Mayinger B, Axelos D, Pavel M, Hahn E G, Hensen J
Medizinische Klinik I mit Poliklinik, Friedrich-Alexander-Universität, Erlangen-Nürnberg.
Dtsch Med Wochenschr. 1999 Jan 29;124(4):73-8. doi: 10.1055/s-2007-1024245.
Magnetic resonance imaging (MRI) of the central nervous system was performed on a 72-year-old woman who was hyperthyroid without suppression of the thyroid-stimulating hormone (TSH) and had complained of a recent onset of headaches. MRI demonstrated a space-occupying lesion, 1 cm in diameter, in the anterior pituitary. The clinical symptoms were marked by a long-standing monosymptomatic illness of rapidly changing mood swings with depressive and manic phases.
Endocrinological-biochemical tests showed hyperthyroidism (fT3 10.55 pmol/l and fT4 39 pmol/l) but no TSH suppression (TSH: 2.9 microU/ml). Octreotide scintigraphy documented an activity-rich area in the anterior pituitary and the upper anterior mediastinum. Mediastinal MRI revealed a 5 cm space-occupying mass lying on the right atrium. 131I scintigraphy identified the mass as a retrosternal goitre.
As an operation on the anterior pituitary would have carried a high risk for the patient who was in a poor general condition and she had refused to be operated, treatment with octreotide, a long-acting somatostatin analogue, was initiated. This achieved a euthyroid state with partly suppressed TSH, and the patient's emotional swings ceased.
If hyperthyroidism coexists with non-suppressed TSH levels, a TSH-producing hypophyseal adenoma should be considered in the differential diagnosis despite its rarity. Octreotide administration is an effective and safe treatment and is the method of choice, especially when there are contraindications to surgical resection of the anterior pituitary.
对一名72岁的女性进行了中枢神经系统的磁共振成像（MRI）检查。该女性患有甲状腺功能亢进，促甲状腺激素（TSH）未受抑制，且近期出现头痛症状。MRI显示垂体前叶有一个直径1厘米的占位性病变。临床症状表现为长期存在的单一症状性疾病，情绪快速波动，有抑郁和躁狂阶段。
内分泌生化检查显示甲状腺功能亢进（游离三碘甲状腺原氨酸[fT3] 10.55 pmol/L，游离甲状腺素[fT4] 39 pmol/L），但TSH未受抑制（TSH：2.9微单位/毫升）。奥曲肽闪烁扫描显示垂体前叶和上纵隔前部有一个活性丰富的区域。纵隔MRI显示右心房有一个5厘米的占位性肿块。131I闪烁扫描确定该肿块为胸骨后甲状腺肿。
由于对这位全身状况较差的患者进行垂体前叶手术风险很高，且她拒绝手术，因此开始使用长效生长抑素类似物奥曲肽进行治疗。这使患者达到了甲状腺功能正常状态，TSH部分受到抑制，患者的情绪波动也停止了。
如果甲状腺功能亢进与未受抑制的TSH水平并存，尽管促甲状腺素分泌型垂体腺瘤罕见，但在鉴别诊断时仍应考虑。奥曲肽给药是一种有效且安全的治疗方法，是首选方法，尤其是在垂体前叶手术切除存在禁忌证时。
