Frandsen N J, Transbøl I
Endokrinologisk afsnit, Hvidovre Hospital, København.
Ugeskr Laeger. 1991 Mar 18;153(12):854-5.
TSH-producing adenomas of the pituitary gland are very rare. Synchronous combinations of TSH-producing adenomas with other causes of hyperthyroidism are certainly extremely rare. We present the second known case, reported in the literature, consisting of observations for 12 years in a woman aged 43 years, who presented with active Graves' disease and an apparently inactive pituitary macro-adenoma. However, after normalisation of serum T3 and serum T4 levels by antithyroid medication for one year, the serum TSH rose inappropriately and continued to rise for the following 11 years. Insidious growth of the adenoma also occurred. After one year of medical treatment, a huge goitre was resected (210 g) leaving the patient euthyroid, clinically and biochemically, for four years. Hereafter, hyperthyroidism developed again this time without Graves' disease. We conclude that the patient experienced hyperthyroidism on two occasions, the first caused by Graves' disease and then caused by a TSH-producing pituitary adenoma.
垂体促甲状腺激素腺瘤非常罕见。促甲状腺激素腺瘤与其他甲状腺功能亢进病因同时存在的情况肯定极为罕见。我们报告了文献中已知的第二例病例，该病例为一名43岁女性，对其进行了12年的观察。该患者患有活动性格雷夫斯病及一个明显无活性的垂体大腺瘤。然而，在使用抗甲状腺药物使血清T3和血清T4水平正常化一年后，血清促甲状腺激素异常升高，并在接下来的11年持续上升。腺瘤也出现了隐匿性生长。药物治疗一年后，切除了一个巨大的甲状腺肿（210克），使患者在临床和生化指标上甲状腺功能正常达四年。此后，再次出现甲状腺功能亢进，此次并非由格雷夫斯病引起。我们得出结论，该患者经历了两次甲状腺功能亢进，第一次由格雷夫斯病引起，第二次由垂体促甲状腺激素腺瘤引起。
