Syndrome of resistance to thyroid hormone and thyrotropin-secreting pituitary adenoma: Case series study
10.3760/cma.j.cn311282-20211209-00786
- VernacularTitle:甲状腺激素抵抗综合征与垂体促甲状腺激素瘤的临床特点分析及鉴别诊断
- Author:
Longfu LIU
1
;
Ning PENG
;
Tiejian JIANG
Author Information
1. 中南大学湘雅医院内分泌科，长沙 410005
- Keywords:
Syndrome of resistance to thyroid hormone;
Thyrotropin-secreting pituitary adenoma;
Octreotide suppression test;
High-dose dexamethasone suppression test
- From:
Chinese Journal of Endocrinology and Metabolism
2022;38(12):1057-1062
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To outline clinical features in syndrome of resistance to thyroid hormone(RTH) and thyrotropin-secreting pituitary adenoma(TSH adenoma) based on a case series, and to assess the value of octreotide suppression test and high-dose dexamethasone suppression test(HDDST) in differentiating the two diseases.Methods:A total of 22 cases with RTH and TSH adenoma clinically diagnosed in Xiangya Hospital of Central South University from October 2010 to December 2021 were retrieved. The clinical characteristics of the two diseases and results to different tests were analyzed and summarized.Results:(1) The tumors in TSH adenoma patients were larger than those with RTH complicated with pituitary mass, which presented chiasmatic compression on images( P<0.05). (2) In octreotide suppression test, thyrotropin(TSH) inhibition rate in RTH patients was lower than that in TSH adenoma patients( P<0.05). In HDDST, TSH inhibition rate was higher in patients with RTH than in patients with TSH adenoma( P<0.05). (3) The TSH inhibition rate was calculated by receiver operating characteristic(ROC) curve. The sensitivity and specificity of octreotide suppression test were 91.9% and 55.6%, respectively, and the threshold value of TSH inhibition rate was 64.24%. The sensitivity and specificity of HDDST were 54.4% and 89.0%, respectively, and the threshold value of TSH inhibition rate was 65.73%.The combined sensitivity and specificity of the two tests were 77.8% and 90.9%, indicating better diagnostic value( P<0.05). Conclusions:The combination of octreotide suppression test and HDDST is of clinical value in differentiating RTH from TSH adenoma. TSH adenoma is more aggressive than that of pituitary adenoma with RTH.
