Kim Daham, Cho Yongin, Ku Cheol Ryong, Jung Hyein, Moon Ju Hyung, Kim Eui Hyun, Shin Dong Yeob, Kim Sun Ho, Lee Eun Jig
Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Korea.
Institute of Endocrine Research, Yonsei University College of Medicine, Seoul 03722, Korea.
J Clin Med. 2019 Jul 31;8(8):1142. doi: 10.3390/jcm8081142.
Thyroid disease mainly has a thyroid origin but can occasionally have a pituitary origin. Clinicians face several challenges when these conditions occur together. We aimed to determine the prevalence of thyroid disorders in patients undergoing trans-sphenoidal adenomectomy (TSA) for pituitary disease. We reviewed the medical records of patients undergoing TSA for pituitary disease between 2008 and 2017 at Severance Hospital. Thyroid disorders were categorized using blood test results and medical histories at the time of preoperative evaluation. Among 2202 patients, 44 (2%), 218 (9.9%), and 74 (3.4%) had hyperthyroidism, hypothyroidism, and post-thyroidectomy status before TSA, respectively. Among the 44 patients with hyperthyroidism, 30 (68.2%) had central hyperthyroidism. Among the 218 patients with hypothyroidism, 165 (75.7%) had central hypothyroidism. Central hypothyroidism was more common in patients with adrenocorticotropic hormone-secreting pituitary adenomas (aOR (adjusted odds ratio) 1.85), Rathke's cleft cysts (aOR 2.34), and craniopharyngiomas (aOR 2.58) (all < 0.05) than in those with nonfunctioning pituitary adenomas. Contrastingly, thyroid cancer had an increased prevalence in patients with growth hormone- (aOR 3.17), prolactin- (aOR 3.66), and thyroid-stimulating hormone-secreting (aOR 6.28) pituitary adenomas (all < 0.05). Pituitary disease sometimes accompanies thyroid disorders; their characteristics vary according to the type of pituitary disease.
甲状腺疾病主要起源于甲状腺，但偶尔也可能起源于垂体。当这些情况同时出现时，临床医生面临着几个挑战。我们旨在确定因垂体疾病接受经蝶窦腺瘤切除术（TSA）的患者中甲状腺疾病的患病率。我们回顾了2008年至2017年在Severance医院因垂体疾病接受TSA的患者的病历。根据术前评估时的血液检查结果和病史对甲状腺疾病进行分类。在2202例患者中，分别有44例（2%）、218例（9.9%）和74例（3.4%）在TSA术前患有甲状腺功能亢进、甲状腺功能减退和甲状腺切除术后状态。在44例甲状腺功能亢进患者中，30例（68.2%）患有中枢性甲状腺功能亢进。在218例甲状腺功能减退患者中，165例（75.7%）患有中枢性甲状腺功能减退。与无功能垂体腺瘤患者相比，促肾上腺皮质激素分泌型垂体腺瘤（调整优势比[aOR]1.85）、拉克氏囊肿（aOR 2.34）和颅咽管瘤（aOR 2.58）患者中中枢性甲状腺功能减退更为常见（均P<0.05）。相反，生长激素分泌型（aOR 3.17）、催乳素分泌型（aOR 3.66）和促甲状腺激素分泌型（aOR 6.28）垂体腺瘤患者中甲状腺癌的患病率增加（均P<0.05）。垂体疾病有时会伴有甲状腺疾病；其特征因垂体疾病的类型而异。
