肢端肥大症与非生长激素分泌垂体腺瘤患者甲状腺癌的患病率：一项前瞻性横断面研究。

Prevalence of thyroid cancer in patients with acromegaly and non-growth hormone secreting pituitary adenomas: A prospective cross-sectional study.

机构信息

SEMPR, Serviço de Endocrinologia e Metabologia, Departamento de Clínica Médica, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil.

出版信息

Growth Horm IGF Res. 2021 Feb;56:101378. doi: 10.1016/j.ghir.2021.101378. Epub 2021 Jan 12.

DOI:10.1016/j.ghir.2021.101378

PMID:33486451

Abstract

OBJECTIVE

To evaluate the prevalence of differentiated thyroid cancer (DTC) in patients with non-GH secreting pituitary adenomas [NGHPA group: non-functioning (NFPA), prolactin (PRL) and corticotropin (ACTH)-secreting adenomas] compared to patients with acromegaly, a pituitary disease that has been associated with increased risk for thyroid cancer.

PATIENTS AND METHODS

Prospective, cross-sectional study involving consecutive outpatients followed in our institution with diagnosis of acromegaly (n = 71; 43 women, median age 57 yrs) and NGHPA (n = 57; 38 women, median age 48 yrs.; PRL (n = 35), ACTH (n = 7), NFPA (n = 15). All participants were subjected to thyroid ultrasound (US) by the same examiner, and US-guided fine needle aspiration (FNA) biopsy when indicated.

RESULTS

Thyroid volume was higher in acromegaly than in NGHPA (median 12.5 ml vs 6.3 ml; p < 0.0001), and thyroid nodules were present in 27/71 (38.0%) of acromegaly patients and in 14/57 (24.6%) of NGHPA group. FNA was indicated in 15/27 (55.5%) of acromegaly patients [Bethesda I (n = 1); II (n = 11), III (n = 1), two patients refused FNA], and in 8/14 (57.1%) of the NGHPA group [Bethesda I (n = 2); II (n = 4); V (n = 1); VI (n = 1)]. The two patients of NGHPA group with Bethesda V and VI were operated and papillary carcinoma was confirmed histologically.

CONCLUSION

DTC was not detected in our acromegaly patients and its presence in patients with NGHPA suggests that DTC predisposition is not related to GH excess.

摘要

目的

评估非生长激素分泌性垂体腺瘤（NGHPA 组：无功能（NFPA）、催乳素（PRL）和促肾上腺皮质激素（ACTH）分泌腺瘤）患者中分化型甲状腺癌（DTC）的患病率与肢端肥大症患者相比，肢端肥大症是一种与甲状腺癌风险增加相关的垂体疾病。

患者和方法

这是一项前瞻性、横断面研究，涉及在我们机构连续就诊的肢端肥大症（n=71；43 名女性，中位年龄 57 岁）和 NGHPA（n=57；38 名女性，中位年龄 48 岁；PRL（n=35），ACTH（n=7），NFPA（n=15）患者。所有患者均由同一位检查者进行甲状腺超声（US）检查，并在有指征时进行 US 引导下细针抽吸活检（FNA）。

结果

肢端肥大症患者的甲状腺体积大于 NGHPA（中位数 12.5ml 比 6.3ml；p<0.0001），且 27/71（38.0%）的肢端肥大症患者和 14/57（24.6%）的 NGHPA 组患者存在甲状腺结节。在 15/27（55.5%）的肢端肥大症患者中，FNA 被认为是必要的[贝塞斯达 I（n=1）；II（n=11），III（n=1），两名患者拒绝 FNA]，而在 14/14（57.1%）的 NGHPA 组患者中[贝塞斯达 I（n=2）；II（n=4）；V（n=1）；VI（n=1）]。NGHPA 组中贝塞斯达 V 和 VI 的两名患者接受了手术，组织学证实为甲状腺乳头状癌。