关键词: 原发性甲减, 垂体增生, 甲状腺激素

Abstract: Objective To explore the causes,diagnosis and treatment of misdiagnosis of pituitary hyperplasia caused by primary hypothyroidism as pituitary adenoma,so as to improve clinicians' understanding of the disease and avoid misdiagnosis.Methods Retrospective analysis of 19 cases of pituitary hyperplasia misdiagnosed as pituitary adenoma in our hospital,to analyze the clinical manifestations,endocrine examination,imaging features and misdiagnosis reasons.The clinical outcome after long-term treatment was reported.Results All the 19 patients underwent pituitary magnetic resonance imaging,and all the patients had the description of “pituitary adenoma” in the imaging report.There were 17 patients with > 10 mm,of which 13 patients had elevated prolactin,3 patients had lactation symptoms,and 2 patients were misdiagnosed as prolactinoma.There were 2 patients with < 10 mm,and prolactin was elevated in both patients with lactation symptoms,and both patients were misdiagnosed as prolactinomas.TSH was elevated in all patients,all patients were misdiagnosed as pituitary adenomas,and 3 patients were recommended for surgery.After 3-19 months of replacement therapy,the T3,T4 and TSH of all patients returned to normal range,and the pituitary gland of 18 patients returned to normal size.Conclusion Pituitary enlargement larger than 10 mm should not be easily diagnosed as pituitary adenoma,and pituitary abnormalities with lactation of less than 10mm should not be easily diagnosed as prolactinoma.The diagnosis of pituitary adenoma in all women of childbearing age should be differentiated from pituitary hyperplasia caused by primary hypothyroidism.The examination of T3,T4 and TSH showed that TSH increased significantly without T3 and T4 increased;Long-term replacement therapy for pituitary hyperplasia can achieve good therapeutic effect.

Key words: Primary hypothyroidism, Pituitary reactive hyperplasia, Thyroxine