PDF(Pubmed)
Abstract：
UNASSIGNED: Hypophyseal dysfunction may be overlooked by the currently generally accepted laboratory routine for the differential diagnosis in patients suffering from symptoms of depression or dementia.
UNASSIGNED: Hypothyroidism is an important cause of depression and potentially reversible cognitive impairment. Whereas the determination of the plasma concentration of thyrotropin (TSH) is generally considered part of the laboratory screening tests for dementia, the measurement of total or free triiodothyronine (T3, FT3), thyroxine (T4, FT4) and cortisol in plasma does not belong to the routine diagnostic workup in patients with depression or suspected dementia. In an 87-year-old lady suffering from increasingly poor general health, decreased fluid and food intake, mood depression and lack of energy, three measurements of plasma TSH produced normal values. A cranial computed tomography (cCT) 2 days prior to hospital admission had been assessed as apparently normal. A second cCT performed following a loss of consciousness complicated by tongue bite showed a hypophyseal tumor. Then, low plasma levels of FT3, FT4 and cortisol were found. Following hormone replacement and transsphenoidal tumor resection, the patient recovered rapidly. The present case report illustrates the pitfalls of measuring merely the TSH level in the detection of thyroid and hypophyseal dysfunction.
UNASSIGNED: Hypothyroidism is an important cause of depression and potentially reversible cognitive impairment. Whereas the determination of the plasma concentration of thyrotropin (TSH) is generally considered part of the laboratory screening tests for dementia, the measurement of total or free triiodothyronine (T3, FT3), thyroxine (T4, FT4) and cortisol in plasma does not belong to the routine diagnostic workup in patients with depression or suspected dementia. In an 87-year-old lady suffering from increasingly poor general health, decreased fluid and food intake, mood depression and lack of energy, three measurements of plasma TSH produced normal values. A cranial computed tomography (cCT) 2 days prior to hospital admission had been assessed as apparently normal. A second cCT performed following a loss of consciousness complicated by tongue bite showed a hypophyseal tumor. Then, low plasma levels of FT3, FT4 and cortisol were found. Following hormone replacement and transsphenoidal tumor resection, the patient recovered rapidly. The present case report illustrates the pitfalls of measuring merely the TSH level in the detection of thyroid and hypophyseal dysfunction.
摘要：
■对于患有抑郁症或痴呆症状的患者，目前普遍接受的实验室常规可忽略垂体功能障碍。
■甲状腺功能减退是抑郁症和潜在可逆性认知障碍的重要原因。虽然促甲状腺激素（TSH）的血浆浓度的测定通常被认为是痴呆的实验室筛查测试的一部分，总或游离三碘甲状腺原氨酸（T3，FT3）的测量，血浆中的甲状腺素（T4，FT4）和皮质醇不属于抑郁症或疑似痴呆患者的常规诊断检查。在一位87岁的女士中，她的健康状况越来越差，减少液体和食物摄入量，情绪低落和缺乏能量，血浆TSH的三个测量值产生正常值。入院前2天的颅骨计算机断层扫描（cCT）被评估为明显正常。在意识丧失并发舌头咬伤后进行的第二次cCT显示垂体肿瘤。然后，发现血浆FT3，FT4和皮质醇水平较低。激素替代和经蝶窦肿瘤切除术后，病人恢复得很快。本病例报告说明了在检测甲状腺和垂体功能障碍时只测量TSH水平的陷阱。
■甲状腺功能减退是抑郁症和潜在可逆性认知障碍的重要原因。虽然促甲状腺激素（TSH）的血浆浓度的测定通常被认为是痴呆的实验室筛查测试的一部分，总或游离三碘甲状腺原氨酸（T3，FT3）的测量，血浆中的甲状腺素（T4，FT4）和皮质醇不属于抑郁症或疑似痴呆患者的常规诊断检查。在一位87岁的女士中，她的健康状况越来越差，减少液体和食物摄入量，情绪低落和缺乏能量，血浆TSH的三个测量值产生正常值。入院前2天的颅骨计算机断层扫描（cCT）被评估为明显正常。在意识丧失并发舌头咬伤后进行的第二次cCT显示垂体肿瘤。然后，发现血浆FT3，FT4和皮质醇水平较低。激素替代和经蝶窦肿瘤切除术后，病人恢复得很快。本病例报告说明了在检测甲状腺和垂体功能障碍时只测量TSH水平的陷阱。
