共存的促甲状腺激素/生长激素分泌垂体腺瘤和甲状腺乳头状癌的治疗管理：一项治疗挑战。

Management of coexisting thyrotropin/growth-hormone-secreting pituitary adenoma and papillary thyroid carcinoma: a therapeutic challenge.

机构信息

Department of Endocrinology, National Naval Medical Center, Bethesda, Maryland 20889-5600, USA.

出版信息

Thyroid. 2010 Jan;20(1):99-103. doi: 10.1089/thy.2009.0160.

DOI:10.1089/thy.2009.0160

PMID:20067380

Abstract

BACKGROUND

A thyrotropin (TSH)-secreting pituitary adenoma coexisting with differentiated thyroid carcinoma is rare. There have been only four previously reported cases; three were treated with thyroidectomy followed by pituitary resection and one was treated with thyroidectomy alone.

METHODS

We hereby report the fifth case, in which a patient presented with a TSH/growth-hormone-secreting pituitary macroadenoma coexisting with papillary thyroid carcinoma (PTC).

RESULTS

She underwent biochemical testing, ophthalmologic examination, thyroid ultrasonography, Tc-99m-pertechnetate thyroid scan, whole-body positron emission tomography, (111)In-octreotide scan, thyroid fine-needle aspiration biopsy, octreotide treatment, total thyroidectomy, recombinant human TSH radioactive iodine remnant ablation, and continued treatment with octreotide and levothyroxine after thyroidectomy. She has remained asymptomatic for 24 months without biochemical or radiological evidence of pituitary hormone oversecretion, pituitary adenoma enlargement, and PTC recurrence.

CONCLUSION

To our knowledge, this is the first case of a TSH/growth-hormone-secreting pituitary macroadenoma coexisting with PTC being successfully treated with octreotide and levothyroxine after thyroidectomy and recombinant human TSH-stimulated radioactive iodine remnant ablation.

摘要

背景

促甲状腺激素（TSH）分泌性垂体腺瘤合并分化型甲状腺癌较为罕见。既往仅报道过四例，三种治疗方法为甲状腺切除术联合垂体切除术，一种为单纯甲状腺切除术。

方法

我们在此报告第五例病例，患者为 TSH/生长激素分泌性垂体大腺瘤合并甲状腺乳头状癌（PTC）。

结果

该患者接受了生化检测、眼科检查、甲状腺超声、Tc-99m-过锝酸盐甲状腺扫描、全身正电子发射断层扫描、（111）In-奥曲肽扫描、甲状腺细针抽吸活检、奥曲肽治疗、甲状腺全切除术、重组人 TSH 放射性碘残留消融，以及甲状腺切除术后继续接受奥曲肽和左甲状腺素治疗。术后 24 个月，患者无症状，且无垂体激素过度分泌、垂体腺瘤增大和 PTC 复发的生化或影像学证据。