Feldt-Rasmussen Ulla
Department of Medical Endocrinology, Rigshospitalet, National University Hospital, Copenhagen, Denmark.
Curr Med Chem. 2007;14(26):2783-8. doi: 10.2174/092986707782360114.
The diagnosis of pituitary disorders is difficult because several hormone systems are involved. The clinical presentation is often vague and slowly progressing, and clinicians therefore have to rely very much on correct biochemical measurements. This is also associated with difficulties since the pituitary hormones interact, the binding proteins are influenced by the other axes and a variety of other effects, and finally the hormone measurements in serum are not totally adequate Several studies have investigated the interaction between the thyroid and growth hormone axes with very variable results. The present review is focussing on the aspects related to clinical decision making based on biochemical assessments. Because of the strong and sometimes unpredictable interrelations between the hypothalamo-pituitary thyroid and the hypothalamo-GH-IGF axes, and the many pitfalls in the measurement of peripheral hormones and interpretation of stimulation tests, clinicians and clinical biochemists should collaborate closely. Only then can the diagnostic accuracy and the management of patients with both growth hormone and thyroid disorders be improved.
垂体疾病的诊断较为困难，因为涉及多个激素系统。临床表现往往模糊且进展缓慢，因此临床医生不得不非常依赖正确的生化检测。这也存在困难，因为垂体激素相互作用，结合蛋白受其他轴及多种其他效应影响，而且血清中的激素检测并不完全充分。多项研究调查了甲状腺轴与生长激素轴之间的相互作用，结果差异很大。本综述聚焦于基于生化评估的临床决策相关方面。由于下丘脑 - 垂体 - 甲状腺轴与下丘脑 - 生长激素 - 胰岛素样生长因子轴之间存在强烈且有时不可预测的相互关系，以及外周激素测量和刺激试验解读中存在诸多陷阱，临床医生和临床生物化学家应密切合作。只有这样，才能提高生长激素和甲状腺疾病患者的诊断准确性及治疗水平。
