Shigemasa C, Abe K, Taniguchi S, Mitani Y, Ueta Y, Adachi T, Urabe K, Tanaka T, Yoshida A, Hori T
First Department of Internal Medicine, Tottori University School of Medicine, Yonago, Japan.
J Endocrinol Invest. 1988 Apr;11(4):231-7. doi: 10.1007/BF03350145.
Impairment of thyrotropin (TSH) response to thyrotropin-releasing hormone (TRH) has been documented in patients with uncontrolled diabetes mellitus (DM). In acromegalic patients, however, there have been no data regarding TSH secretion studied taking the existence of DM into consideration. Therefore, we investigated the TSH response to TRH [expressed as TSH increment (delta TSH)] in 14 untreated acromegalic patients, who did not show the suprasellar extension of adenoma, divided into two groups on the basis of either presence or absence of uncontrolled DM, and in 28 normal subjects. The mean max delta TSH was significantly reduced (p less than 0.02) in acromegalic patients despite similar mean serum T4 and free T4 index (FT4l) levels. Furthermore, the mean basal and max delta TSH in 7 patients with DM (FBS, 120-300 mg/dl; HbA1, 8.8-15.2%) were significantly lower than those in 7 patients without DM (p less than 0.05 and p less than 0.02, respectively) despite similar the mean serum T3, T4, FT4l, growth hormone (GH) and prolactin (PRL) levels and sellar volume. In 4 patients with DM the TSH response to TRH 6-8 weeks after insulin therapy, when their HbA1 levels were normal, increased compared to that before insulin therapy. The mean max delta TSH after selective adenomectomy in 8 patients (3 in DM group and 5 in non-DM group), whose fasting basal GH fell to less than 5 ng/ml, was almost identical to that in normal subjects. In conclusion, the present study suggests that the abnormality in TSH secretion in acromegalic patients may be increased by the existence of uncontrolled DM.
在未控制的糖尿病（DM）患者中，已证实促甲状腺激素（TSH）对促甲状腺激素释放激素（TRH）的反应受损。然而，在肢端肥大症患者中，尚未有考虑到DM存在的情况下对TSH分泌进行研究的数据。因此，我们在14例未接受治疗的肢端肥大症患者中研究了TSH对TRH的反应[以TSH增加值（△TSH）表示]，这些患者未显示腺瘤的鞍上扩展，根据是否存在未控制的DM分为两组，并与28名正常受试者进行了比较。尽管平均血清T4和游离T4指数（FT4I）水平相似，但肢端肥大症患者的平均最大△TSH显著降低（p<0.02）。此外，7例DM患者（空腹血糖，120 - 300mg/dl；糖化血红蛋白，8.8 - 15.2%）的平均基础和最大△TSH显著低于7例无DM患者（分别为p<0.05和p<0.02），尽管平均血清T3、T4、FT4I、生长激素（GH）和催乳素（PRL）水平以及蝶鞍体积相似。4例DM患者在胰岛素治疗6 - 8周后，当糖化血红蛋白水平正常时，其对TRH的TSH反应较胰岛素治疗前增加。8例患者（DM组3例，非DM组5例）在选择性腺瘤切除术后，空腹基础GH降至低于5ng/ml，其平均最大△TSH与正常受试者几乎相同。总之，本研究表明，未控制的DM的存在可能会增加肢端肥大症患者TSH分泌异常。
