Sato Yuya, Koyama Satomi, Kuwashima Shigeko, Kato Masaya, Okuya Mayuko, Fukushima Keitaro, Kurosawa Hidemitsu, Arisaka Osamu
Department of Pediatrics Department of Radiology, Dokkyo Medical University School of Medicine, Mibu, Tochigi, Japan.
Medicine (Baltimore). 2017 Jun;96(26):e7329. doi: 10.1097/MD.0000000000007329.
Central nervous system (CNS) leukemia is a frequent diagnosis in pediatric acute myeloblastic leukemia (AML) and includes neural symptoms. However, CNS leukemia is rarely associated with central hypsothyroidism.
A 2-year-old female with AML with MLL rearrangement presented with CNS infiltration. Laboratory tests suggested the presence of central hypothyroidism (thyroid-stimulating hormone [TSH]: 0.48 mIU/ml, normal range 0.7-6.4 mIU/ml; serum free thyroxine [FT4]: 0.62 ng/dl, normal range 0.8-2.2 ng/dl; free triiodothyronine: 1.57 pg/ml, normal range 2.7-5.6 pg/ml). Magnetic resonance imaging detected no lesions in the hypothalamus, pituitary, or thyroid.
Levothyroxine (2.5 mg/kg/day) was administered together with chemotherapy and intrathecal injection of methotrexate, cytarabine, and hydrocortisone into the cerebrospinal fluid. The FT4 concentration increased after levothyroxine treatment, but later decreased after relapse of CNS leukemia. The TSH concentrations remained low. After remission of CNS leukemia, the TSH and FT4 concentrations quickly recovered to their normal ranges.
We believe that the CNS leukemia directly affected TSH and thyroid hormone secretion in our patient.
中枢神经系统（CNS）白血病是小儿急性髓细胞白血病（AML）的常见诊断结果，且伴有神经症状。然而，CNS白血病很少与中枢性甲状腺功能减退相关。
一名2岁患有MLL重排AML的女性出现CNS浸润。实验室检查提示存在中枢性甲状腺功能减退（促甲状腺激素[TSH]：0.48 mIU/ml，正常范围0.7 - 6.4 mIU/ml；血清游离甲状腺素[FT4]：0.62 ng/dl，正常范围0.8 - 2.2 ng/dl；游离三碘甲状腺原氨酸：1.57 pg/ml，正常范围2.7 - 5.6 pg/ml）。磁共振成像未检测到下丘脑、垂体或甲状腺有病变。
左旋甲状腺素（2.5 mg/kg/天）与化疗以及向脑脊液鞘内注射甲氨蝶呤、阿糖胞苷和氢化可的松同时使用。左旋甲状腺素治疗后FT4浓度升高，但CNS白血病复发后又降低。TSH浓度持续偏低。CNS白血病缓解后，TSH和FT4浓度迅速恢复至正常范围。
我们认为CNS白血病直接影响了我们这位患者的TSH和甲状腺激素分泌。
