Ogawa Yoshikazu, Tominaga Teiji
Department of Neurosurgery, Kohnan Hospital, 4-20-1 Nagamachiminami, Taihaku-ku, Sendai, Miyagi, 982-8523, Japan.
J Med Case Rep. 2013 Jan 21;7:27. doi: 10.1186/1752-1947-7-27.
The coexistence of autoimmune hyperthyroid disease and thyroid-stimulating hormone-secreting pituitary adenoma is rare. The simple presumption of coincidence of these two diseases has a calculated incidence of less than one/several hundred million, and only four cases with histological confirmation have been reported. A rapid decrease in thyroid-stimulating hormone level after pituitary tumor removal may induce subsequent activation of autoimmune responses against the thyroid gland. We report the first case of a sequential and paradoxical occurrence of Graves' disease and a thyroid-stimulating hormone-secreting pituitary adenoma.
A 32-year-old Japanese woman had recurrent hyperthyroidism. She had a history of Graves' hyperthyroidism, which had been successfully treated with propylthiouracil. A head magnetic resonance imaging showed a less enhanced area in the left lateral wing of her sella turcica. Transsphenoidal surgery was performed, and the diagnosis was established as thyroid-stimulating hormone-secreting plurihormonal adenoma. A rapid reduction in thyroid hormone levels was achieved, and her blood pressure was normalized after the operation.
Although incidental occurrence is the most probable etiology, long and repeated followup examinations of both thyroid and pituitary gland should be performed in patients with an atypical clinical course.
自身免疫性甲状腺功能亢进症与分泌促甲状腺激素的垂体腺瘤并存的情况较为罕见。简单推测这两种疾病的巧合发生率计算不到亿分之一/几亿分之一，且仅有4例经组织学证实的病例报道。垂体肿瘤切除后促甲状腺激素水平迅速下降可能会引发随后针对甲状腺的自身免疫反应激活。我们报告了第一例格雷夫斯病与分泌促甲状腺激素的垂体腺瘤先后出现且情况反常的病例。
一名32岁的日本女性反复出现甲状腺功能亢进。她有格雷夫斯甲状腺功能亢进病史，曾用丙硫氧嘧啶成功治疗。头部磁共振成像显示其蝶鞍左侧翼有强化减弱区域。进行了经蝶窦手术，诊断为分泌促甲状腺激素的多激素腺瘤。术后甲状腺激素水平迅速降低，血压恢复正常。
尽管偶然发生是最可能的病因，但对于临床病程不典型的患者，应长期反复对甲状腺和垂体进行随访检查。
