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目的比较分析垂体促甲状腺激素(TSH)分泌瘤的临床特点。方法回顾性比较解放军总医院2006年2月-2016年10月与上海华山医院2006年4月-2013年4月分别收治的26例和20例TSH分泌瘤患者的一般资料、临床特点、实验室检查、影像学表现和病理结果。结果解放军总医院患者中女性略多于华山医院[57.7%(15/26)vs.45.0%(9/20)],两组诊断时年龄相当[39.5±14.1(18~67)岁vs.40.0±14.5(17~74)岁]。患者就诊的首要原因均为甲状腺毒症[73.1%(19/26)vs.55.0%(11/20)],轻中度甲状腺肿是最常见体征。解放军总医院和华山医院患者血清TSH水平分别为5.06(2.97~6.27)m U/L和6.16(3.76-10.91)m U/L,TSH水平正常者以解放军总医院多见[57.7%(15/26)vs.40.0%(8/20)],华山医院则以TSH水平升高者多见。解放军总医院患者中微腺瘤相对多见[34.6%(9/26)vs.20.0%(4/20)],华山医院则以巨大腺瘤多见[20.0%(4/20)vs.7.7%(2/26)];两组微腺瘤均多见于女性,分别为66.7%(6/9)和75.0%(3/4),巨大腺瘤则均为男性。大腺瘤常常向周围组织和结构侵袭。两组患者奥曲肽抑制试验中24h时TSH抑制率范围相当,分别为37.4%~91.8%和46.5%~94.1%。两组所有经病理证实的患者中混合瘤少见。解放军总医院8例行免疫组化检查者中3例TSH阴性,12例行奥曲肽扫描者中2例阴性。结论两家医院TSH分泌瘤患者临床上既有共性,也存在明显差异。总体上,国内TSH分泌瘤发病无明显性别差异,诊断时年龄明显小于国外资料;微腺瘤多见于女性,巨大腺瘤男性多见;血清TSH水平可正常,免疫组化TSH染色和奥曲肽扫描可阴性。
Objective To compare the clinical characteristics of thyroid stimulating hormone (TSH) secreting tumor in pituitary. Methods Retrospectively compare the general data, clinical features, laboratory of 26 cases and 20 cases of TSH secreting tumor admitted to PLA General Hospital from February 2006 to October 2016 with Shanghai Huashan Hospital from April 2006 to April 2013 respectively. Examination, imaging findings and pathological findings. Results There were slightly more women in PLA general hospital than those in Huashan Hospital [57.7% (15/26) vs 45.0% (9/20)], with a mean age of 39.5 ± 14.1 (18-67) vs. 40.0 ± 14.5 (17 ~ 74) years old]. The primary reason for treatment was thyrotoxicosis [73.1% (19/26) vs.55.0% (11/20)]. Mild to moderate goiter was the most common sign. Serum TSH levels were 5.06 (2.97 ~ 6.27) mU / L and 6.16 (3.76-10.91) mU / L respectively in People’s Liberation Army General Hospital and Huashan Hospital. People with normal TSH level were more common in People’s Liberation Army General Hospital [57.7% (15 / 26) vs.40.0% (8/20)], Huashan Hospital is more common in patients with elevated TSH levels. People’s Liberation Army General Hospital patients were more common in the micro-adenoma (34.6% (9/26) vs.20.0% (4/20)], Huashan Hospital with a large adenoma more common [20.0% (4/20) vs.7.7 % (2/26)]. The two groups of micro-adenomas were more common in women, which were 66.7% (6/9) and 75.0% (3/4) respectively, while the giant adenomas were all male. Large adenomas often attack the surrounding tissues and structures. In the two groups of patients, the inhibition rate of TSH in the octreotide inhibition test ranged from 37.4% to 91.8% and 46.5% to 94.1%, respectively. Mixed tumors were rare in both groups of patients with pathologically confirmed disease. Three cases of TSH were negative in 8 of the PLA general hospitals and two of 12 patients undergoing octreotide scanning. Conclusion The TSH secretion tumor patients in both hospitals have both common features and obvious differences. Overall, there was no significant gender difference in the incidence of TSH in China, and the age at diagnosis was significantly less than that in foreign countries. Micro-adenomas were more common in women than in men with huge adenomas. Serum TSH levels were normal, immunohistochemical TSH staining and octreotide scanning negative.