ketendoКлиническая и экспериментальная тиреоидологияClinical and experimental thyroidology1995-54722310-3787Endocrinology Research Centre10.14341/ket2016439-45ketendo-8667Research ArticleРедакционные материалыEditorial noteПо материалам клинических рекомендаций Европейской Тиреоидной Ассоциации по диагностике и лечению ТТГ-продуцирующих опухолей гипофизаReview of European Thyroid Association guidelines for the diagnosis and treatment of thyrotropin-secreting pituitary tumourshttps://orcid.org/0000-0002-3026-6315ФадеевВалентин ВикторовичFadeyevValentin V.

Доктор медицинских наук, профессор, заведующий кафедрой эндокринологии лечебного факультета Первого МГМУ им. И.М.Сеченова

MD, DSc, professor, Head of the Endocrinology Department of Medical faculty

walfad@mail.ru<p>ФГАОУ ВО &laquo;Первый МГМУ им. И.М. Сеченова Минздрава России&raquo;</p>Россия<p>I.M. Sechenov First Moscow State Medical University</p>Russian Federation2016070620171243945Copyright &#x00A9; Фадеев В.В., 20162016Фадеев В.В.Fadeyev V.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.cet-endojournals.ru/jour/article/view/8667

Тиреотоксикоз в большинстве случаев обусловлен аутоиммунными заболеваниями щитовидной железы или многоузловым токсическим зобом; крайне редко его причиной являются ТТГ-секретирующие аденомы гипофиза (ТТГ-омы). Эти опухоли характеризуются высоким уровнем циркулирующих тиреоидных гормонов в сочетании с отсутствием подавления или повышенным уровнем ТТГ. Неправильная диагностика ТТГ-ом зачастую является причиной неоправданных тиреоидэктомий или проведения терапии радиоактивным йодом, что в свою очередь сопровождается существенным увеличением размера опухоли гипофиза. Диагноз может быть подтвержден при помощи определения уровня ТТГ на фоне супрессивной терапии L-Т3 или в тесте с тиреолиберином. Эти тесты в комбинации с МРТ гипофиза и генетическим исследованием лежат в основе дифференциальной диагностики ТТГ-ом и синдромов резистентности к тиреоидным гормонам. Методом выбора в лечении ТТГ-ом является хирургическая транссфеноидальная аденомэктомия. При невозможности проведения или неэффективности оперативного лечения эффективным методом нормализации продукции ТТГ в 90% случаев является назначение аналогов соматостатина.

Hyperthyroidism is mainly due to autoimmune thyroid disorders or toxic goiter, and very rarely to the presence of thyrotropin (TSH)-secreting pituitary adenomas (TSHomas). These tumours are characterized by high levels of circulating free thyroid hormones (FT4 and FT3) in the presence of nonsuppressed serum TSH concentrations. Failure to correctly diagnose TSHomas may result in inappropriate thyroid ablation, which results in a significant increase of pituitary tumor mass. The diagnosis is mainly achieved by measuring TSH after T3 suppression and TRH stimulation tests. These dynamic tests, together with pituitary imaging and genetic testing are useful in distinguishing TSHomas from the syndromes of resistance to thyroid hormone action. The treatment of choice is surgery. In cases of surgical failure, somatostatin analogues have been found to be effective in normalizing TSH secretion in more than 90% of patients.

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