ketendoКлиническая и экспериментальная тиреоидологияClinical and experimental thyroidology1995-54722310-3787Endocrinology Research Centre10.14341/ket2016337-42ketendo-8138Research ArticleКлинический случайCase ReportТиреотропинома. Описание двух клинических случаевThyrotropin-producing adenoma. Report of two clinical caseshttps://orcid.org/0000-0002-2559-1404КарапетянАни РафаиловнаKarapetyanAni R.

PhD

a_karapetyan@neuronsk.ruГормолысоваЕкатерина ВладимировнаGormolysovaEkaterina V.

врач-нейрохирург

MD

shirochan@inbox.ruГалушкоЕвгений ВалерьевичGalushkoEugeniy V.

врач-нейрохирург

MD

evga8778@gmail.comФГБУ “Федеральный центр нейрохирургии”РоссияFederal Neurosurgical CenterRussian Federation2016090320171233742Copyright © Карапетян А.Р., Гормолысова Е.В., Галушко Е.В., 20162016Карапетян А.Р., Гормолысова Е.В., Галушко Е.В.Karapetyan A.R., Gormolysova E.V., Galushko E.V.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.cet-endojournals.ru/jour/article/view/8138

Диагностика тиреотоксикоза в настоящее время не представляет серьезных трудностей. Распространение методов визуализации с каждым годом увеличивает выявляемость аденом гипофиза. Тиреотропинома – редкая причина тиреотоксикоза.Ранняя диагностика ТТГ-секретирующей аденомы предупредит ошибки в лечебной тактике, приводящие к необоснованному хирургическому вмешательству на щитовидной железе, и позволит повысить качество жизни пациентов. В статье приведены два клинических случая ТТГ-секретирующих аденом гипофиза у пациенток с различной  длительностью заболевания и, соответственно, размерами аденом, наличием осложнений тиреотоксикоза. Обе пациентки были оперированы в Федеральном Центре Нейрохирургии г. Новосибирска из трансназального транссфеноидального доступа. В послеоперационном периоде достигнут стойкий эутиреоз в обоих случаях. У пациентки с многолетним анамнезом заболевания, большими размерами аденомы в послеоперационном периоде развился вторичный гипокортицизм, а качество ее жизни значительно ниже, учитывая сопутствующую патологию. Период дальнейшего наблюдения этих случаев составил 3 года и год соответственно.

Diagnosis of hyperthyroidism does not present serious difficulties currently. Distribution of imaging techniques increasing the detection of pituitary adenomas every year. Thyrotropin-producing adenoma is a rare cause of hyperthyroidism. Early detection will alert its errors in treatment strategy, unjustified surgery on the thyroid gland, and will improve the quality of patients life. The article presents two clinical cases of thyroid-stimulating hormone (TSH)-secreting pituitary adenomas in patients with different disease duration, and thus the presence of hyperthyroidism complications. Both patients were operated in the Federal Center of Neurosurgery Novosibirsk by transnasal transsphenoidal approach. The resistant euthyroidism was reached postoperatively, but in patients with long-term history of the disease, large size of adenoma in the postoperative period developed secondary adrenal insufficiency and her quality of life is significantly lower, taking into account comorbidities. The period of follow-up consists 3 years and one year respectively.

тиреотропиноматиреотоксикозаденома гипофизаклинический случайthyrotropin-producing adenomathyrotoxicosissyndrome of resistance to thyroid hormonecase reportReferencesШестакова Т.П., Комердус И.В. Диагностика редких заболеваний щитовидной железы // Русский медицинский журнал – 2015. – Т. 23. – №8. – С. 458–460. [Shestakova TP, Komerdus IV. Diagnostika redkikh zabolevanii shchitovidnoi zhelezy. Russkii meditsinskii zhurnal. 2015;23(8):458-460. (In Russ.)]Шестакова Т.П., Комердус И.В. Диагностика редких заболеваний щитовидной железы // Русский медицинский журнал – 2015. – Т. 23. – №8. – С. 458–460. [Shestakova TP, Komerdus IV. Diagnostika redkikh zabolevanii shchitovidnoi zhelezy. Russkii meditsinskii zhurnal. 2015;23(8):458-460. (In Russ.)]Khandwala H, Lee C. Inappropriate secretion of thyroid-stimulating hormone. CMAJ. 2006;175(4):351. doi: 10.1503/cmaj.060266.Khandwala H, Lee C. Inappropriate secretion of thyroid-stimulating hormone. CMAJ. 2006;175(4):351. doi: 10.1503/cmaj.060266.Калдымова В.А., Кияев А.В., Тюльпаков А.Н. Синдром резистентности к тиреоидным гормонам // Клиническая и экспериментальная тиреоидология. – 2013. – Т. 9. – №1. – C. 51–53. [Kaldymova VA, Kiyaev AV, Tyulpakov AN. Syndromes of resistance to thyroid hormone. Clinical and experimental thyroidology. 2013;9(1):51-53. (In Russ.)] doi: 10.14341/ket20139151-53.Калдымова В.А., Кияев А.В., Тюльпаков А.Н. Синдром резистентности к тиреоидным гормонам // Клиническая и экспериментальная тиреоидология. – 2013. – Т. 9. – №1. – C. 51–53. [Kaldymova VA, Kiyaev AV, Tyulpakov AN. Syndromes of resistance to thyroid hormone. Clinical and experimental thyroidology. 2013;9(1):51-53. (In Russ.)] doi: 10.14341/ket20139151-53.Gurnell M, Visser TJ, Beck-Peccoz P, Chatterjee VK. Resistance to Thyroid Hormone. In: Jameson LJ, DeGroot LJ, editors. Endocrinology, Adult and Pediatric (7th Edition, vol. II). Philadelphia, PA: Sauderns Elsevier; 2016. Pp. 1648-1665. doi: 10.1016/b978-0-323-18907-1.00095-0.Gurnell M, Visser TJ, Beck-Peccoz P, Chatterjee VK. Resistance to Thyroid Hormone. In: Jameson LJ, DeGroot LJ, editors. Endocrinology, Adult and Pediatric (7th Edition, vol. II). Philadelphia, PA: Sauderns Elsevier; 2016. Pp. 1648-1665. doi: 10.1016/b978-0-323-18907-1.00095-0.Beck-Peccoz P. TSH-secreting pituitary tumors. Italy Summer School. 2006. Available at http://www.bioscilibrary.com/resource/summerschool/2006/ss06/ss06_bec.htmBeck-Peccoz P. TSH-secreting pituitary tumors. Italy Summer School. 2006. Available at http://www.bioscilibrary.com/resource/summerschool/2006/ss06/ss06_bec.htmJailer JW, Holub DA. Remission of Graves' disease following radiotherapy of a pituitary neoplasm. Am J Med. 1960;28(3):497-500. doi: 10.1016/0002-9343(60)90181-9.Jailer JW, Holub DA. Remission of Graves' disease following radiotherapy of a pituitary neoplasm. Am J Med. 1960;28(3):497-500. doi: 10.1016/0002-9343(60)90181-9.Socin H, Chanson P, Delemer B, et al. The changing spectrum of TSH-secreting pituitary adenomas: diagnosis and management in 43 patients. Eur J Endocrinol. 2003;148(4):433-442. doi: 10.1530/eje.0.1480433.Socin H, Chanson P, Delemer B, et al. The changing spectrum of TSH-secreting pituitary adenomas: diagnosis and management in 43 patients. Eur J Endocrinol. 2003;148(4):433-442. doi: 10.1530/eje.0.1480433.Mouslech Z, Somali M, Sakali AK, et al. TSH-secreting pituitary adenomas treated by gamma knife radiosurgery: our case experience and a review of the literature. Hormones. 2015. doi: 10.14310/horm.2002.1640.Mouslech Z, Somali M, Sakali AK, et al. TSH-secreting pituitary adenomas treated by gamma knife radiosurgery: our case experience and a review of the literature. Hormones. 2015. doi: 10.14310/horm.2002.1640.Beck-Peccoz P, Lania A, Persani L. TSH-Producing Adenomas. 2016:266-274.e263. doi: 10.1016/b978-0-323-18907-1.00015-9.Beck-Peccoz P, Lania A, Persani L. TSH-Producing Adenomas. 2016:266-274.e263. doi: 10.1016/b978-0-323-18907-1.00015-9.Пржиялковская Е.Г., Газизова Д.О., Григорьев А.Ю., и др. Тиреотропинома: трудности дифференциальной диагностики (клинический случай) // Клиническая и экспериментальная тиреоидология. – 2011. – Т. 7. – №2. – C. 68–73. [Prgijalkovskaja EG, Gasisova DO, Grigoryev AY, et al. Thyrotropin-producing adenoma: diagnostic challenges (Сase report). Clinical and experimental thyroidology. 2011;7(2):68-73. (In Russ.)] doi: 10.14341/ket20117268-73.Пржиялковская Е.Г., Газизова Д.О., Григорьев А.Ю., и др. Тиреотропинома: трудности дифференциальной диагностики (клинический случай) // Клиническая и экспериментальная тиреоидология. – 2011. – Т. 7. – №2. – C. 68–73. [Prgijalkovskaja EG, Gasisova DO, Grigoryev AY, et al. Thyrotropin-producing adenoma: diagnostic challenges (Сase report). Clinical and experimental thyroidology. 2011;7(2):68-73. (In Russ.)] doi: 10.14341/ket20117268-73.Beck-Peccoz P, Persani L. TSH-induced hyperthyroidism caused by a pituitary tumor. Nat Clin Pract Endocrinol Metab. 2006;2(9):524-528. doi: 10.1038/ncpendmet0276.Beck-Peccoz P, Persani L. TSH-induced hyperthyroidism caused by a pituitary tumor. Nat Clin Pract Endocrinol Metab. 2006;2(9):524-528. doi: 10.1038/ncpendmet0276.Beck-Peccoz P, Persani L. Thyrotropinomas. Endocrinol Metab Clin North Am. 2008;37(1):123-134, viii-ix. doi: 10.1016/j.ecl.2007.10.001.Beck-Peccoz P, Persani L. Thyrotropinomas. Endocrinol Metab Clin North Am. 2008;37(1):123-134, viii-ix. doi: 10.1016/j.ecl.2007.10.001.Brucker-Davis F, Oldfield EH, Skarulis MC, et al. Thyrotropin-secreting pituitary tumors: diagnostic criteria, thyroid hormone sensitivity, and treatment outcome in 25 patients followed at the National Institutes of Health. J Clin Endocrinol Metab. 1999;84(2):476-486. doi: 10.1210/jcem.84.2.5505.Brucker-Davis F, Oldfield EH, Skarulis MC, et al. Thyrotropin-secreting pituitary tumors: diagnostic criteria, thyroid hormone sensitivity, and treatment outcome in 25 patients followed at the National Institutes of Health. J Clin Endocrinol Metab. 1999;84(2):476-486. doi: 10.1210/jcem.84.2.5505.Beck-Peccoz P, Roncoroni R, Mariotti S, et al. Sex hormone-binding globulin measurement in patients with inappropriate secretion of thyrotropin (IST): evidence against selective pituitary thyroid hormone resistance in nonneoplastic IST. J Clin Endocrinol Metab. 1990;71(1):19-25. doi: 10.1210/jcem-71-1-19.Beck-Peccoz P, Roncoroni R, Mariotti S, et al. Sex hormone-binding globulin measurement in patients with inappropriate secretion of thyrotropin (IST): evidence against selective pituitary thyroid hormone resistance in nonneoplastic IST. J Clin Endocrinol Metab. 1990;71(1):19-25. doi: 10.1210/jcem-71-1-19.Persani L, Preziati D, Matthews CH, et al. Serum levels of carboxyterminal cross-linked telopeptide of type I collagen (ICTP) in the differential diagnosis of the syndromes of inappropriate secretion of TSH. Clin Endocrinol (Oxf). 1997;47(2):207-214. doi: 10.1046/j.1365-2265.1997.2351057.x.Persani L, Preziati D, Matthews CH, et al. Serum levels of carboxyterminal cross-linked telopeptide of type I collagen (ICTP) in the differential diagnosis of the syndromes of inappropriate secretion of TSH. Clin Endocrinol (Oxf). 1997;47(2):207-214. doi: 10.1046/j.1365-2265.1997.2351057.x.Chatterjee VKK, Clifton-Bligh RJ, Gurnell M. Thyroid Hormone Resistance. In: Jameson JL, editor. Contemporary Endocrinology: Hormone Resistance Syndromes. Totowa: Humana Press; 1999. Р. 145–153. doi: 10.1007/978-1-59259-698-0_7.Chatterjee VKK, Clifton-Bligh RJ, Gurnell M. Thyroid Hormone Resistance. In: Jameson JL, editor. Contemporary Endocrinology: Hormone Resistance Syndromes. Totowa: Humana Press; 1999. Р. 145–153. doi: 10.1007/978-1-59259-698-0_7.Chanson P. Octreotide therapy for thyroid-stimulating hormone-secreting pituitary adenomas: a follow-up of 52 patients. Ann Intern Med. 1993;119(3):236. doi: 10.7326/0003-4819-119-3-199308010-00010.Chanson P. Octreotide therapy for thyroid-stimulating hormone-secreting pituitary adenomas: a follow-up of 52 patients. Ann Intern Med. 1993;119(3):236. doi: 10.7326/0003-4819-119-3-199308010-00010.Malchiodi E, Profka E, Ferrante E, et al. Thyrotropin-secreting pituitary adenomas: outcome of pituitary surgery and irradiation. J Clin Endocr Metab. 2014;99(6):2069-2076. doi: 10.1210/jc.2013-4376.Malchiodi E, Profka E, Ferrante E, et al. Thyrotropin-secreting pituitary adenomas: outcome of pituitary surgery and irradiation. J Clin Endocr Metab. 2014;99(6):2069-2076. doi: 10.1210/jc.2013-4376.Clarke MJ, Erickson D, Castro MR, Atkinson JLD. Thyroid-stimulating hormone pituitary adenomas. J Neurosurg. 2008;109(1):17-22. doi: 10.3171/jns/2008/109/7/0017.Clarke MJ, Erickson D, Castro MR, Atkinson JLD. Thyroid-stimulating hormone pituitary adenomas. J Neurosurg. 2008;109(1):17-22. doi: 10.3171/jns/2008/109/7/0017.Yamada S, Fukuhara N, Horiguchi K, et al. Clinicopathological characteristics and therapeutic outcomes in thyrotropin-secreting pituitary adenomas: a single-center study of 90 cases. J Neurosurg. 2014;121(6):1462-1473. doi: 10.3171/2014.7.jns1471.Yamada S, Fukuhara N, Horiguchi K, et al. Clinicopathological characteristics and therapeutic outcomes in thyrotropin-secreting pituitary adenomas: a single-center study of 90 cases. J Neurosurg. 2014;121(6):1462-1473. doi: 10.3171/2014.7.jns1471.Zhao W, Ye H, Li Y, et al. Thyrotropin-secreting pituitary adenomas: diagnosis and management of patients from one Chinese center. Wiener klinische Wochenschrift. 2012;124(19-20):678-684. doi: 10.1007/s00508-012-0216-z.Zhao W, Ye H, Li Y, et al. Thyrotropin-secreting pituitary adenomas: diagnosis and management of patients from one Chinese center. Wiener klinische Wochenschrift. 2012;124(19-20):678-684. doi: 10.1007/s00508-012-0216-z.

The authors declare that there are no conflicts of interest present.