儿童甲状腺功能减低并发垂体增生8例报告

徐爱晶; 李堂

PDF(1179 KB)

中国当代儿科杂志 ›› 2010, Vol. 12 ›› Issue (1) : 17-20.

论著·临床研究

儿童甲状腺功能减低并发垂体增生8例报告

徐爱晶，李堂

作者信息 +

Pituitary hyperplasia secondary to primary hypothyroidism in children: report of 8 cases

XU Ai-Jing, LI Tang

Author information +

文章历史 +

摘要

目的：探讨甲状腺功能减低致垂体增生的内分泌激素的改变及治疗效果。方法：回顾性分析8例甲状腺功能减低致垂体增生儿童（3例男性，5例女性，年龄5～9岁）的临床资料,治疗随访1～6年。结果：8例患儿的甲状腺激素水平均降低，促甲状腺素（TSH）及血浆泌乳素（PRL）水平增高，予以甲状腺素替代治疗，用药2～6月后，血清游离三碘甲腺原氨酸(FT3)、游离四碘甲腺原氨酸(FT4)、TSH及PRL恢复正常,垂体体积恢复正常大小。其中6 例身高增长由治疗前3.1±0.5 cm/年，提高到治疗后11.6±1.7 cm/年，差异有显著性(P<0.01)。另外2例儿童甲状腺素替代治疗后身高增长不理想，予以基因重组人生长激素（rhGH）治疗后，随访身高增长为11 cm/年。8例均无垂体增生复发。结论：对于身材矮小儿童进行甲状腺功能及垂体检查十分必要，甲状腺素替代治疗是儿童甲状腺功能减低致垂体增生的有效手段。在垂体增生恢复后仍然合并生长激素缺乏的患儿予以生长素治疗可以获得满意的身高增长。［中国当代儿科杂志，2010，12（1）：17-20］

Abstract

OBJECTIVE: To study the changes in hormone levels and the therapy of pituitary hyperplasia secondary to primary hypothyroidism in children. METHODS: The clinical data of 8 children with pituitary hyperplasia secondary to primary hypothyroidism (5 girls and 3 boys) at ages of 5 to 9 years were studied retrospectively. All of the children had a short stature. They were followed up 1 to 6 years. RESULTS: The thyroid hormone levels decreased and the serum thyroid stimulating hormone (TSH) and prolactin (PRL) levels increased in the 8 children. After 2 to 6 months thyroxine replacement therapy, the levels of free triiodothyronine (FT3), free thyroxine (FT4) and serum TSH and PRL returned to normal, and the pituitary enlargement regressed to normal in the 8 children. Of them, 6 children′s height growth rate increased significantly from 3.1±0.5 cm per year to 11.6±1.7 cm per year (P<0.01). The other 2 cases had low growth rate and then received additional recombinant human growth hormone (rhGH) therapy. Their height growth rate increased by 11 cm per year. Pituitary hyperplasia did not recur in the 8 children during the follow-up. CONCLUSIONS: The thyroid function and pituitary examinations are necessary for children with a short stature. Thyroxine substitution therapy appears to be effective for primary hypothyroidism secondary to pituitary hyperplasia. rhGH replacement therapy after regression of the pituitary enlargement can result in a satisfactory height growth in children with low thyroid hormone levels and growth hormone deficiency.［Chin J Contemp Pediatr, 2010, 12 (1):17-20］

导出引用

徐爱晶, 李堂. 儿童甲状腺功能减低并发垂体增生8例报告[J]. 中国当代儿科杂志. 2010, 12(1): 17-20

XU Ai-Jing, LI Tang. Pituitary hyperplasia secondary to primary hypothyroidism in children: report of 8 cases[J]. Chinese Journal of Contemporary Pediatrics. 2010, 12(1): 17-20

中图分类号： R725.8

参考文献

［1］Khawaja NM, Taher BM, Barham ME, Naser AA, Hadidy AM, Ahmad AT, et al. Pituitary enlargement in patients with primary hypothyroidism［J］. Endocr Pract, 2006, 12(1):29-34.
［2］Desai MP, Mehta RU, Choksi CS, Colaco MP. Pituitary enlargement on magnetic resonance imaging in congenital hypothyroidism［J］. Arch Pediatr Adol Med, 1996, 150（6）:623-628.
［3］Alves C, Alves AC. Primary hypothyroidism in a child simulating a prolactin-secreting adenoma［J］. Childs Nerv Syst, 2008, 24(12): 1505-1508.
［4］王德亮, 解建军, 张喜凤, 王明经. 儿童慢性淋巴细胞性甲状腺炎76例临床分析［J］. 中国实用儿科杂志, 2003, 18(8):486-487.
［5］Joshi AS, Woolf PD. Pituitary hyperplasia secondary to primary hypothyroidism: a case report and review of the literature［J］. Pituitary, 2005, 8(2):99-103.
［6］李莹,雷益,徐坚民,龚静山,陈宇,黄飚. 儿童和青少年垂体疾病的MRI诊断［J］. 中国医学影像技术, 2005, 21 (8):1196-1198.
［7］李桂林,田宇,李永宁,王任直. 原发性甲状腺功能减低性垂体增生的诊断和处理［J］. 中国实验诊断学, 2006, 10(6):601-604.
［8］朱妍,郝继山,刘庆国,焦德让. 垂体增生与垂体腺瘤［J］. 中华神经外科疾病研究杂志, 2005, 4(4):361-362.
［9］马慧静,邵剑波. 青春前期儿童甲状腺功能减低致垂体增生的MRI 表现［J］. 临床放射学杂志, 2007, 26 (3): 298-300.
［10］Asa SL, Ezzat S. The pathogenesis of pituitary tumors ［J］. Annu Rev Pathol, 2009, 4: 97-126.
［11］Clarke MJ, Erickson D, Castro MR, Atkinson JL. Thyroid-stimulating hormone pituitary adenomas ［J］. J Neurosurg, 2008, 109 (1): 17-22.
［12］Diaz-Espineira MM, Galac S, Mol JA, Rijnberk A, Kooistra HS. Thyrotropin releasing hormone-induced growth hormone secretion in dogs with primary hypothyroidism ［J］. Domest Anim Endocrinol, 2008, 34(2):176-181.
［13］Vidal S, Horvath E, Kovacs K, Cohen SM, Lloyd RV, Scheithauer BW. Transdifferentiation of somatotrophs to thyrotrophs in the pituitary of patients with protracted primary hypothyroidism［J］. Virchows Arch, 2000, 436(1):43-51.
［14］Burnside J, Darling DS, Carr FE, Chin WW. Thyroid hormone regulation of the rat glycoprotein hormone α-subunit gene promoter activity［J］. J Biol Chem, 1989, 264（12）: 6886-6891.
［15］Ashley WW Jr, Ojemann JG, Park TS, Wippold FJ 2nd. Primary hypothyroidism in a 12-year-old girl with a suprasellar pituitary mass: rapid regression after thyroid replacement therapy: case report［J］. J Neurosurg, 2005, 102(4 Suppl):413-416.
［16］Atchison JA, Lee PA, Albright AL. Reversible suprasellar pituitary mass secondary to hypothyroidism［J］.JAMA, 1989, 262(22):3175-3177.
［17］Hindmarsh PC, Dattani MT. Use of growth hormone in children［J］.Nat Clin Pract Endocrinol Metab, 2006, 2(5):260-268.
［18］Bogarin R, Steinbok P. Growth hormone treatment and risk of recurrence or progression of brain tumors in children: a review ［J］. Childs Nerv Syst, 2009, 25(3):273-279.