Ferraz Carolina, Paschke Ralf
Endocrinology and Metabolism of Faculty of Medical Science of Santa Casa de São Paulo, FCMSCSP, Brazil.
Division of Endocrinology and Metabolism, Chair Provincial Endocrine Tumour Team, Departments of Medicine, Oncology, Pathology and Biochemistry and Molecular Biology & Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, HMRB, Room 382B, 3330 Hospital Dr NW, Calgary, Alberta, T2N 4N1, Canada.
Best Pract Res Clin Endocrinol Metab. 2017 Mar;31(2):265-275. doi: 10.1016/j.beem.2017.04.005. Epub 2017 Apr 22.
Hyperthyroidism is a clinical state that results from high thyroid hormone levels which has multiple etiologies, manifestations, and potential therapies. Excluding the autoimmune Graves disease, autonomic adenomas account for the most import cause of non-autoimmune hyperthyroidism. Activating germline mutations of the TSH receptor are rare etiologies for hyperthyroidism. They can be inherited in an autosomal dominant manner (familial or hereditary, FNAH), or may occur sporadically as a de novo condition, also called: persistent sporadic congenital non-autoimmune hyperthyroidism (PSNAH). These three conditions: autonomic adenoma, FNAH and PSNAH constitute the inheritable and sporadic non-autoimmune hyperthyroidism. Particularities in epidemiology, etiology, molecular and clinical aspects of these three entities will be discussed in this review in order to guide to an accurate diagnosis allowing among others genetic counseling and presymptomatic diagnosis for the affected families. The optimal treatment based on the right diagnosis will avoid consequences of a persistent or relapsing hyperthyroidism.
甲状腺功能亢进是一种由于甲状腺激素水平升高导致的临床状态,其病因、表现和潜在治疗方法多种多样。排除自身免疫性格雷夫斯病,自主性腺瘤是非自身免疫性甲状腺功能亢进的最重要原因。促甲状腺激素受体的激活种系突变是甲状腺功能亢进的罕见病因。它们可以以常染色体显性方式遗传(家族性或遗传性,FNAH),或者可能作为一种新发疾病散发性出现,也称为:持续性散发性先天性非自身免疫性甲状腺功能亢进(PSNAH)。自主性腺瘤、FNAH和PSNAH这三种情况构成了遗传性和散发性非自身免疫性甲状腺功能亢进。本文将讨论这三种实体在流行病学、病因、分子和临床方面的特殊性,以便指导准确诊断,从而为受影响家庭提供遗传咨询和症状前诊断等服务。基于正确诊断的最佳治疗将避免持续性或复发性甲状腺功能亢进的后果。