罕见的甲状腺毒症:分泌促甲状腺激素的垂体腺瘤

M. A. Telegina, Zhanna Evgen'evna Belaya
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摘要

甲亢最常见的原因是甲状腺自身免疫性疾病或多结节毒性甲状腺肿,但也可能是分泌促甲状腺激素的垂体腺瘤引起的。在这些腺瘤存在的情况下,即使促甲状腺激素水平升高,循环游离 T3 和 T4 水平也会在没有抑制的情况下升高。对仅测量促甲状腺激素的研究结果进行不正确的解释会导致错误的诊断和患者管理策略,包括不必要的手术或放射性碘治疗。这可能会导致垂体瘤的生长。已有多种检测方法被用于诊断垂体瘤,但没有一种方法被证明是有效的。只有结合脑垂体核磁共振成像进行实验室检查,才能准确诊断和治疗。在选择治疗产生促甲状腺激素的垂体腺瘤的方法时,优先考虑经蝶窦腺瘤切除术这种手术方法。如果无法进行手术或手术效果不佳,则使用体生长抑素类似物来使促甲状腺激素水平恢复正常。在某些情况下,可以在神经外科手术前使用体生长抑素类似物疗法。在特殊情况下,可以像治疗其他类型的腺瘤一样使用放射治疗。
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Rare forms of thyrotoxicosis: thyrotropin-secreting pituitary adenomas
Thyrotoxicosis most often occurs due to autoimmune diseases of the thyroid gland or a multi-nodular toxic goiter, but it can also be caused by TSH-secreting pituitary adenomas. In the presence of these adenomas, the levels of circulating free T3 and T4 increase in the absence of suppression, even with elevated TSH levels. Incorrect interpretation of results from studies that only measure TSH can lead to erroneous diagnoses and management strategies for patients, including unnecessary surgery or radioactive iodine therapy. This can contribute to the growth of pituitary tumors. Various tests have been used to try to diagnose them, but none have proven to be eff ective. Only laboratory tests in combination with MRI of the pituitary can accurately diagnose and prescribe treatment. When choosing a treatment for TSH-producing pituitary adenomas, preference is given to the surgical method of transsphenoidal adenomectomy. If surgery is not possible or eff ective, the method used to normalize TSH levels is to prescribe somatostatin analogs. In some cases, it is possible to use somatostatin analog therapy before neurosurgery. In exceptional circumstances, radiation therapy may be used, as with other types of adenomas.
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