Heni M, Besemer B, Guthoff M, Häntschel M, Wirths S, Mayer F, Kanz L, Häring H- U, Schnauder G, Vogel W
Medizinische Klinik IV, Endokrinologie und Diabetologie, Angiologie, Nephrologie und Klinische Chemie, Universitätsklinikum Tübingen.
Dtsch Med Wochenschr. 2013 Apr;138(17):908. doi: 10.1055/s-0032-1333050. Epub 2013 Apr 26.
We report on a 24-year-old male patient who presented with worsening of the general condition and abdominal pain.
On physical examination, gynecomastia was noted. Laboratory tests showed manifest hyperthyroidism. The beta-hCG levels were markedly increased. By ultrasound, the thyroid gland was hyperperfused without thyroid nodules. Several large echo mixed lesions were found in the liver. The testes appeared normal.
In light of the typical laboratory findings, a non-seminomatous extragonadal germ cell tumor was diagnosed. Hyperthyroidism was most probably HCG induced.
Initially the patient was treated with thyreostatic drugs. After initiation of chemotherapy and a marked decrease in beta-hCG, thyreostatic therapy could be terminated.
Germ cell tumors may cause an increase in beta-hCG concentration. By cross-reacting with the TSH-receptor this could induce hyperthyroidism. Germ cell tumors are therefore a rare differential diagnosis of hyperthyreoidism.
我们报告一例24岁男性患者，其表现为全身状况恶化和腹痛。
体格检查发现男性乳腺增生。实验室检查显示明显的甲状腺功能亢进。β-人绒毛膜促性腺激素（β-hCG）水平显著升高。超声检查显示甲状腺血流丰富但无甲状腺结节。肝脏发现几个大的回声混合性病变。睾丸外观正常。
根据典型的实验室检查结果，诊断为非精原性性腺外生殖细胞肿瘤。甲状腺功能亢进很可能是由HCG诱导的。
最初患者接受抗甲状腺药物治疗。化疗开始且β-hCG显著下降后，抗甲状腺治疗可以终止。
生殖细胞肿瘤可能导致β-hCG浓度升高。通过与促甲状腺激素（TSH）受体交叉反应，这可能诱发甲状腺功能亢进。因此，生殖细胞肿瘤是甲状腺功能亢进症一种罕见的鉴别诊断。
