Tanaka Y, Sawa H, Inden M, Kosaka Y, Takezawa H
Jpn J Med. 1981 Jul;20(3):222-6. doi: 10.2169/internalmedicine1962.20.222.
The availability of thyrotropin hormone (TRH) has made it possible to determine whether tropic hormone deficiency is caused by pituitary or hypothalamic dysfunction. A case of hypothalamic hypothyroidism was described ina a 17 year old woman. This patient was admitted for the evaluation of hypothyroidism and secondary amenorrhea. Her T3 and T4 were decreased, with an undetectable level of base line thyrotropin. the TRH test revealed normal but delayed response of TSH. Her base line prolactin and its response to TRH were normal. Adenocorticotropic hormone (ACTH), cortisol, growth hormone (GH), and urinary 17-hydroxysteroids were also normal. ACTH response to metyrapone was normal. Evaluation of the pituitary-gonadal axis revealed a normal increase in both lutenizing hormone (LH) and follicle stimulating hormone (FSH) following the intravenous administration of lutenizing hormone releasing hormone (LHRH). These results suggest that she had hypothalamic hypothyroidism as an isolated disturbance in the hypothalamic-pituitary axis. A deficiency of TRH is probably caused by a disorder of hypothalamic function of unknown etiology since the extensive studies did not reveal any secondary causes. It is recommended that patients with amenorrhea and hypothyroidism be evaluated for possible hypothalamic hypothyroidism.
促甲状腺激素（TRH）的可获得性使得确定促激素缺乏是由垂体功能障碍还是下丘脑功能障碍引起成为可能。本文描述了一名17岁女性下丘脑性甲状腺功能减退症的病例。该患者因甲状腺功能减退症和继发性闭经入院评估。她的T3和T4降低，基线促甲状腺激素水平检测不到。TRH试验显示促甲状腺激素（TSH）反应正常但延迟。她的基线催乳素及其对TRH的反应正常。促肾上腺皮质激素（ACTH）、皮质醇、生长激素（GH）和尿17-羟类固醇也正常。ACTH对甲吡酮的反应正常。对垂体-性腺轴的评估显示，静脉注射促黄体生成素释放激素（LHRH）后，促黄体生成素（LH）和促卵泡生成素（FSH）均正常升高。这些结果表明，她患有下丘脑性甲状腺功能减退症，这是下丘脑-垂体轴的一种孤立性紊乱。由于广泛研究未发现任何继发原因，TRH缺乏可能是由病因不明的下丘脑功能障碍引起的。建议对闭经和甲状腺功能减退症患者进行评估，以确定是否可能患有下丘脑性甲状腺功能减退症。
