clinmedКлиническая медицинаClinical Medicine (Russian Journal)0023-21492412-1339ООО «Медицинское информационное агентство»10.30629/0023-2149-2024-102-4-291-296clinmed-809Research ArticleОБЗОРЫ И ЛЕКЦИИREVIEWS AND LECTURESРедкие формы тиреотоксикоза: тиреотропин-секретирующие аденомы гипофизаRare forms of thyrotoxicosis: thyrotropin-secreting pituitary adenomashttps://orcid.org/0009-0001-2805-4460ТелегинаМ. А.TeleginaM. A.

Телегина Мария Алексеевна

Maria А. Telegina

telegina-07@yandex.ruhttps://orcid.org/0000-0002-6674-6441БелаяЖ. Е.BelayaZh. E.

Белая Жанна Евгеньевна — д-р мед. наук, профессор, заведующая отделением остеопороза и остеопатии

Zhanna E. Belaya — Dr. of Sci. (Med.), Professor, Head of the Department of Osteoporosis and Osteopathy

ГНЦ РФ ФГБУ «Национальный медицинский исследовательский центр эндокринологии» Минздрава РоссииРоссияNational Medical Research Center of EndocrinologyRussian Federation2024230720241024291296Copyright © Телегина М.А., Белая Ж.Е., 20242024Телегина М.А., Белая Ж.Е.Telegina M.A., Belaya Z.E.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.clinmedjournal.com/jour/article/view/809

Тиреотоксикоз, чаще всего, возникает из-за аутоиммунных заболеваний щитовидной железы или многоузлового токсического зоба. Однако иногда он может быть вызван ТТГ-секретирующими аденомами гипофиза (ТТГ-омами). При наличии ТТГ-ом, уровень циркулирующих свободных Т3 и Т4 повышается на фоне отсутствия подавления или даже при повышенном уровне ТТГ. Неправильная трактовка результатов исследования с определением только уровня ТТГ может привести к ошибочному диагнозу и тактике ведения пациента, включая ненужные операции или проведение терапии радиоактивным йодом, что может способствовать увеличению размера гипофизарной опухоли. При диагностике ТТГ-ом были испробованы различные тесты, включая стимулирующие и ингибирующие, однако диагностическая ценность ни одного из них не доказана. Лишь лабораторные данные в сочетании с МРТ гипофиза, помогают правильно поставить диагноз и назначить соответствующее лечение. При выборе метода лечения ТТГ-ом предпочтение отдается хирургической транссфеноидальной аденомэктомии. В случаях, когда операция невозможна или неэффективна, методом нормализации уровня ТТГ является назначение аналогов соматостатина. В ряде случаев, возможно предварительное лечение аналогами соматостатина с последующим проведением нейрохирургического вмешательства. В исключительных случаях, как и при других аденомах, возможна лучевая терапия.

Thyrotoxicosis most often occurs due to autoimmune diseases of the thyroid gland or a multi-nodular toxic goiter, but it can also be caused by TSH-secreting pituitary adenomas. In the presence of these adenomas, the levels of circulating free T3 and T4 increase in the absence of suppression, even with elevated TSH levels. Incorrect interpretation of results from studies that only measure TSH can lead to erroneous diagnoses and management strategies for patients, including unnecessary surgery or radioactive iodine therapy. This can contribute to the growth of pituitary tumors. Various tests have been used to try to diagnose them, but none have proven to be eff ective. Only laboratory tests in combination with MRI of the pituitary can accurately diagnose and prescribe treatment. When choosing a treatment for TSH-producing pituitary adenomas, preference is given to the surgical method of transsphenoidal adenomectomy. If surgery is not possible or eff ective, the method used to normalize TSH levels is to prescribe somatostatin analogs. In some cases, it is possible to use somatostatin analog therapy before neurosurgery. In exceptional circumstances, radiation therapy may be used, as with other types of adenomas.

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The authors declare that there are no conflicts of interest present.