The Diagnosis And Manangement Of 4 Cases Of Thyrotropin-secreting Pituitary Adenomas And Literature Review

Objective To summarize the clinical manifestations and management of thyrotropin-secreting pituitary adenomas?TSHomas?,and to improve the recognition of this diease,to discuss the methods diagnosing early and treating correctly.Methods The paper retrospectively analyzes the material of 4 cases of TSHomas patients admitted to the first affiliated hosipital of Dalian medical university from January 2011 to December 2016,including symptoms,signs,laboratory tests,imaging examination,pathological diagnosis,treatment and follow-up,To summarize the characteristics of TSHomas combining with domestic and foreign literature.Results1.The sex of 4 patients is 3 males and 1 female,the average age of them is 41years old,duration is 0.11-2 years.All patients are treated with thyrotoxicosis,with varying degrees of goiter.2 cases of Mobius sign is positive.3 cases of hand tremor sign is positive.1 case is slightly exophthalmic.None of them is with anterior tibial myxedema.2.Circulating serum free triiodothyronine?FT₃?is 10.04±2.32 pmol/L,free thyroxine ?FT₄?is 32.27±6.71 pmol/L,thyroid-stimulating hormone?TSH?is 7.77±4.05?IU/ml.Thyroid autoantibodys is negative.1 case of ACTH 65.19pg/ml,a little higher than normal.PRL,GH,ACTH,LH,FSH are normal.3.Pituitary magnetic resonance imaging prompt the area of TSHomas is 1.28×1.02³.20×2.70cm,1 case is invasive growth,1 case ectopic sphenoid sinus thyrotropin secreting pituitary adenomas.4.4 patients underwent transsphenoidal sinus pituitary adenoma resection,pathology postoperation certified pituitary adenoma,immunohistochemistry proved TSH?+?.5.1 patient postoperation is in stable condition,the illness state of 3 patients fluctuate,1 patient had the gamma knife and 1 patient takes antithyroid drug.Conclusions1.TSHomas is a rare cause of thyrotoxicosis.The clinical manifestations is thyrotoxicosis and mass effect.Elevated FT₃?FT₄ and non-suppressed TSH,thyroid autoantibodies are negative.MRI proves most TSHomas are large adenomas.2.The first-line therapy is transsphenoidal sinus pituitary adenoma resection.Somatostatin analogs is the first choice for preoperation and failure postoperation.3.The misdiagnosis and recurrence rate of TSHomas are high,which seriously affect the quality of life and prognosis of patients,so it is critical to early diagnosis and choose the appropriate treatment.