垂体多激素腺瘤病例报道：单中心研究

A case report of pituitary multi-hormone adenoma：a single center study

摘要:

目的 加强对于同时产生生长激素（growth hormone，GH）和促甲状腺激素（thyroidstimulatinghormone，TSH）的垂体腺瘤的认识，防止误诊、漏诊、延诊，并探讨其治疗。方法 回顾性分析5例在四川大学华西医院确诊为垂体GH+TSH 瘤患者的临床表现、激素生化检查、影像学检查、治疗方式以及预后情况。结果 ①5例GH+TSH瘤占四川大学华西医院同期诊断的垂体瘤的2.9%（4/172）；其中2例患者病理提示：TSH+GH+PRL为阳性，另外3例病理提示：TSH+GH为阳性。②鞍区MRI扫描5例均为大腺瘤（直径≥1 cm），无小腺瘤。③术前4例患者（病例2、3、4、5）GH基线水平明显升高（随机值>2.5 ng/mL），其中2例不被高糖抑制，2例患者未行高糖抑制实验；病例1因既往已多次反复治疗，目前GH已完全生化缓解。4例患者（病例1、2、4、5）FT4升高且TSH不被抑制，其中2例患者存在甲状腺毒症；2例患者性腺轴水平下降。5例患者中4例为经鼻内镜鞍区占位切除术，其术后大部分GH、TSH、FT4均明显下降（其中2例恢复到正常范围，另有1例GH水平有下降，但未完全缓解，TSH、FT4水平恢复正常，另1例GH、TSH、FT4均无明显变化）。余病例1既往伽玛刀治疗后给予药物治疗，第3次复发采用手术治疗后GH水平缓解，但TSH、FT4仍未得到缓解；术后性激素结果提示：2例患者性腺功能减退患者性腺功能未立即恢复正常。5例患者术前、术后垂体-肾上腺轴功能均正常。结论 垂体GH+TSH混合瘤临床发病率低，起病隐匿，多因甲状腺毒症而被误诊，易错过最佳治疗时机，手术治疗仍是该病的一线治疗方式。

Abstract:

Objective To strengthen the understanding of pituitary adenoma that produces growth hormone（GH） and thyroidstimulatinghormone（TSH）. And more，to prevent misdiagnosis，missed diagnosis and delayed diagnosis，and to explore its treatment.Methods The clinical manifestations，hormone biochemical examination，imaging examination，treatment and prognosis of 5 patients with pituitary GH+TSH adenoma diagnosed in West China Hospital were analyzed retrospectively.Results ①5 cases of GH+TSH tumors accounted for 2.9%（4 /172） of pituitary tumors diagnosed at the same time in west china hospital. Pathological findings of 2 patients showed that TSH，GH and PRL were all positive，and pathological findings of 3 patients showed that TSH and GH were all positive. ②MRI scan of sellar region showed that 5 cases were large adenomas（diameter > 1cm） and no small adenomas. ③Before operation，the baseline level of GH in 4 patients（cases 2，3，4 and 5） increased significantly（random value > 2.5ng/mL），of which 2 patients were not inhibited by high glucose，and 2 patients were not subjected to high glucose inhibition experiment； Case 1 has been repeatedly treated in the past，and now GH has completely biochemical remission. Four patients（cases 1，2，4 and 5） had elevated 5）FT4 and TSH was not inhibited，among which 2 patients had thyrotoxicosis. The level of gonadal axis decreased in 2 patients. Among the 5 patients，4 cases underwent space-occupying resection in the sellar region through nasal endoscope，and most of their GH，TSH and FT4 decreased significantly after operation（2 cases recovered to the normal range，while the GH level in another case decreased，but not completely relieved，and the TSH and FT4 levels returned to normal，while the GH，TSH and FT4 in the other case did not change significantly）. The remaining case 1 was treated with gamma knife first，then with drug，and the GH level was relieved after the third recurrence was treated with surgery，but TSH and FT4 were still not relieved. The results of postoperative sex hormones suggest that the gonadal function of 2 patients with hypogonadism did not return to normal immediately. The function of pituitary-adrenal axis was normal in 5 patients before and after operation.Conclusion The clinical incidence of pituitary GH+TSH mixed tumor is low，the onset is insidious，and it is often misdiagnosed because of thyrotoxicosis，which is easy to miss the best treatment opportunity. Surgery is still the first-line treatment for this disease.