中枢甲状腺功能障碍与格雷夫斯病结合:病例系列和文献综述
Caiyan Mo1, Han Chen1, Qi Zhang1
1Department of Endocrinology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
European thyroid journal
|August 21, 2023
概括
中枢甲状腺功能障碍症,通常是由TSH分泌的垂体腺瘤 (TSHoma) 或对甲状腺激素β (RTHβ) 的抵抗引起的,很少与格雷夫斯病 (GD) 共存. 这项研究介绍了GD与中央甲状腺功能障碍结合的病例,突出了诊断方面的挑战.
科学领域:
- 内分泌学 在内分泌学.
- 内部医学 内部医学
- 下垂体疾病 下垂体疾病
背景情况:
- 中枢甲状腺功能障碍症涉及高甲状腺激素与未抑制的TSH,源于TSH分泌的垂体腺瘤 (TSHoma) 或对甲状腺激素β (RTHβ) 的抵抗.
- 中枢甲状腺功能障碍和格雷夫斯病 (GD) 的同时发生很少被记录下来.
研究的目的:
- 报告罕见的格雷夫斯病与中央甲状腺功能障碍并存的病例.
- 为了阐明与这些结合的内分泌条件相关的诊断和治疗复杂性.
主要方法:
- 病例系列描述了三名TSHoma和GD患者,以及一名GD和RTHβ患者.
- 使用甲状腺功能测试,TSH受体抗体测量,垂体成像 (MRI) 和RTHβ.的遗传测试.
主要成果:
- 患有TSHoma和GD的患者呈现高甲状腺激素,正常/高TSH,以及阳性TSH受体抗体.
- 患有GD和RTHβ的患者在治疗后显示出矛盾的TSH升高,由遗传突变 (c.1148G>A,p.R383H) 证实.
- 在甲状腺毒性控制后,对TSHoma病例进行了外科干预 (转形手术).
结论:
- 强调在患有不一致的甲状腺功能测试表明中央甲状腺功能过高的患者中考虑GD的重要性.
- 为复杂的中央甲状腺功能障碍和格雷夫斯病共存的复杂情景提出了临床管理策略.
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