TSH-secreting Pituitary Adenomas:Clinical Analysis Of Five Cases And Literature Review

Objective To analyse the clinical characteristics,treatment process and clinical outcomes of TSH-secreting pituitary adenomas(TSHomas).And through reviewing the relevant literature,to improve the understanding of the disease and summarize the diagnosis and treatment experience.Methods Collecting the clinical data of five patients of TSHomas diagnosed and treated in The First Affiliated Hospital of Guangxi Medical University from January 2011 to December 2018.Retrospectively analyse the diagnosis and treatment process of TSHomas,to discussion and summary the disease combination with domestic and foreign literatureResults 1.Among the 5 patients,4 were male and 1 female;The mean age at diagnosis was(28.60±3.78)years;course of disease ranging from two years to more than decade years.2.The initial clinical manifestation: Two cases of thyroid toxicosis,one case of hypogonadism and two cases of oncothlipsis symptoms.Four patients had thyroid enlargement,heart rate fast,and hand shaking.None of the 5 patients presented with anterior tibial mucus edema.,and no family history of thyroid-related diseases.3.T3,T4,FT3 and FT4 were elevated in all five patients,and nonsuppressed TSH levels;Thyroid antibodywas negative in four patients,and one case was not measured;One patient had microadenomas and three patients had macroadenomas,One patient had a large adenoma.4.Misdiagnosed as primary hyperthyroidism in the exceptional hospital,1 case of which was difficult to distinguish from thyroid hormone resistance syndrome.After clinical observation of the disease progress,the diagnosis was finally confirmed.5.Treatment:2 cases were treated with octreotide preoperatively,3 cases were treated with anti-thyroid drugs(ATD)preoperatively.All the 5 patients received surgical treatment.6.Postoperative pathological diagnosis of pituitary tumor,immunohistochemical results: 4 cases of TSH(+),1 case of TSH(-).7.cured one cases,treatment improved in three cases,lost to follow-up of One case.Conclusion 1.Patients with TSH tumors have a long course of disease and are often seen with high metabolic syndrome or intracranial mass effect.They are easily misdiagnosed as primary hyperthyroidism.2.If the clinical manifestations cannot be distinguished from thyroid hormone resistance syndrome,dynamic observation should be performed to make a clear diagnosis.3.The surgery is still first-line treatment,and the use of somatostatin analogues before surgery can be used as first-line drugs for perioperative treatment.