中枢性甲状腺功能减退
小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 虚弱
- 疲劳
- 怕冷
其他诊断因素
- 记忆力减退
- 便秘
- 肌肉痉挛
- 体重升高
- 抑郁症
- 皮肤干燥粗糙
- 月经过少/闭经
- 心动过缓
- 体毛和头发减少
- 深部腱反射松弛期延长
- 听力损失
- 面部表情冷漠
- 尿崩症 (DI)
- 头痛
- 复视
- 周边视力下降
- 乳房萎缩
- 溢乳
- 满月脸
- 水牛背
危险因素
- 存在垂体占位病变
- 多发性内分泌腺瘤病（MEN）1型
- 头颈部放射治疗
- 创伤性脑损伤 (TBI)
- 5-15 岁和 45-60 岁（颅咽管瘤）
- 20-50 岁（泌乳素瘤）
- 40-80 岁（无功能垂体腺瘤）
- 结节病
- 组织细胞增多症
- 血色病
- 席汉综合征（产后垂体坏死）
- 淋巴细胞性垂体炎
- 中枢性甲状腺功能减退家族史
- 抗惊厥药物
诊断性检查
首要检查
- 血清游离甲状腺素（FT4）
- 血清促甲状腺激素 (TSH)
需考虑的检查
- 垂体 MRI 检查
- 头部 CT
- 血清催乳素 (PRL)
- 清晨的空腹血清皮质醇水平
- 血清睾酮
- 血清促性腺激素
- 遗传学分析
治疗流程
所有患者
撰稿人
作者
Angela M. Leung, MD, MSc
Associate Professor of Medicine
UCLA David Geffen School of Medicine
VA Greater Los Angeles Healthcare System
Los Angeles
CA
利益声明
AML serves on the board of directors of the American Thyroid Association (ATA); is editor-in-chief of Clinical Thyroidology, a journal of the ATA; speaks for Medical Education Resources and MCE Conferences; consulted for Vertice Pharma; received article process charges paid by IBSA Institut Biochimique for an invited review article; lectured at a conference sponsored by Merck; presented educational content for the Endocrine Society and the American Association of Clinical Endocinology; is an advisor to Medscape; and has received research funding from the US Department of Veterans Affairs.
鸣谢
Dr Angela M. Leung would like to gratefully acknowledge Dr Jacqueline Gilbert and Dr Rasa Zarnegar, previous contributors to this topic.
利益声明
JG and RZ declare that they have no competing interests.
同行评议者
James Lee, MD
Assistant Professor
Department of Endocrine Surgery
Columbia University
New York
NY
利益声明
JL declares that he has no competing interests.
James V. Hennessey, MD
Director of Clinical Endocrinology
Beth Israel Deaconess Medical Center
Boston
MA
利益声明
JVH declares that he has no competing interests.
Anthony Weetman, MD, DSc, FRCP, FMedSci
Sir Arthur Hall Professor of Medicine/Pro Vice Chancellor
University of Sheffield
Sheffield
UK
利益声明
AW declares that he has no competing interests.
鉴别诊断
- 原发性甲状腺功能减退症
- 非甲状腺疾病
- 碘缺乏
更多 鉴别诊断指南
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- 中枢性甲状腺功能减退的诊断和管理指南
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