垂体促甲状腺素腺瘤探究进展.doc

垂体促甲状腺素腺瘤探究进展 　　[摘要] 垂?w促甲状腺素腺瘤（thyrotropinomas，TSH瘤）是来源于垂体促甲状腺细胞的肿瘤。此种垂体瘤发病率较低，自首例TSH瘤报道至今全球报道的病例数约450多例。TSH瘤的临床表现为甲状腺功能亢进症。实验室检查可见甲状腺激素水平增高，促甲状腺激素水平不被抑制。垂体核磁（Magnetic resonance imaging，MRI）提示鞍区占位。目前首选治疗方法为经碟手术切除肿瘤，此外还有放射治疗、药物治疗。但TSH瘤多为侵袭性肿瘤，单一手术难以彻底治愈，所以多采用手术结合药物进行治疗，与单一药物治疗TSH瘤的方法被国内外医生广泛重视。目前国内外有关于手术结合药物治疗的报道不占少数，但关于单一运用药物治疗TSH瘤的报道甚少 [关键词] 垂体促甲状腺素腺瘤；弥漫性毒性甲状腺肿；甲状腺激素抵抗 [中图分类号] R736 [文献标识码] A [文章编号] 1673-9701（2016）33-0165-04 [Abstract] Pituitary thyrotropinoma（TSH） adenoma is a tumor derived from pituitary thyrotropin-secreting cells. The incidence of this pituitary tumor is low， and since the first case of TSH adenoma， there have been reported over 450 cases around the world. The clinical manifestation is hyperthyroidism. Laboratory tests show increased thyroid hormone levels， and non-inhibition of thyrotropin levels. Pituitary magnetic resonance imaging（MRI） suggests a sellar region lesion. At present the preferred treatment is transsphenoidal surgical resection. In addition， there are radiation therapy and drug therapy. However， TSH tumors are mostly invasive tumors， and a single operation is difficult to completely cure it. Therefore， surgery combined with drug therapy， with a single drug treatment of TSH tumor is prioritized by domestic and foreign doctors. At present， there are a substantial number of reports about the combination of surgery and drug therapy， but there is little report about the treatment of TSH with single drug. [Key words] TSH； Graves’ disease； Resistance to thyroid hormones 自1960年提出首例垂体促甲状腺素腺瘤（thyrotropinomas，TSH瘤）患者后，国内外少有类似病例的报道。近年来随着超敏TSH测定的发展，TSH瘤的诊断率较之前提高。同时随着实验技术的发展，为TSH瘤提出了新的诊断依据。目前随着生长抑素类似物的应用，其在诊断及治疗方面的作用被临床医生接受。本文就其流行病学、病理、病理生理、临床表现、诊断、鉴别诊断及新型治疗方案展开论述 1 流行病学 1960年，Jailer、Holub报道了首例甲状腺亢进症和X线片上蝶鞍占位的患者，并提出其病因是促甲状腺激素的不适当分泌，后来证明是一种可以分泌促甲状腺激素的垂体瘤导致的[1]。1960年首次提出了甲状腺激素不适当分泌后，在1970年Hamilton应用放免法测定促甲状腺激素并首次报道了TSH瘤[2]。这种肿瘤发病率极低，有报道为百万分之一[3] 2 病理、生理 垂体腺瘤约占颅内肿瘤的10%，其中TSH瘤是发病率最低的一种分型，仅占垂体腺瘤的1%，这可能与促甲状腺细胞约占腺垂体细胞总数的5%有关[