Four patients with pituitary GH/PRL/TSH mixed adenoma: case studies and literature review
10.3760./cma.j.cn311282-20230420-00195
- VernacularTitle:垂体GH/PRL/TSH混合腺瘤四例临床特征分析及文献复习
- Author:
Fang HU
1
;
Na YU
;
Linjie WANG
;
Hongbo YANG
;
Huijuan ZHU
;
Yong YAO
;
Kan DENG
;
Xinxin MAO
;
Lian DUAN
Author Information
1. 中国医学科学院北京协和医学院，北京协和医院内分泌科，国家卫生健康委员会内分泌重点实验室，疑难重症及罕见病国家重点实验室 100730
- Keywords:
Pituitary plurihormonal mixed adenoma;
Clinical characteristics;
Comprehensive treatment;
Prognosis
- From:
Chinese Journal of Endocrinology and Metabolism
2023;39(10):839-845
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To summarize the clinical characteristics of 4 cases of mixed pituitary adenomas involving growth hormone(GH), prolactin(PRL), and thyroid stimulating hormone(TSH), and explore the standardized management approaches.Methods:The clinical data of four GH/PRL/TSH mixed pituitary adenoma patients diagnosed by Peking Union Medical College Hospital were retrospectively analyzed, including clinical manifestations, biochemical parameters, radiographic characteristics, as well as treatment and prognosis. Then literature review was conducted.Results:Among the 4 patients, 3 were male, with onset ages ranging from 15 to 38 years. All patients presented with coarse facial features as initial symptom. Three patients had visual impairment or visual field defects. All 4 patients had significantly elevated levels of GH and insulin-like growth factor-Ⅰ(IGF-Ⅰ). GH was not inhibited by oral glucose tolerance test. PRL concentration was over 100 ng/mL. Triiodothyronine(T 3)and thyroxine(T 4)were also elevated, while TSH was not inhibited. All pituitary adenomas in four cases were macroadenomas or giant adenomas, all of which were invasive growth, and one case developed pituitary stroke. Except for one patient who did not receive treatment in our hospital due to medical expenses, the remaining three patients underwent a combined treatment of medication and transnasal transsphenoidal pituitary adenoma resection. Among them, one patient had relief of central hyperthyroidism and hyperprolactinemia, but GH/IGF-Ⅰ did not meet the remission criteria. The other two patients had persistent non-resolution of at least 2 hormone axes. Conclusions:Patients with GH/PRL/TSH mixed pituitary adenoma were mainly characterized by coarse facial features, GH/PRL/TSH hyperfunction, large adenoma volume, low biochemical remission after surgery combined with drug treatment, and poor clinical prognosis.
