Mills G H, Ellis R D, Beck P R
Department of Medicine, Rotherham District General Hospital.
J Clin Pathol. 1991 Jun;44(6):522-3. doi: 10.1136/jcp.44.6.522.
A 60 year old man with panhypopituitarism due to a large meningioma and prolonged and exaggerated thyroid stimulating hormone (TSH) responses is described. Initial investigations showed a subnormal urinary free cortisol concentration, a low serum cortisol taken at 0900 hours, and a low free T4 concentration. The TSH was towards the upper end of the normal range. Subsequently pituitary function tests showed subnormal production of luteinising hormone in response to luteinising hormone releasing hormone (LHRH) and a short synacthen test with a low 30 minute cortisol value. Long synacthen testing showed a normal response at four days, confirming that the abnormalities were due to a pituitary or hypothalamic cause. A computed tomogram showed a large meningioma compressing the hypothalamus, pituitary, and temporal lobe. TRH testing showed a prolonged and exaggerated response, consistent with tertiary hypothyroidism.
本文描述了一名60岁男性，因巨大脑膜瘤导致全垂体功能减退，并伴有甲状腺刺激激素（TSH）反应延长和亢进。初步检查显示尿游离皮质醇浓度低于正常，上午9点测得的血清皮质醇水平较低，游离T4浓度也较低。TSH处于正常范围上限。随后的垂体功能测试显示，黄体生成素释放激素（LHRH）刺激下黄体生成素分泌低于正常，短程促肾上腺皮质激素（Synacthen）试验中30分钟时皮质醇值较低。长程促肾上腺皮质激素试验显示第4天反应正常，证实异常是由垂体或下丘脑病变引起的。计算机断层扫描显示一个巨大脑膜瘤压迫下丘脑、垂体和颞叶。促甲状腺激素释放激素（TRH）试验显示反应延长和亢进，符合三发性甲状腺功能减退。
