Section on Genetics and Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA.
Section on Translational Endocrinology, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA.
J Clin Endocrinol Metab. 2021 Mar 8;106(3):e1316-e1331. doi: 10.1210/clinem/dgaa858.
We do not fully understand how hypercortisolism causes central hypothyroidism or what factors influence recovery of the hypothalamic-pituitary-thyroid axis. We evaluated thyroid function during and after cure of Cushing syndrome (CS).
We performed a retrospective cohort study of adult patients with CS seen from 2005 to 2018 (cohort 1, c1, n = 68) or 1985 to 1994 (cohort 2, c2, n = 55) at a clinical research center. Urine (UFC) and diurnal serum cortisol (F: ~8 am and ~midnight [pm]), morning 3,5,3'-triiodothyronine (T3), free thyroxine (FT4), and thyrotropin (TSH) (c1) or hourly TSH from 1500 to 1900 h (day) and 2400 to 04000 h (night) (c2), were measured before and after curative surgery.
While hypercortisolemic, 53% of c1 had central hypothyroidism (low/low normal FT4 + unelevated TSH). Of those followed long term, 31% and 44% had initially subnormal FT4 and T3, respectively, which normalized 6 to 12 months after cure. Hypogonadism was more frequent in hypothyroid (69%) compared to euthyroid (13%) patients. Duration of symptoms, morning and midnight F, adrenocorticotropin, and UFC were inversely related to TSH, FT4, and/or T3 levels (r = -0.24 to -0.52, P < .001 to 0.02). In c2, the nocturnal surge of TSH (mIU/L) was subnormal before (day 1.00 ± 0.04 vs night 1.08 ± 0.05, P = .3) and normal at a mean of 8 months after cure (day 1.30 ± 0.14 vs night 2.17 ± 0.27, P = .01). UFC greater than or equal to 1000 μg/day was an independent adverse prognostic marker of time to thyroid hormone recovery.
Abnormal thyroid function, likely mediated by subnormal nocturnal TSH, is prevalent in Cushing syndrome and is reversible after cure.
我们不完全了解高皮质醇血症如何导致中枢性甲状腺功能减退症，也不知道哪些因素会影响下丘脑-垂体-甲状腺轴的恢复。我们评估了库欣综合征（CS）治疗期间和治疗后的甲状腺功能。
我们对 2005 年至 2018 年（队列 1，c1，n=68）或 1985 年至 1994 年（队列 2，c2，n=55）在临床研究中心就诊的成年 CS 患者进行了回顾性队列研究。检测尿游离皮质醇（UFC）和日间血清皮质醇（F：约 8 点和午夜[pm]）、清晨 3、5、3'-三碘甲状腺原氨酸（T3）、游离甲状腺素（FT4）和促甲状腺激素（TSH）（c1）或 1500 至 1900 小时（白天）和 2400 至 04000 小时（夜间）的 TSH（c2），在治愈性手术后进行测量。
在高皮质醇血症时，c1 的 53%患有中枢性甲状腺功能减退症（FT4 低/正常低+未升高的 TSH）。在长期随访的患者中，31%和 44%的患者 FT4 和 T3 最初亚正常，分别在治愈后 6 至 12 个月恢复正常。甲状腺功能减退患者的性腺功能减退症更为常见（69%）比甲状腺功能正常患者（13%）。症状持续时间、清晨和午夜 F、促肾上腺皮质激素和 UFC 与 TSH、FT4 和/或 T3 水平呈负相关（r=-0.24 至-0.52，P<0.001 至 0.02）。在 c2 中，TSH（mIU/L）的夜间激增在治愈前（白天 1.00±0.04 与夜间 1.08±0.05，P=0.3）和治愈后 8 个月左右正常（白天 1.30±0.14 与夜间 2.17±0.27，P=0.01）。UFC 大于或等于 1000μg/天是甲状腺激素恢复时间的独立不良预后标志物。
库欣综合征中常见甲状腺功能异常，可能由夜间 TSH 亚正常介导，且在治愈后可逆转。
Zotero 插件