Characteristics of pituitary-thyroid axis in patients with pituitary stalk interruption syndrome: An analysis of 89 cases
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摘要: 目的 分析垂体柄中断综合征(pituitary stalk interruption syndrome，PSIS)患者垂体-甲状腺轴激素特点。 方法 回顾性分析解放军总医院自2000 - 2013年收治的89例PSIS患者垂体-甲状腺轴激素特点。 结果 89例中71例(79.78%)发生中枢性甲减，血清促甲状腺激素(thyroid stimulating hormone，TSH)为(5.42±3.67) mU/L；18例甲状腺功能正常，TSH为(3.66±1.50) mU/L。中枢性甲减患者中29例(40.85%)TSH高于正常[(8.79±3.17) mU/L]，38例(53.53%)在正常范围内[(3.42±1.30) mU/L]，4例(5.63%)低于正常范围[(0.02±0.01) mU/L]；TSH升高组血清游离T4 (serum free T4，FT4)较TSH正常组略低，但差异无统计学意义[(7.90±1.38) pmol/L vs (8.08±1.42) pmol/L，P> 0.05)]。中枢性甲减伴TSH升高患者行甲状腺激素替代治疗后TSH降至正常[(7.24±0.98) mU/L vs (1.67±1.51) mU/L]。PSIS患者TSH水平与垂体高度及垂体柄状态不相关(P> 0.05)。 结论 PSIS所致中枢性甲减患者TSH升高比例更高，升高幅度更大。PSIS患者TSH升高与垂体柄的状态及垂体前叶高度无关，其原因可能为甲状腺激素的反馈抑制作用减弱致使垂体TSH细胞分泌了无生物活性的TSH。Abstract: Objective To analyze the characteristics of thyrotrophic axis and the influencing factors in patients with pituitary stalk interruption syndrome (PSIS). Methods Clinical data about 89 patients with PSIS admitted to Chinese PLA General Hospital from 2000 to 2013 were retrospectively analyzed. Results Of the 89 patients, 71 patients (79.78%) were diagnosed with central hypothyroidism based on FT4 levels lower than 10.4 pmol/L with the TSH level of 5.42±3.67 mU/L. The FT4 levels in the remaining 18 patients with no central hypothyroidism were close to the lower limit of reference range and the TSH was 3.66±1.50 mU/L. Of the 71 central hypothyroidism patients, TSH level in 29 patients (40.85%) was higher than 5.5 mU/L with a mean±SD of 8.79±3.17 mU/L, 38 patients (53.53%) was in the normal range with a mean±SD of 8.79±3.17 mU/L and 4 patients (5.63%) was lower than the normal level with a mean ±SD of 0.02±0.01 mU/L. The FT4 levels of the higher TSH group were slightly higher than that of normal TSH group, but there was no differences in statistics (7.90±1.38 pmol/L vs 8.08±1.42 pmol/L, P> 0.05). Elevated TSH level in the PSIS patients with central hypothyroidism decreased to normal after hormone replacement therapy (7.24±0.98 mU/ L vs 1.67±1.51 mU/L). TSH Level had no relationship with pituitary height and pituitary stalk (P> 0.05). Conclusion The ratio and amplitude of elevated TSH in PSIS induced central hypothyroidism patients are higher than that of the other causes of central hypothyroidism. The TSH level in PSIS patients is independent of the height of anterior pituitary and status of pituitary stalk, the possible reason is reduced thyroid hormone feedback inhibition stimulated the secretion of TSH with no biological activity.
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期刊类型引用(2)
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