Thyrotropin-secreting pituitary adenomas: report of seven cases.
Thyrotropin-secreting pituitary adenomas: report of seven cases.
复制标题
促甲状腺素分泌型垂体腺瘤七例报告。
DOI：
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发表时间：
1991
影响因子：
5.8
通讯作者：
A. Stevenaert
中科院分区：
文献类型：
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作者：
Albert Beckers;R. Abs;Charles Mahler;J. Vandalem;G. Pirens;G. Hennen;A. Stevenaert
在15年的时间里，共800例垂体肿瘤患者中观察到7例因分泌TSH的垂体大腺瘤导致的甲状腺功能亢进。血清TSH水平在1.1-36.3 mU/L之间变化。1例血清α -亚单位水平低，4例血清α -亚单位浓度升高，在3.7 ~ 7.8 μ g /L之间变化。4例患者血清TSH β水平均正常。5例血清GH或PRL水平升高。1例患者经免疫细胞化学检查证实TSH、GH、PRL共分泌。在研究中，血清TSH和α -亚单位对TRH、GnRH、CRF、GRF、地塞米松、甲巯咪唑、T3和溴隐亭的反应是不同的。1例血清TSH和α亚单位昼夜节律缺失，另1例逆转。1例患者血清α亚单位搏动无TSH搏动。5例患者行蝶窦腺瘤切除术。在我中心手术的4例患者中，3例治愈，但其中1例5年后腺瘤复发，第5例未治愈。3例患者经奥曲肽治疗后血清TSH、GH和甲状腺激素水平恢复正常。PRL共分泌1例，α -亚单位共分泌2例。1例发生部分速敏反应。总之，临床表现、激素表达和治疗反应的异质性似乎是这些tsh分泌腺瘤的特征。
Seven patients with hyperthyroidism due to a TSH-secreting pituitary macroadenoma have been observed of a total of 800 patients with pituitary tumors over a period of 15 yr. Serum TSH levels varied between 1.1-36.3 mU/L. The serum alpha-subunit level was low in 1 case, while in 4 other cases the concentration was elevated and varied between 3.7-7.8 micrograms/L. Serum TSH beta levels were normal in the 4 cases in which it was determined. Serum GH or PRL levels were elevated in 5 cases. In 1 patient the cosecretion of TSH, GH, and PRL was confirmed by immunocytochemical examination. Serum TSH and alpha-subunit responses to TRH, GnRH, CRF, GRF, dexamethasone, methimazole, T3, and bromocriptine administration were variable when studied. Serum TSH and alpha-subunit circadian rhythms were absent in 1 case and inverted in another. A serum alpha-subunit pulsatility without TSH pulses was observed in 1 patient. Five patients underwent transsphenoidal adenomectomy. Three of 4 patients operated on in our center were cured, but a recurrence of the adenoma was found in 1 of them after 5 yr. The fifth patient was not cured. Treatment with octreotide in 3 patients resulted in normalization of serum TSH, GH, and thyroid hormones levels. Cosecretion of PRL in 1 case and alpha-subunit in 2 cases was also inhibited. Partial tachyphylaxis occurred in 1 patient. In summary, heterogeneity in clinical presentation, hormonal expression, and therapeutic response appears to characterize these TSH-secreting adenomas.