Résumé
Objective:To analyze clinical characteristics and experiences in the treatment of thyroid-stimulating hormone (TSH)-secret-ing pituitary adenoma. Methods:To summarize the diagnosis, treatment and prognosis of 14 cases of pituitary thyrotropin (TSH) tu-mor in the Department of Neurosurgery, 251 Hospital of China People's Liberation Army (PLA) from January 2006 to February 2014. Re-sults:Of 14 patients, two received direct surgical treatment and 12 received drug treatment before surgery. Thyroid function fully re-covered in 10 patients who underwent total tumor resection. Four patients, for whom resections failed, were treated with hormone re-placement therapy after radiotherapy. Conclusions:It is important to diagnose TSH-secreting pituitary adenoma early, perform proper perioperative management, and choose the right operative time after early diagnosis and select correct treatment.
Résumé
A 25 year old female was presented with the complaints of weight gain of 15 kg, oligomenorrhea, and hirsutism of 1 year duration. She was known hypertensive. On clinical examination, facial plethora, atrophy of the skin, stria purpurea, hyper pigmented patches over the extremities, over the abdomen, axilla and knees were present, acne was present over the face. On examination, patient was obese; blood pressure (BP) was 150/ 110 mmHg. Bilateral pitting edema was evident and all other systems were normal. On investigations, thyroid stimulating hormone (TSH) and serum cortisol was high. A diagnosis of Cushing’s syndrome with Hypothyroidism was entertained. MRI brain (sella) with contrast revealed pituitary microadenoma. Transsphenoidal excision was done. Histopathology features were consistent with Pituitary Adenoma. Normally Cushing’s syndrome is dependent on ACTH. Pituitary adenoma is present without any physical signs or symptoms. Among them microadenoma is commonly associated with thyrotoxicosis. But this case was presented with hypothyroidism which is very rare
Résumé
Forty-four patients were operated on functioning pituitary adenomas during 5 years since Jun. 1977 at the Department of Neurosurgery, Seoul National University Hospital. Clinical and laboratory findings were analyzed and the following results were obtained. 1) The peak incidence was in the 3rd and 4th decade 21 cases were male and 23 cases were female. 2) Endocrinologic study revealed prolactinoma in 28 cases(37%), somatotropic adenoma in 13 cases(17%), corticotropic adenoma in 3 cases(4%), endocrine-inactive adenoma in 32 cases(42%). 3) MAin symptoms were endocrine symptoms(86%), headache(75%) and visual field defect(59%). 4) Seven(16%) were in the stage I(micro-adenoma), 27(61%) in the stage II, 6(14%) in the stage III, 4(9%) in the stage IV. 5) The rate of endocrinologic cure or improvement was 65% in prolactinoma and 75% in somatotropic adenoma. This result was less favorable less favorable than the result of other recent studies, but it seemed to be due to large proportion of large or invasive adenoma instead of micro-adenoma in this series. 6) In prolactinoma, 7 out of 12 patients with amenorrhea resumed menstrual cycle and 2 patients had pregnancies postoperatively. 7) The visual field defect was improved in 16 of 21 cases(76%) postoperatively.