Losa M, Giovanelli M, Persani L, Mortini P, Faglia G, Beck-Peccoz P
Department of Neurosurgery, IRCCS San Raffaele, Ospedale Maggiore IRCCS, University of Milan, Italy.
J Clin Endocrinol Metab. 1996 Aug;81(8):3084-90. doi: 10.1210/jcem.81.8.8768879.
The recorded number of patients with central hyperthyroidism due to TSH-secreting pituitary adenoma doubled in the last few years after the introduction of ultrasensitive TSH assays in the assessment of thyroid function; however, information about the results and the criteria for cure after pituitary surgery is scanty. Seventeen patients with a TSH-secreting adenoma, diagnosed on the basis of detectable TSH levels in the face of high free thyroid hormone concentrations and pituitary lesion at neuroimaging, underwent pituitary surgery. Hypersecretion of other pituitary hormones was diagnosed in 5 of 17 patients. Four patients were initially misdiagnosed and treated with thyroid surgery or radioiodine therapy. The majority (86%) of hyperthyroid patients normalized thyroid hormone concentrations and regained euthyroidism, although pituitary imaging, alpha-subunit, and alpha-subunit/TSH molar ratio normalized in only 47%, 54%, and 58% of patients, respectively. Moreover, TSH secretion was normally suppressed by T3 in 40% of the patients. Interestingly, the finding of undetectable TSH levels 7 days after surgery was highly predictive of successful outcome. During long term follow-up, there was one relapse of hyperthyroidism. Early diagnosis of TSH-secreting adenomas permits a high rate of remission of hyperthyroidism after surgery. However, normalization of thyroid function alone does not necessarily reflect complete removal of the tumor, and more comprehensive criteria of cure based on pituitary imaging, hormone measurement, and suppression of TSH during T3 administration should be used. Lastly, all patients need an accurate long term follow-up to monitor the possible recurrence of the adenoma.
在评估甲状腺功能中引入超敏促甲状腺激素（TSH）检测方法后的过去几年里，因分泌TSH的垂体腺瘤导致的中枢性甲状腺功能亢进患者的记录数量增加了一倍；然而，关于垂体手术后的结果及治愈标准的信息却很少。17例因分泌TSH的腺瘤而被诊断的患者，其诊断依据是在游离甲状腺激素浓度升高且神经影像学显示垂体病变的情况下可检测到TSH水平，这些患者接受了垂体手术。17例患者中有5例被诊断出存在其他垂体激素分泌过多。4例患者最初被误诊并接受了甲状腺手术或放射性碘治疗。大多数（86%）甲状腺功能亢进患者的甲状腺激素浓度恢复正常并重新恢复甲状腺功能正常，尽管垂体影像学、α亚基以及α亚基/TSH摩尔比分别仅在47%、54%和58%的患者中恢复正常。此外，40%的患者中TSH分泌通常会被T3抑制。有趣的是，术后7天TSH水平检测不到这一发现对成功结果具有高度预测性。在长期随访中，有1例甲状腺功能亢进复发。分泌TSH腺瘤的早期诊断使得手术后甲状腺功能亢进的缓解率很高。然而，仅甲状腺功能正常并不一定反映肿瘤已被完全切除，应采用基于垂体影像学、激素测量以及T3给药期间TSH抑制情况的更全面的治愈标准。最后，所有患者都需要进行准确的长期随访以监测腺瘤可能的复发情况。
