Sazonova D V, Perepelova M A, Shutova A S, Nikankina L V, Kolesnikova G S, Pigarova E A, Dzeranova L K
Endocrinology Research Centre.
Probl Endokrinol (Mosk). 2024 Nov 5;70(5):34-39. doi: 10.14341/probl13390.
Laboratory diagnostic methods are the main tools in the practice of a doctor of any specialty, including an endocrinologist. Factors were identified that could change the concentration of the biologically active fraction of the test substance, subsequently complicating the interpretation of laboratory results and making the right clinical decision. The literature describes a variety of circulating autoantibodies involved in binding to pituitary hormones (prolactin (PRL), thyroid-stimulating hormone (TSH), growth hormone, luteinizing, follicle-stimulating, and adrenocorticotropic hormones), hypothalamus (vasopressin and oxytocin), pancreas (insulin and glucagon) , parathyroid glands (parathyroid hormone), as well as with thyroid hormones. As a rule, the resulting macromolecules lead to an increase in laboratory parameters, in which the prevailing fraction of the hormone does not have biological activity, which determines the main problem of this phenomenon. The most common variants include immune complexes with PRL and TSH, causing the phenomena of macroprolactinemia and macrothyrotropinemia (macro-TSH-emia/macro-TSH), respectively. Most laboratory test systems used in clinical practice are capable of determining only the total amount of PRL and TSH. The presented clinical observation describes a combination of the phenomena of macro-TSH and macroprolactinemia in a patient with autoimmune thyroiditis (AIT) and vitiligo.
实验室诊断方法是包括内分泌科医生在内的任何专科医生临床实践中的主要工具。已确定了一些因素，这些因素可能会改变被测物质生物活性部分的浓度，进而使实验室结果的解读变得复杂，并影响做出正确的临床决策。文献中描述了多种循环自身抗体，它们可与垂体激素（催乳素（PRL）、促甲状腺激素（TSH）、生长激素、黄体生成素、卵泡刺激素和促肾上腺皮质激素）、下丘脑（抗利尿激素和催产素）、胰腺（胰岛素和胰高血糖素）、甲状旁腺（甲状旁腺激素）以及甲状腺激素结合。通常，由此产生的大分子会导致实验室参数升高，其中占主导的激素部分不具有生物活性，这就决定了这一现象的主要问题。最常见的变体包括与PRL和TSH形成的免疫复合物，分别导致巨催乳素血症和巨促甲状腺激素血症（巨TSH血症/巨TSH）现象。临床实践中使用的大多数实验室检测系统只能测定PRL和TSH的总量。本文所呈现的临床观察描述了一名自身免疫性甲状腺炎（AIT）和白癜风患者同时出现巨TSH和巨催乳素血症的情况。
