在TSH分泌的垂体腺瘤中长期的外科治疗结果:无症状甲状腺功能增强症的隐藏负担
Jie Liu1,2, Jifang Liu1,2, Xiaofeng Chai2,3,4
1Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Endocrine
|June 8, 2025
概括
进行TSH分泌的垂体腺瘤 (TSHomas) 的手术治疗提供了良好的缓解率. 然而,无症状的TSHomas的缓解率较低,而CSF泄漏会增加并发症风险.
科学领域:
- 内分泌学 在内分泌学.
- 神经外科 神经外科
- 在瘤学瘤学.
背景情况:
- 甲状腺素 (TSH) 分泌的垂体腺瘤 (TSHomas) 是一种罕见的瘤,会导致甲状腺功能障碍.
- 对TSHomas的管理带来了重大的临床挑战.
研究的目的:
- 评估TSHoma患者的手术结果,缓解率和预测因素.
- 评估术后并发症及其相关风险因素.
主要方法:
- 177名TSHoma手术患者 (2001-2022) 的回顾性分析.
- 专注于152名患者的长期随访.
- 主要结局:缓解;次要结局:感染,下垂体.
主要成果:
- 整体缓解率为72.4%.
- 诸如Knosp 3-4级和超细胞延伸等瘤因素预测了非缓解.
- 无症状的TSHomas具有较低的缓解率 (54.1%) 和更大的瘤大小.
- 手术后的TSH水平和瘤直径是缓解的预测指标.
- 并发症包括中枢神经系统感染 (7.7%) 和下垂体 (15.1%).
- 脑脊液 (CSF) 泄漏显著增加了感染和下垂体病的风险.
结论:
- 对TSHomas的手术干预产生了一个有希望的缓解率.
- 无症状的TSHomas需要谨慎管理,因为缓解率较低.
- 脑液泄漏是术后并发症的一个重要危险因素.
相关概念视频
Hyperthyroidism I: Introduction
Hyperthyroidism is a type of thyrotoxicosis characterized by the thyroid gland's overproduction of the thyroid hormones triiodothyronine (T3) and thyroxine (T4). This hormone excess increases the basal metabolic rate and enhances sensitivity to catecholamines.DiagnosisDiagnosis is based on clinical features and biochemical testing. It typically shows suppressed thyroid-stimulating hormone (TSH) levels below 0.4 mIU/L, with elevated free T3 and/or T4. Additional tests, including thyroid...
Hyperthyroidism II: Pathophysiology
Hyperthyroidism is a hypermetabolic state caused by elevated levels of thyroid hormones, triiodothyronine (T3) and thyroxine (T4). It results from dysregulation at the thyroid, pituitary, or immune system level and affects multiple organ systems.PathophysiologyThe most common cause of hyperthyroidism is Graves’ disease, an autoimmune disorder in which antibodies, specifically thyroid-stimulating antibodies (TSAb), a subtype of TSH receptor antibodies (TRAb), bind to and activate TSH receptors...
Graves' Disease I: Introduction
Graves' disease is an autoimmune disorder that causes hyperthyroidism, or overactivity of the thyroid gland. It results from autoantibodies called thyroid-stimulating immunoglobulins (TSIs), which bind to thyroid-stimulating hormone (TSH) receptors, leading to overstimulation of hormone production and a hypermetabolic state.EtiologyAlthough considered idiopathic, Graves’ disease has well-established contributing factors. There is a strong genetic component, with increased prevalence in...
Graves Disease II: Pathophysiology
Graves’ disease is an autoimmune disorder characterized by the production of thyroid-stimulating immunoglobulins (TSI) that activate TSH receptors, leading to excessive synthesis and release of thyroid hormones (T3 and T4) and resulting in hyperthyroidism.Among all causes of hyperthyroidism, Graves’ disease is the most common and can happen at any age, though it is more frequent in women. It produces a hypermetabolic state with features such as weight loss, tachycardia, tremor, and heat...
Goiter
Goiter refers to an abnormal enlargement of the thyroid gland that may appear as a diffuse goiter (uniform enlargement) or nodular (single or multiple nodules). Functionally, it is classified as nontoxic (normal/low hormone levels) or toxic (excess hormone production).PathophysiologyDiffuse thyroid enlargement typically results from prolonged stimulation by thyroid-stimulating hormone (TSH) or TSH-like agents, commonly seen in hypothyroidism or iodine deficiency. In contrast, in hyperthyroid...
Hypothyroidism II: Pathophysiology
Hypothyroidism is a disorder characterized by insufficient production of thyroid hormones, which regulate metabolism, energy balance, and multiple organ systems.TypesHypothyroidism is classified based on the level of dysfunction. Primary hypothyroidism results from intrinsic thyroid gland dysfunction, causing reduced hormone production despite normal or increased stimulation. Secondary hypothyroidism arises from inadequate thyroid-stimulating hormone (TSH) secretion by the pituitary. Tertiary...


