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目的:探讨原发性甲状腺功能减退致垂体增生的临床特点、发病机制、治疗方法。方法:依据临床症状、实验室及影像学检查确诊甲状腺功能减退致垂体增生患者22例,均给予左甲状腺素钠片25~150μg/d,晨空腹顿服,至甲状腺功能恢复正常。治疗期间每月复查甲状腺功能,依据甲状腺功能检测结果调整剂量。随访6个月,观察其症状、体征、甲状腺功能改善情况。结果:4例误诊垂体大腺瘤,其中1例外院误诊行手术治疗致永久性垂体功能减退。症状缓解14例,消失8例;泌乳素恢复正常14例,8例较治疗前降低;FT3,FT4,促甲状腺激素均恢复正常,甲状腺球蛋白抗体、甲状腺过氧化酶抗体滴度分别较治疗前下降38%、32%;垂体MRI检查示14例恢复正常,7例垂体占位较前缩小0.5~0.8 cm。14例4~13岁患儿中5例身高平均增长8 cm,8例增长2~6 cm,1例因手术造成全垂体功能减退,身高无明显增长。结论:原发性甲状腺功能减退症引起的垂体增生易误诊为垂体大腺瘤,详细询问病史和全面的实验室检查可避免误诊。
Objective: To investigate the clinical features, pathogenesis and treatment of pituitary hyperplasia caused by primary hypothyroidism. Methods: Twenty-two patients with pituitary hyperplasia who were diagnosed as hypothyroidism according to clinical symptoms, laboratory and imaging examination were given levothyroxine sodium 25 ~ 150μg / d, morning fasting abdomen service, and thyroid function returned to normal. Thyroid function is reviewed monthly for the duration of treatment and the dose is adjusted based on thyroid function test results. Follow-up for 6 months, observe the symptoms, signs, thyroid function improvement. Results: Four cases of pituitary adenoma were misdiagnosed, and one case of misdiagnosis outside the hospital caused permanent pituitary dysfunction. Symptoms were relieved in 14 cases, disappeared in 8 cases; prolactin returned to normal in 14 cases, 8 cases lower than before treatment; FT3, FT4, thyroid stimulating hormone were back to normal, thyroglobulin antibody, thyroid peroxidase antibody titers were Decreased by 38% and 32% respectively. Pituitary MRI examination showed that 14 cases returned to normal, and 7 cases had pituitary reduction of 0.5 ~ 0.8 cm. Five of the 14 children aged 4 to 13 years had an average increase of 8 cm in height and 8 cm in 2 to 6 cm. One patient had hypopituitarism due to surgery and no significant increase in height. Conclusion: Primary hypothyroidism caused by pituitary hyperplasia easily misdiagnosed as pituitary adenoma, a detailed history and a comprehensive laboratory examination to avoid misdiagnosis.