Horn K, Erhardt F, Fahlbusch R, Pickardt C R, Werder K V, Scriba P C
J Clin Endocrinol Metab. 1976 Jul;43(1):137-43. doi: 10.1210/jcem-43-1-137.
A 22-year-old woman with recurrent goiter, hyperthyroidism, galactorrhea, and amenorrhea due to a pituitary tumor is described. She had been treated surgically twice for recurrent goiter with tracheal compression. Despite clinical signs of hyperthyroidism and slightly elevated plasma thyroid hormone levels (T4: 11 mug/dl; T3: 189 ng/dl), without thyroid hormone replacement therapy the basal TSH level was elevated up to 23 muU/ml and could not be suppressed by exogenous thyroid hormones: even when the serum thyroid hormone levels were raised into the thyrotoxic range (T4: 16.2 mug/dl T3: 392 ng/dl), the basal TSH fluctuated between 12 and 29 muU/ml. The basal PRL level was elevated up to 6000 muU/ml. The administration of TRH (200 mug iv) led only to small increments of TSH and PRL levels. Bromocriptin (5 mg p.o.) or l-dopa (0.5 g p.o.) suppressed TSH and PRL values significantly. After transsphenoidal hypophysectomy, TSH and PRL were below normal and the patient development panhypopituitarism. The adenoma showed two cell types which could be identified as lactotrophs and thyrotrophs by electronmicroscopy and immunofluorescence. From these data we conclude that the patient had a pituitary tumor with an overproduction of thyrotropin and prolactin.
本文描述了一名22岁女性，因垂体瘤出现复发性甲状腺肿、甲状腺功能亢进、溢乳和闭经。她曾因复发性甲状腺肿伴气管受压接受过两次手术治疗。尽管有甲状腺功能亢进的临床体征且血浆甲状腺激素水平略有升高（T4：11μg/dl；T3：189ng/dl），但在未进行甲状腺激素替代治疗的情况下，基础促甲状腺激素（TSH）水平升高至23μU/ml，且不能被外源性甲状腺激素抑制：即使血清甲状腺激素水平升高至甲状腺毒症范围（T4：16.2μg/dl；T3：392ng/dl），基础TSH仍在12至29μU/ml之间波动。基础催乳素（PRL）水平升高至6000μU/ml。静脉注射促甲状腺激素释放激素（TRH，200μg）仅导致TSH和PRL水平小幅升高。溴隐亭（口服5mg）或左旋多巴（口服0.5g）可显著降低TSH和PRL值。经蝶窦垂体切除术后，TSH和PRL低于正常水平，患者出现全垂体功能减退。腺瘤显示出两种细胞类型，通过电子显微镜和免疫荧光可鉴定为催乳素细胞和促甲状腺激素细胞。根据这些数据，我们得出结论，该患者患有垂体瘤，伴有促甲状腺激素和催乳素分泌过多。
