Gesundheit N, Petrick P A, Nissim M, Dahlberg P A, Doppman J L, Emerson C H, Braverman L E, Oldfield E H, Weintraub B D
National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland.
Ann Intern Med. 1989 Nov 15;111(10):827-35. doi: 10.7326/0003-4819-111-10-827.
To evaluate the clinical and biochemical features of patients with TSH (thyroid-stimulating hormone, thyrotropin)-secreting pituitary tumors; to measure the biologic activity in vitro of circulating TSH from selected patients before and after pituitary surgery.
Case series.
Patients in an endocrinology unit.
Nine patients with TSH-secreting pituitary tumors.
All patients had hyperthyroidism, elevated free thyroxine and triiodothyronine levels, and detected levels of TSH. The free alpha subunit, a tumor marker for neoplasms of gonadotropic or thyrotropic cell origin, was elevated in all nine patients. Seven of the nine patients had been treated with thionamides, radioactive iodine, or thyroidectomy for presumed primary hyperthyroidism. The delay from the initial treatment of hyperthyroidism to the correct diagnosis of a pituitary neoplasm was 6.2 +/- 4.8 (mean +/- SD) years. Two of the seven patients with macroadenomas died in the perioperative period (one at NIH, one at a referring hospital). Of the remaining five patients with macroadenomas, four have residual tumor and inappropriate TSH secretion, despite surgery and radiation therapy, at follow-up from 3.5 to 6 years. In contrast, the two patients with microadenomas are clinically cured 2.5 and 4 years after transsphenoidal adenomectomy. The biologic to immunologic (B/I) ratio of serum TSH, determined preoperatively in five patients with TSH-secreting tumors, was elevated compared with euthyroid subjects. In three patients the B/I ratio of serum TSH was also measured after pituitary surgery; in two the elevated B/I ratio returned to normal after successful pituitary adenomectomy, while in the third this ratio remained elevated after incomplete adenoma resection.
With the routine availability of ultrasensitive TSH assays and their increasing use to confirm thyrotoxicosis from all causes, we expect that TSH-secreting pituitary tumors will be diagnosed earlier, before inappropriate antithyroid therapy, permitting an improved outcome.
评估促甲状腺激素（TSH，甲状腺刺激激素，促甲状腺素）分泌性垂体瘤患者的临床和生化特征；测量部分患者垂体手术前后循环TSH的体外生物学活性。
病例系列研究。
内分泌科的患者。
9例促甲状腺激素分泌性垂体瘤患者。
所有患者均有甲状腺功能亢进，游离甲状腺素和三碘甲状腺原氨酸水平升高，且可检测到TSH水平。促性腺激素或促甲状腺素细胞来源肿瘤的标志物游离α亚基在所有9例患者中均升高。9例患者中有7例曾因疑似原发性甲状腺功能亢进接受过硫代酰胺、放射性碘或甲状腺切除术治疗。从最初治疗甲状腺功能亢进到正确诊断垂体肿瘤的延迟时间为6.2±4.8（均值±标准差）年。7例大腺瘤患者中有2例在围手术期死亡（1例在美国国立卫生研究院，1例在转诊医院）。其余5例大腺瘤患者中，4例在3.5至6年的随访中，尽管接受了手术和放射治疗，但仍有残留肿瘤和不适当的TSH分泌。相比之下，2例微腺瘤患者在经蝶窦腺瘤切除术后2.5年和4年临床治愈。术前测定的5例促甲状腺激素分泌性肿瘤患者血清TSH的生物学与免疫学（B/I）比值高于甲状腺功能正常者。3例患者在垂体手术后也测定了血清TSH的B/I比值；2例患者在垂体腺瘤切除成功后，升高的B/I比值恢复正常，而第3例患者在腺瘤切除不完全后该比值仍升高。
随着超敏TSH检测方法的常规应用及其在确认各种原因导致的甲状腺毒症中的使用增加，我们预计促甲状腺激素分泌性垂体瘤将在不适当的抗甲状腺治疗之前更早被诊断出来，从而改善预后。
