促甲状腺激素染色垂体腺瘤：罕见、无声、多激素分泌。

TSH-STAINING PITUITARY ADENOMAS: RARE, SILENT, AND PLURIHOROMONAL.

出版信息

Endocr Pract. 2018 Jun;24(6):580-588. doi: 10.4158/EP-2018-0084.

DOI:10.4158/EP-2018-0084

PMID:29949434

Abstract

OBJECTIVE

To characterize a single referral center experience with thyroid-stimulating hormone (TSH)-staining adenomas.

METHODS

A retrospective chart review was conducted on histopathologic-proven TSH-staining adenomas resected between 2000-2015 at a single center. Tumors were classified as functional (hormonally active) or silent (hormonally inactive). Categorical variables were summarized using counts (n) and percentages; continuous variables were summarized using medians and ranges.

RESULTS

From the 1,065 pituitary adenomas operated, 32 (3.0%) showed diffuse staining for TSH. Median (range) age of patients was 49 years (20 to 77 years), and 21 (66%) were male. Tumor diameter was 20 mm (2 to 37 mm), with 7 (22%) microadenomas and 25 (78%) macroadenomas. Functional tumors (n = 5, 16%) had median diameter of 10 mm (5 to 21 mm) (2 microadenomas). At diagnosis, median (range) TSH was 4.3 μU/mL (1.2 to 6.9 μU/mL), and free thyroxine (FT4) was 2.4 ng/dL (2.1 to 3.4 ng/dL). Three tumors stained for TSH alone, and 2 tumors costained with growth hormone (GH). No cavernous sinus invasion was seen, and 3 (60%) were considered cured after surgery. Silent tumors (n = 27, 84%) had median diameter of 20 mm (2 to 37 mm), with 5 (19%) microadenomas and 22 (81%) macroadenomas. Median (range) TSH was 1.2 μU/mL (0.48 to 4.6 μU/mL), and FT4 was 1.2 ng/dL (0.6 to 1.6). Only 2 (7.4%) tumors stained for TSH alone; the rest were plurihormonal, with GH being the most common. Cavernous sinus invasion was seen in 7 (27%) of the tumors, and 17 (63%) were considered surgically cured.

CONCLUSION

In our series, 22% of TSH-staining adenomas were microadenomas, and 84% were silent. Most TSH-staining adenomas were plurihormonal, particularly costaining with GH.

ABBREVIATIONS

αSU = alpha-subunit; ACTH = adrenocorticotropic hormone; FSH = follicle-stimulating hormone; FT3 = free triiodothyronine; FT4 = free thyroxine; GH = growth hormone; LH = luteinizing hormone; MRI = magnetic resonance imaging; PRL = prolactin; T4 = thyroxine; TSH = thyroid-stimulating hormone.

摘要

目的

描述一个单中心关于促甲状腺激素（TSH）染色腺瘤的经验。

方法

对 2000 年至 2015 年间在一个中心切除的经组织病理学证实的 TSH 染色腺瘤进行回顾性图表审查。肿瘤分为功能性（激素活性）或无功能性（激素不活跃）。分类变量用计数（n）和百分比表示；连续变量用中位数和范围表示。

结果

在 1065 例垂体腺瘤中，32 例（3.0%）显示 TSH 弥漫染色。患者的中位（范围）年龄为 49 岁（20 至 77 岁），21 例（66%）为男性。肿瘤直径为 20 毫米（2 至 37 毫米），其中 7 例（22%）为微腺瘤，25 例（78%）为大腺瘤。功能性肿瘤（n=5，16%）的肿瘤直径中位数为 10 毫米（5 至 21 毫米）（2 例微腺瘤）。诊断时，中位（范围）TSH 为 4.3 μU/mL（1.2 至 6.9 μU/mL），游离甲状腺素（FT4）为 2.4ng/dL（2.1 至 3.4ng/dL）。有 3 个肿瘤仅染色 TSH，有 2 个肿瘤同时染色 GH。未见海绵窦侵犯，3 例（60%）术后认为治愈。无功能性肿瘤（n=27，84%）肿瘤直径中位数为 20 毫米（2 至 37 毫米），其中 5 例（19%）为微腺瘤，22 例（81%）为大腺瘤。中位（范围）TSH 为 1.2 μU/mL（0.48 至 4.6 μU/mL），FT4 为 1.2ng/dL（0.6 至 1.6）。仅有 2 例（7.4%）肿瘤仅染色 TSH；其余为多激素，以 GH 最为常见。有 7 例（27%）肿瘤存在海绵窦侵犯，17 例（63%）认为手术治愈。