Med J Chin PLA, Vol. 42, No. 7, July 1, 2017 591 [ ] (TSH) 2006 2 2016 10 2006 4 2013 4 26 20 TSH [57.7%(15/26) vs. 45.0% (9/20)] [39.5 14.1(18~67) vs. 40.0 14.5(17~74) ] [73.1%(19/26) vs. 55.0%(11/20)] TSH 5.06(2.97~6.27)mU/L 6.16(3.76-10.91)mU/L TSH [57.7%(15/26) vs 40.0%(8/20)] TSH [34.6%(9/26) vs. 20.0%(4/20)] [20.0%(4/20) vs. 7.7%(2/26)] 66.7%(6/9) 75.0%(3/4) 24h TSH 37.4%~91.8% 46.5%~94.1% 8 3 TSH 12 2 TSH TSH TSH TSH [ ] [ ] R736.4 [ ] A [ ] 0577-7402(2017)07-0591-06 [DOI] 10.11855/j.issn.0577-7402.2017.07.03 A comparative study of the clinical features of thyrotropin-secreting pituitary adenomas FAN Xiao-jing, ZANG Li, JIN Nan, DU Jin, WANG Lin, GU Wei-jun, CHEN Kang, YANG Guo-qing, GUO Qing-hua, WANG Xian-ling, LV Zhao-hui *, BA Jian-ming, DOU Jing-tao, MU Yi-ming Department of Endocrinology, Chinese PLA General Hospital, Beijing 100853, China * Corresponding author, E-mail: metabolism301@126.com [Abstract] Objective To comparatively analyze the clinical characteristics of thyrotropin-secreting pituitary adenomas (TSH-omas). Methods The clinical features, laboratory variables, imaging and pathological results were retrospectively compared and analyzed of 26 cases with TSH-omas admitted in Chinese PLA General Hospital from Feb. 2006 to Oct. 2016 and 20 cases with TSH-omas admitted in Shanghai Huashan Hospital from Apr. 2006 to Apr. 2013. Results The female ratio was slightly higher in patients of Chinese PLA General Hospital than in Huashan Hospital [(57.7%(15/26) vs. 45.0%(9/20)], while the mean age was similar [39.5 14.1(18-67 years) vs. 40.0 14.5(17-74 years)]. The most common chief complaint was thyrotoxicosis [73.1%(19/26) vs. 55.0%(11/20)], and mild-to-moderate goiter was the most common symptom. The mean serum TSH levels in Chinese PLA General Hospital and in Huashan Hospital were 5.06(2.97-6.27)mU/L and 6.16(3.76-10.91)mU/L respectively, and patients with normal serum TSH levels were more common in Chinese PLA General Hospital than in Huashan Hospital [57.7%(15/26) vs. 40.0%(8/20)]. Microadenoma was more common in Chinese PLA General Hospital than in Huashan Hospital [34.62%(9/26) vs. 20.0%(4/20)], while macroadenoma was more common in Huashan Hospital than in Chinese PLA General Hospital [20.0%(4/20) vs. 7.7%(2/26)]. Microadenoma was more common in female patients of the both groups [66.7%(6/9) vs. 75.0%(3/4)], while macroadenoma was all found in male patients. Tumor invasion of surrounding tissue and structure was often found in macroadenoma. In terms of octreotide inhibition test, the range of 24h TSH inhibition rate was roughly the same in the two groups (37.4%-91.8% and 46.5%-94.1%, respectively). Mixed adenoma was rare among all the pathologically confirmed cases. In [ ] [ ] 100853 ( ) [ ] E-mail metabolism301@126.com
592 2017 7 1 42 7 Chinese PLA General Hospitals, TSH immunoreactive negative neoplastic cells were found in 3 of 8 cases, and octreotide scanning showed negative in 2 of 12 cases. Conclusions Patients with TSH-omas in the two hospitals show similarities but also some significant differences in the clinical features. Overall, the domestic patients with TSH-omas are diagnosed without gender difference according to the reports in China. The mean age at diagnosis is significantly younger than that in foreign data. Microadenoma is more common in females, while macroadenoma is more common in males. Serum TSH levels can be normal in patients with TSHomas. Immunostaining and/or octreotide scanning for TSH can be negative. [Key words] thyrotropin-secreting pituitary adenoma; hyperthyroidism; pituitary neoplasma; clinical characteristics (TSH) 0.5%~2.8% [1] 1960 Jailer 450 [2] 1981 [3] 1 TSH [4] TSH 10 TSH 20 [4-6] TSH 2006 2 2016 10 2006 4 2013 4 26 20 TSH [5] 1 1.1 2006 2 2016 10 26 TSH 2006 4 2013 4 20 TSH ( ) TSH ~ [1-2] ( ) FT 3 FT 4 TSH ( ) (TRH) T 3 TSH [5] 1.2 1.2.1 [TSH (GH) (LH) (FSH) (PRL) (ACTH)] PRL FSH LH GH ACTH 1.2.2 8 00 16 00 20 00 0.1mg 1 2 4 6 8 24h TSH 1.2.3 MRI ( )CT 1.3 SPSS 16.0 x±s M(Q) Student-t (%) χ 2 Fisher's P<0.05 2 2.1 26 TSH ( 11 15 ) 20 ( 11 9 ) [39.5 14.1(18~67) 40.0 14.5(17~74) P>0.05] 5 4 15 ( 1) TSH 73.1%(19/26) 55.0%(11/20) 12 1 8 4 ( 1)
Med J Chin PLA, Vol. 42, No. 7, July 1, 2017 593 1 Tab.1 Comparison of clinical data, chief complaint and goiter between subjects in Chinese PLA General Hospital and Shanghai Huashan Hospital Item Chinese PLA General Hospital (n=26) Shanghai Huashan Hospital (n=20) t/χ 2 P value Age (year) 39.5 14.1(18-67) 40.0 14.5(17-74) 0.115 0.909 Male/Female 11/15 11/9 0.730 0.393 Disease course [n(%)] 1.434 a 0.231 <1 year 12(46.2) 7(35.0) 1-5 year 10(38.5) 6(30.0) 6-10 year 3(11.5) 3(15.0) >10 year 1(3.8) 4(20.0) Chief complaint [n(%)] Thyrotoxicosis 8(30.8) 9(45.0) SEM 4(15.4) 4(20.0) Thyrotoxicosis and SEM 7(26.9) 2(10.0) Goiter 1(3.9) 1(5.0) Goiter and SEM 3(11.5) 1(5.0) Pituitary incidentaloma 3(11.5) 3(15.0) Goiter Grading [n(%)] 6.398 b 0.011 N 18(69.2) 8(40.0) 4(15.4) 2(10.0) 4(15.4) 7(35.0) 0(0) 3(15.0) SEM. Symptoms of expanding mass; N. No goiter. a. Disease course was divided into 5 years and >5 years when performed by continuity correction formula; b. Goiter grading was divided into grade and > grade when performed by Pearson Chi-square test 2.2 2.2.1 TSH 5.06(2.97~6.27)mU/L TSH [6.12(4.52~8.81)mU/L 3.14(2.55~5.84)mU/L P =0.040] TSH 6.16(3.76~10.91)mU/L TSH [6.04(3.74~10.41)mU/L vs. 6.27(3.30~12.36)mU/L P>0.05] TSH 15 8 TSH 11 12 TSH [57.7%(15/26) vs. 40.0%(8/20)] TSH TSH (P>0.05) 2 TSH 30%(6/20)TPOAb 10%(2/20)TgAb 14 TRAb 15 2 TPOAb Tg Ab 1 TRAb 2.2.2 4 PRL 3 PRL 45.17 g/l 46.94 g/l 69.33 g/l( 2.8~29.2 g/l) 2 1 TSH/ PRL 1 1 1 PRL 21.36 g/l ( 2.10~17.70 g/l) TSH 1 PRL 33.63 g/l( 3.86~22.80 g/l) 1 FSH 15.60U/L( 1.50~12.40U/L) ACTH GH LH 2.2.3 9 24h TSH 37.4%~91.8% 46.5%~94.1% 2.3 2 CT MRI [34.6%(9/26) vs. 20.0%(4/20)] [20.0%(4/20) vs. 7.7%(2/26)] 46mm 54mm( 2) 17 10mm 82.4% (14/17) ( 1) 9 9 8 8 3
594 2017 7 1 42 7 2 Tab.2 Comparison of laboratory data and imaging features between subjects in PLA General Hospital and Shanghai Huashan Hospital Item Chinese PLA General Hospital (n=26) Shanghai Huashan Hospital (n=20) Z/χ 2 P value TSH level (mu/l) 5.06(2.97-6.27) 6.16(3.76-10.91) 1.640 0.101 TSH group Normal TSH level 3.10(2.33-4.54) 3.32(2.32-4.42) 0.000 1.000 Elevated TSH level 6.71(5.88-9.65) 10.02(6.39-13.34) 1.723 0.085 Thyroid hormones (pmol/l) FT 3 9.69(8.71-12.29) 9.22(7.06-13.85) 0.665 0.506 FT 4 28.90(26.68-34.96) 30.05(24.83-44.56) 0.510 0.610 Octreotide suppression test (%) Inhibition rate of TSH 37.39-91.80 46.50-94.10 Inhibition rate of FT 4 11.79-26.35 6.00-28.80 Inhibition rate of FT 3 19.28-24.32 12.30-40.20 Imaging feature (mm) Tumor size 14.00(6.88-26.00) 19.50(10.25-34.75) 1.110 0.267 Microadenoma (<10) 9(34.6) 4(20.0) 1.191 0.275 Macroadenoma (10 39) 15(57.7) 12(60.0) Giant adenoma ( 40) 2(7.7) 4(20.0) Normal reference range in Chinese PLA General Hospital: FT 3 : 2.76-6.30pmol/L; FT 4 : 10.42-24.32pmol/L; TSH: 0.35-5.50mU/L. Normal reference range in Shanghai Huashan Hospital: FT 3 : 3.50-6.50pmol/L; FT 4 : 11.50-22.70pmol/L; TSH: 0.55-4.78mU/L Sagittal plane Coronal plane 1 MRI Fig.1 MRI image of pituitary macroadenoma 12 10 2 4 5 1 1 1 ( 3) 2.4 26 14 8 2 TSH(+) 3 (TSH+PRL TSH+GH+LH TSH+FSH 1 ) 3 TSH ( 1 ACTH GH PRL FSH ) 15 TSH 13 TSH+FSH 1 TSH+PRL l 3 Tab.3 Results of octreotide scanning and octreotide suppression test in patients of PLA General Hospital Case Gender Age (year) Octreoscan TM Imaging Tumor size (mm) TSH inhibition rate (%) TSH baseline (mu/l) 1 Female 54 ( ) Micro 7 67.68 9.65 2 Female 52 ( ) Macro 10 64.79 4.54 3 Male 43 (+) Macro 20 80.96 7.34 4 Male 47 (+) Giant 46 74.89 5.17 5 Male 29 (+) Macro 23 54.00 4.52 6 Female 59 (+) Micro 6.5 37.39 2.97 7 Female 45 (+) Micro 6 66.82 2.55 8 Male 54 (+) Micro 5 None 3.63 9 Female 66 (+) Micro 6 None 2.33 10 Female 48 (+) Macro 21 None 5.88 11 Female 28 (+) Macro 10 None 5.84 12 Male 39 (+) Macro 13 None 5.18 13 Male 50 None Macro 26 91.80 5.88 14 Female 38 None Micro 5 73.37 3.10
Med J Chin PLA, Vol. 42, No. 7, July 1, 2017 595 3 40%~45% TSH TSH 0.5%~2.8% [1] TSH 0.6%(26/4162) 2008 1.2%(12/1000) [7] 2011 1.0% (19/1849) [8] TSH 50~60 [1,9] 39.5 14.1 40.0 14.5 ( 41.2 40.5 ) [7-8] TSH 16 51.6 13.2 [10] TSH TSH [9] [11-13] [14-15] (57.7%) (55.0%) [7] [8] [10] ( : =49:44) TSH TSH TSH 3.14(2.55~5.84)mU/L 6.12(4.52~8.81)mU/L (P=0.040) TSH 6.27(3.30~12.36)mU/L 6.04(3.74~10.41)mU/L(P>0.05) 34.6%(9/26) 66.7%(6/9) 20.0%(4/20) 75.0%(3/4) 2 4 TSH ( ) TSH TSH TSH 90% [15] TSH TSH [10] 2 4 2 2 42 48 4 2 TSH PRL 5%~10% [16] TSH PRL (Pit-1) TSH PRL (TRH) PRL TSH TSH TSH Beck- Peccoz [1] Socin [14] 30% 58% TSH TSH [ 40.0%(8/20) 57.7%(15/26)] 75.0%(12/16) [10] 15.8%(3/19) [8] TSH TSH TSH TSH TSH [2] TSH [ 2.97(2.44~6.22)mU/L vs. 5.57(4.53~6.42)mU/L 6.94(3.20~12.13)mU/L vs. 5.99(3.76~10.91)mU/L P>0.05] TSH 75%~80% 20%~25% ( GH/TSH PRL/TSH ) [9] 14 8 3 (TSH+PRL TSH+GH+LH TSH+FSH 1 ) 15 2 (TSH+FSH TSH+PRL l ) 21.7%(5/23)
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