRAb升高，24小时甲状腺高摄取~(123)I，提示诊断为Graves病。未给予特殊治疗，但其血清甲状腺激素水平于术后第140天开始下降，至第520天恢复正常。血清TRAb也自发下降，但血清TRAb峰值的时间比甲状腺激素的峰值时间推迟了230天。这是库欣病手术成功后报告的首例Graves病病例。我们推测，在手术导致血浆糖皮质激素水平突然下降后，甲状腺中潜在的自身免疫过程被皮质醇过多抑制，发展为显性Graves病。
A 49-year-old man, diagnosed as having Cushing disease in 1976 at the age of 26, underwent a Hardy operation 13 years after treatment with reserpine combined with pituitary radiation. In laboratory examinations before and 2 weeks after the successful surgery, the patient's serum thyroid hormones were found to be normal except for suppressed serum thyroid-stimulating hormone (TSH), and his serum anti-TSH receptor (TRAb) and anti-TSH receptor-stimulating antibodies (TSAb) were negative. Glucocorticoid supplemental treatment was withdrawn on the 15th day after surgery and was restarted on the 48th day, during which time there were no signs of an adrenal crisis. Sinus tachycardia, fine finger tremor, and enlarged thyroid gland, approximately the size of a thumb head, were observed on the 140th day after surgery. Thyrotoxicosis with increased serum TSAb and TRAb and high 24-h thyroid uptake of 123I was noted, indicating a diagnosis of Graves disease. No special treatment was prescribed, but his serum thyroid hormone levels started to decrease on the 140th day after the operation and returned to normal on the 520th day. Serum TRAb also spontaneously decreased, but the timing of the peak of serum TRAb was delayed 230 days from that of the thyroid hormones. This is the first reported case of Graves disease after successful surgery for Cushing disease. We presume that a latent autoimmune process in the thyroid, suppressed by hypercortisolism, developed into overt Graves disease after the abrupt reduction of plasma glucocorticoid levels induced by surgery.
N.Takasu、T.Yamada、N.Ohara、I.Komiya：“卡尼综合征患者双侧肾上腺切除术后以及库欣病患者切除产生 ACTH 的垂体腺瘤后发生自身免疫性甲状腺功能障碍”J Endocrinol Inv
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