促甲状腺激素分泌腺瘤(TSH-oma)是一种非常罕见的功能性垂体腺瘤,尤其是在青少年中发生的。然而,其潜在的临床和治疗特征仍然未知。
本研究旨在总结青少年型TSH-oma患者的临床和治疗特点。
我们回顾性分析了2012年1月至2020年10月在我院确诊为TSH-oma的148例患者中的6例(4.1%)青少年TSH-oma病例。对PubMed在线数据库进行了文献综述,并检索到14例青少年发病TSH-oma病例。然后,临床表现的特点,治疗结果,并与成年TSH-oma患者进行随访分析和比较。
总之,本研究包括20例青少年发病病例,平均发病年龄为13.4±3.3岁。在我们的研究中发现雄性稍微占优势(M:F=1.5:1)。TSH的基线水平中位数,青少年发病病例中的FT3和FT4为6.30[四分位距(IQR)9.82]µIU/ml,9.18(IQR11.61)pg/ml,和3.22(IQR1.90)ng/dl,分别,均明显高于我院成年患者。此外,青少年发病病例显示更大的肿瘤比率(36.8%vs.9.3%,p=0.007)与成年患者相比。与文献中所有年龄段的患者相比,在青少年发病患者中,SSA的生化缓解率(57.1%)和TSS的缓解率(38.9%)明显较低。而复发率(44.4%)明显较高。
青少年TSH-oma患者的TSH和甲状腺激素水平较高,更大的肿瘤,治疗结果比成人更差。因此,早期诊断,多学科治疗,应重视密切随访以改善预后。
Thyrotropin-secreting adenoma (TSH-oma) is a very rare kind of functional pituitary adenoma, especially that which occurs in adolescents. However, its potential clinical and therapeutic characteristics are still unknown.
The study was aimed to summarize the clinical and therapeutic characteristics of patients with adolescent-onset TSH-oma.
We retrospectively analyzed six (4.1%) adolescent-onset TSH-oma cases from 148 patients who were diagnosed with TSH-oma at our hospital between January 2012 and October 2020. A literature review was performed on the PubMed online database, and 14 adolescent-onset TSH-oma cases were retrieved. Then, the characteristics of clinical manifestations, treatment outcomes, and follow-ups were analyzed and compared to the adult TSH-oma patients.
Altogether, 20 adolescent-onset cases were included in this study having mean onset age of 13.4 ± 3.3 years. Males were found to be slightly predominant (M: F = 1.5:1) in our study. The median baseline levels of TSH, FT3, and FT4 in adolescent-onset cases were found to be 6.30 [interquartile range (IQR) 9.82] µIU/ml, 9.18 (IQR 11.61) pg/ml, and 3.22 (IQR 1.90) ng/dl, respectively, which were all significantly higher than the adult patients of our hospital. Also, the adolescent-onset cases showed more large tumor ratio (36.8% vs. 9.3%, p = 0.007) compared to the adult patients. Compared to the patients of all ages in the literature, the biochemical remission rate of SSAs (57.1%) and remission rate of TSS (38.9%) were found to be considerably lower in adolescent-onset patients, while the recurrence rate (44.4%) was found to be considerably higher.
Adolescent-onset TSH-oma patients showed higher TSH and thyroid hormone levels, more large tumors, and worse treatment outcomes than adult cases. Hence, early diagnosis, multidisciplinary therapy, and close follow-up should be highlighted to improve the prognosis.