Endocrinology and Metabolism Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Int J Neurosci. 2022 Feb;132(2):207-211. doi: 10.1080/00207454.2020.1803304. Epub 2020 Aug 5.
The syndrome of inappropriate thyroid-stimulating hormone (TSH) secretion is characterized by high circulating thyroid hormone concentrations in the presence of non-suppressed TSH. After exclusion of the laboratory interference, TSH-secreting pituitary adenoma (TSHoma) or resistance to thyroid hormone-beta (RTH-β) should be suspected. The presence of a pituitary adenoma on the hypothalamic-pituitary imaging supports the diagnosis of TSHoma. However, the incidental findings of non-functioning pituitary adenomas may appear in patients with RTH-β. Abnormal MRI finding in the RTH-β patient also includes pituitary enlargement from thyrotroph hyperplasia. We herein reported a patient with inappropriate TSH secretion who has pituitary hyperplasia mimicking TSHoma. This case illustrates the diagnostic tests to distinguish an RTH-β from TSHoma.
不适当的促甲状腺激素（TSH）分泌综合征的特征是循环中甲状腺激素浓度高，而 TSH 未被抑制。排除实验室干扰后，应怀疑是促甲状腺激素分泌垂体腺瘤（TSH 瘤）或甲状腺激素-β 抵抗（RTH-β）。下丘脑-垂体影像学上存在垂体腺瘤支持 TSH 瘤的诊断。然而，RTH-β 患者可能会出现无功能垂体腺瘤的偶然发现。RTH-β 患者的 MRI 异常发现还包括由于促甲状腺激素细胞增生导致的垂体增大。我们在此报告了一例表现为不适当 TSH 分泌的患者，其垂体增生类似于 TSH 瘤。该病例说明了用于区分 RTH-β 和 TSH 瘤的诊断性检查。
