Fan Linling, Wang Zhihong, Sun Wanwan, Cui Qiaoli, Wu Wei, Xiang Boni, Ma Zengyi, Wu Yue, Wang Yongfei, Zhang Zhaoyun, Li Yiming, He Min, Ye Hongying
Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China.
Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China.
Clin Endocrinol (Oxf). 2024 Sep;101(3):249-254. doi: 10.1111/cen.15066. Epub 2024 May 31.
Thyrotropin-secreting adenoma (TSHoma) is a rare type of pituitary adenoma, occurring in one per million people. Little is known about TSHoma. We summarized the demographic, clinical and hormonal characteristics of TSHoma based on a single-centre experience. Moreover, we explored the predictive value of postoperative thyroid function for long-term remission.
DESIGN, PATIENTS AND MEASUREMENTS: We retrospectively analysed 63 patients who were diagnosed as TSHoma and surgically treated at our hospital from January 2015 to June 2021. The preoperative clinical characteristics were analysed and compared between remission and nonremission groups. Thyroid function was measured at 1 day, 1 month, 3 months, 6 months, 12 months and over 12 months after surgery to determine whether they could predict long-term remission.
The male to female ratio for TSHoma was 1.25. The mean age at diagnosis was 45 ± 12 years. Clinical presentation was varied, presenting with hyperthyroidism (68.25%), space-occupying effect (15.87%), amenorrhea (7.14% of female patients) and nonsymptoms (22.22%). 88.14% of patients achieved postoperative endocrinological remission. Larger tumour size and tumour invasion into cavernous sinus and suprasellar with chiasmal compression were strong predictors of lower rates of endocrinological remission. Postoperative thyroid function at 3 months was a viable diagnostic predictor for postoperative remission, especially for FT4 level with a 20.65 pmol/L cutoff.
Tumour size and extent are major prognostic factors for remission. Postoperative thyroid function at 3 months could be used as a clinical prediction tool for long-term endocrinological remission.
促甲状腺素分泌腺瘤（TSH瘤）是一种罕见的垂体腺瘤，发病率为百万分之一。目前对TSH瘤了解甚少。我们基于单中心经验总结了TSH瘤的人口统计学、临床和激素特征。此外，我们探讨了术后甲状腺功能对长期缓解的预测价值。
设计、患者和测量方法：我们回顾性分析了2015年1月至2021年6月在我院诊断为TSH瘤并接受手术治疗的63例患者。分析并比较缓解组和未缓解组的术前临床特征。在术后1天、1个月、3个月、6个月、12个月及12个月以上测量甲状腺功能，以确定其是否能预测长期缓解。
TSH瘤的男女比例为1.25。诊断时的平均年龄为45±12岁。临床表现多样，表现为甲状腺功能亢进（68.25%）、占位效应（15.87%）、闭经（女性患者的7.14%）和无症状（22.22%）。88.14%的患者术后实现内分泌缓解。肿瘤体积较大以及肿瘤侵犯海绵窦和鞍上并压迫视交叉是内分泌缓解率较低的有力预测因素。术后3个月的甲状腺功能是术后缓解的可行诊断预测指标，尤其是游离甲状腺素（FT4）水平，临界值为20.65 pmol/L。
肿瘤大小和范围是缓解的主要预后因素。术后3个月的甲状腺功能可作为长期内分泌缓解的临床预测工具。
