Wang Qing, Lu Xiao-Jie, Sun Jun, Wang Jing, Huang Ci You, Wu Zhi Feng
Department of Neurosurgery, Neuroscience Center, Wuxi Second Hospital Affiliated with Nanjing Medical University, Wu'xi, Jiangsu Province, China.
Department of Neurosurgery, Neuroscience Center, Wuxi Second Hospital Affiliated with Nanjing Medical University, Wu'xi, Jiangsu Province, China.
World Neurosurg. 2016 Nov;95:617.e13-617.e18. doi: 10.1016/j.wneu.2016.08.062. Epub 2016 Aug 25.
Ectopic thyroid-stimulating hormone (TSH)-secreting pituitary adenomas are rare and can often be misdiagnosed as primary hyperthyroidism. We present a case of an ectopic suprasellar TSH-secreting pituitary adenoma. A literature review of previously reported ectopic TSH-secreting and suprasellar pituitary adenomas is included to illustrate the clinical characteristics of this disease entity and the diversity of operative approaches to treating ectopic suprasellar pituitary adenomas.
A 46-year-old man presented with typical clinical signs of hyperthyroidism and a history of progressive visual field impairment and vision loss. Laboratory investigations revealed that the patient had elevated levels of free thyroxine and free triiodothyronine and a normal level of TSH. Neuro-ophthalmologic examination showed right eye/left eye = 1.0/0.6 and left temporal hemianopia. Magnetic resonance imaging revealed a mass located in the suprasellar space. The patient underwent preoperative short-term octreotide treatment followed by gross total resection of the tumor via the extended endoscopic endonasal transtuberculum sellar approach. At 6-month follow-up evaluation, the patient's endocrinologic function tests met the criteria for cure, and magnetic resonance imaging revealed a normal pituitary gland and stalk with no tumor recurrence. Histologic diagnosis confirmed the presence of a TSH-secreting pituitary adenoma.
To the best of our knowledge, this is the first reported case of an ectopic suprasellar TSH-secreting pituitary adenoma. Preoperative preparation and complete resection are the keys to a cure. The extended endoscopic endonasal transtuberculum sellar approach is an alternative minimally invasive method for the removal of an ectopic suprasellar pituitary adenoma.
异位分泌促甲状腺激素（TSH）的垂体腺瘤较为罕见，常被误诊为原发性甲状腺功能亢进症。我们报告一例异位鞍上分泌TSH的垂体腺瘤病例。本文还对先前报道的异位分泌TSH的垂体腺瘤和鞍上垂体腺瘤进行了文献综述，以阐明该疾病实体的临床特征以及治疗异位鞍上垂体腺瘤手术方法的多样性。
一名46岁男性出现典型的甲状腺功能亢进临床症状，并有进行性视野缺损和视力丧失病史。实验室检查显示患者游离甲状腺素和游离三碘甲状腺原氨酸水平升高，TSH水平正常。神经眼科检查显示右眼/左眼 = 1.0/0.6，左侧颞侧偏盲。磁共振成像显示鞍上区有一肿块。患者术前接受短期奥曲肽治疗，随后通过扩大经鼻内镜经结节蝶鞍入路对肿瘤进行了全切除。在6个月的随访评估中，患者的内分泌功能检查达到治愈标准，磁共振成像显示垂体和垂体柄正常，无肿瘤复发。组织学诊断证实为分泌TSH的垂体腺瘤。
据我们所知，这是首例报道的异位鞍上分泌TSH的垂体腺瘤病例。术前准备和完整切除是治愈的关键。扩大经鼻内镜经结节蝶鞍入路是切除异位鞍上垂体腺瘤的一种微创替代方法。
