垂体促甲状腺激素瘤的临床分析与诊治探讨

Clinical analysis and treatment of thyrotropin-secreting pituitary adenomas

摘要:

目的：探讨垂体促甲状腺激素（thyrotropin，TSH）瘤的不同临床表现，提高对垂体TSH瘤的认识，降低漏诊率和误诊率。方法：收集3例不同类型的垂体TSH瘤或可疑为垂体TSH瘤患者的临床特征、生化指标、影像学资料、免疫组化结果、手术方式和术后情况。结果：1例以甲状腺毒症和甲状腺肿大为首发症状及体征，2例以肿瘤占位效应为首发症状；2例甲状腺素水平升高，3例TSH均升高；3例垂体磁共振成像（magnetic resonance imaging，MRI）均提示垂体大腺瘤；1例行“肿瘤切除术”，2例行“经鼻蝶窦垂体腺瘤切除术”；2例免疫组化TSH阳性；随访过程中2例术后出现“腺垂体功能减退症”，经过补充垂体激素治疗目前病情均较稳定。结论：经典的垂体TSH瘤临床较容易识别，但特殊类型的垂体TSH瘤比较容易漏诊或误诊，需要加强医务工作者对垂体TSH瘤各种临床表现的认识，针对各种类型的患者进行个体化诊治。

Abstract:

Objective：To describe the diverse clinical and laboratory manifestations of multiple thyrotropin-secreting pituitary adeno－mas cases and to improve diagnostic success. Methods：Clinical characteristics，biochemical indicators，imaging and immunohisto－chemical staining results，surgical procedures，and postoperative outcomes were collected for three cases with identified or suspected thyrotropin-secreting pituitary adenomas. Results：Thyrotoxicosis and thyroid enlargement were the first symptoms and signs in one case，while space occupying effects of tumors were the first symptoms in the other two cases. Levels of thyroxine increased in two cases and those of TSH increased in all three cases. Pituitary magnetic resonance imaging（MRI） in all three cases indicated pituitary macroadenoma. One patient underwent tumorectomy and the other two underwent transnaso-sphenoidal resection of pituitary adenoma. TSH-positive immunohistochemical staining was observed in two cases. During follow-up，two cases of hypopituitarism occurred，both of which improved following hypophyseal hormone therapy. Conclusion：Typical TSHoma can be identified by TSH measurement and pituitary MRI，but clinicians should be aware of atypical clinical manifestations for improved diagnostic accuracy. Treatment should be tailored according to clinical manifestations.