2013 年欧洲甲状腺协会促甲状腺素分泌性垂体瘤诊断和治疗指南。
2013 European thyroid association guidelines for the diagnosis and treatment of thyrotropin-secreting pituitary tumors.
机构信息
Department of Clinical Sciences and Community Health, University of Milan, Endocinology and Diabetology Unit, Fondazione IRCCS Cà Granda Policlinico, Milan, Italy.
Dipartimento di Biotecnologie Mediche e Medicina Traslazionale, University of Milan, Endocrine Unit, Istituto Clinico Humanitas IRCCS, Rozzano, Milan, Italy.
出版信息
Eur Thyroid J. 2013 Jun;2(2):76-82. doi: 10.1159/000351007. Epub 2013 May 7.
Hyperthyroidism is mainly due to autoimmune thyroid disorders or toxic goiter, and very rarely to the presence of thyrotropin (TSH)-secreting pituitary adenomas (TSHomas). These tumors are characterized by high levels of circulating free thyroid hormones (FT4 and FT3) in the presence of nonsuppressed serum TSH concentrations. Failure to correctly diagnose TSHomas may result in inappropriate thyroid ablation, which results in a significant increase of pituitary tumor mass. The diagnosis is mainly achieved by measuring TSH after T3 suppression and TRH stimulation tests. These dynamic tests, together with pituitary imaging and genetic testing are useful in distinguishing TSHomas from the syndromes of resistance to thyroid hormone action. The treatment of choice is surgery. In cases of surgical failure, somatostatin analogs have been found to be effective in normalizing TSH secretion in more than 90% of patients.
甲状腺功能亢进症主要是由于自身免疫性甲状腺疾病或毒性甲状腺肿引起的，极少数情况下是由于促甲状腺激素（TSH）分泌垂体腺瘤（TSH 瘤）引起的。这些肿瘤的特点是在血清 TSH 浓度未被抑制的情况下，循环游离甲状腺激素（FT4 和 FT3）水平升高。未能正确诊断 TSH 瘤可能导致甲状腺消融不当，从而导致垂体瘤体积显著增大。诊断主要通过 T3 抑制后和 TRH 刺激试验测量 TSH 来实现。这些动态试验，结合垂体成像和基因检测，有助于区分 TSH 瘤与甲状腺激素作用抵抗综合征。治疗选择是手术。在手术失败的情况下，生长抑素类似物已被发现对超过 90%的患者有效，可使 TSH 分泌正常化。
Zotero 插件