Gruñeiro-Papendieck L, Chiesa A, Martínez A, Heinrich J J, Bergadá C
Centro de Investigaciones Endocrinológicas, División de Endocrinología, Hospital de Niños R. Gutiérrez, Buenos Aires,
Horm Res. 1998;50(5):252-7. doi: 10.1159/000023286.
We studied, by means of TSH nocturnal secretion and TRH test, 42 children (4.2-19.9 years) with hypothalamic pituitary disorders and 24 healthy euthyroid children (5.7-15.4 years) as control group. Patients were divided according to their serum values of FT4 in group 1 (n = 27) with FT4 >/=10.3 pmol/l and group 2 (n = 15) with FT4 <10.3 pmol/l. TSH was measured by immunoradiometric assay. TSH nadir, TSH peak and TSH surge were calculated. Both groups differed significantly from control group in TSH surge values: group 1 (p < 0. 05), group 2 (p < 0.01). TRH test was abnormal in 11/27 patients of group 1 and 10/15 patients of group 2. In group 1, 7 patients had normal tests, 2 had abnormalities in both tests, 9 had only TSH nocturnal surge altered and 9 showed only TRH alterations. All patients of group 2 presented thyroid axis abnormalities. In conclusion, in patients with hypothalamic pituitary disorders with low FT4, no further investigation is required to demonstrate thyroid axis alterations, however in patients with normal FT4, nocturnal TSH secretion and TRH test may be required to evidence thyroid abnormalities.
我们通过促甲状腺激素（TSH）夜间分泌及促甲状腺激素释放激素（TRH）试验，对42例患有下丘脑 - 垂体疾病的儿童（4.2 - 19.9岁）以及24例健康的甲状腺功能正常儿童（5.7 - 15.4岁）作为对照组进行了研究。患者根据其血清游离甲状腺素（FT4）值分为两组：第1组（n = 27），FT4≥10.3 pmol/l；第2组（n = 15），FT4 < 10.3 pmol/l。采用免疫放射分析法测定TSH。计算TSH最低点、TSH峰值及TSH波动值。两组的TSH波动值与对照组相比均有显著差异：第1组（p < 0.05），第2组（p < 0.01）。第1组27例患者中有11例TRH试验异常，第2组15例患者中有10例异常。在第1组中，7例患者试验正常，2例两项试验均异常，9例仅夜间TSH波动改变，9例仅显示TRH改变。第2组所有患者均出现甲状腺轴异常。总之，对于下丘脑 - 垂体疾病且FT4低的患者，无需进一步检查即可证明甲状腺轴改变，然而对于FT4正常的患者，可能需要进行夜间TSH分泌及TRH试验以证实甲状腺异常。
