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Brain and Nerve No to Shinkei Volume 43, Issue 2 （February 1991）

Brain and Nerve 脳と神経 43巻2号（1991年2月発行）

Japanese English

症例報告

二次性甲状腺機能低下症に伴う偽TSH・PRL産生下垂体腫瘍の1例—甲状腺製剤投与に伴う下垂体腫瘤のMRI所見の推移 A Case of Pseudo-TSH･PRL-Producting Pituitary Adenoma with Secondary Hypothyroidism 小山勉 ¹ , 篠田宗次 ² , 谷諭 ¹ , 上久保毅 ¹ , 中村紀夫 ¹ , 奥田真琴 ³ Tsutomu Koyama ¹ , Soji Shinoda ² , Satoshi Tani ¹ , Tsuyoshi Kamikubo ¹ , Norio Nakamura ¹ , Makoto Okuda ³ ¹東京慈恵会医科大学脳神経外科 ²自治医科大学脳神経外科 ³東京慈恵会医科大学眼科 ¹The Jikei University School of Medicine, Department of Neurosurgery ²The Jichi Medical School, Department of Neurosurgery ³The Jikei University School of Medicine, Department of Opthalmology キーワード： hypothyroidism , TSH , pituitary hyperplasia , MRI image , thyroid replacement therapy Keyword: hypothyroidism , TSH , pituitary hyperplasia , MRI image , thyroid replacement therapy pp.187-191

発行日 1991年2月1日 Published Date 1991/2/1

DOI https://doi.org/10.11477/mf.1406900166

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Abstract 文献概要
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　慢性甲状腺機能低下症に伴って，頭部単純XPにてトルコ鞍の拡大，頭部CT，MRIにてトルコ鞍内，トルコ鞍上に進展した下垂体腫瘤を認めることがある。これは甲状腺機能低下によりfeedback機構の働きで視床下部よりTRHの放出→下垂体よりTSH，PRLの合成・分泌が生じ血漿TSH，PRLの高値を認め，下垂体の過形成，または下垂体腫瘍を形成するからである。

　治療方針は第1に，甲状腺末の補充療法であり，これにより血漿TSH，PRLの正常化および下垂体腫瘤の縮小を見る。しかし，注意しなければならない点は甲状腺末のlow doseではTSHの分泌は抑制するが，合成は抑制しないので下垂体腫瘤は増大する。また，下垂体補充療法の長期経過でempty sellarになることがあるので経過観察が必要である。手術適応はchiasma syndromeを呈する時，補充療法に反応しない下垂体腫瘍の時である。

A 24-year-old housewife presented with weight gain of about 30 kg, constipation and piting edema of extremity nine years after having a thyroidectory.

Hormonal examination revealed low levels of serum T₃ and T₄ and high levels of serum TSH and PRL. She also had enlarged pituitary gland (pitui-tary hyperplasia) with suprasellar extension on CT and MRI image. Thyroid replacement therapy and follow-up by MRI were performed without resort to surgery, because she had no visual disturbance. Within about 1 month after thyroid replacement therapy, serum TSH and PRL were normalized. And also thyroid function was normalized by Tyronine (T₃) .

Following this results, pituitary hyperplasia regression was seen on MRI image. About 1 year after thyroid replacement therapy, pituitary hyper-plasia regression was more seen on MRI image.

Prolonged hypothyroidism can result in hypertro-phy of the pituitary thyrotopin-secreting cells and prolactin secreting cells. So, it can increase pitui-tary weight (pituitary hyperplasia) . Radiological examination, abnormal sellar x-ray films suggest-ing intrasellar tumor are common in patients with primary hypothyroidism.

Suprasellar extention of pituitary mass (pituitary hyperplasia) due to hypothyroidism was reported by radiological examination (PEG, CT and MRI image), and regression of pituitary hyperplasia was revealed by radiological examination after thyroid replacement therapy.

The first choice of this type of pituitary hyper-plasia is thyroid replacement therapy unless the patient has a visual disturbance. However, if this replacement therapy is not effective for diminution of the tumor, surgical removal of the tumor should be considered.