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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">problendo</journal-id><journal-title-group><journal-title xml:lang="ru">Проблемы Эндокринологии</journal-title><trans-title-group xml:lang="en"><trans-title>Problems of Endocrinology</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">0375-9660</issn><issn pub-type="epub">2308-1430</issn><publisher><publisher-name>Endocrinology Research Centre</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.14341/probl12860</article-id><article-id custom-type="elpub" pub-id-type="custom">problendo-12860</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>Клиническая эндокринология</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>Clinical endocrinology</subject></subj-group></article-categories><title-group><article-title>ТТГ-продуцирующая микроаденома гипофиза: проблемы диагностики в дебюте заболевания</article-title><trans-title-group xml:lang="en"><trans-title>TSH-рroducing pituitary microadenoma: diagnostic problems in the debut of the disease</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-1577-7077</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Климчук</surname><given-names>А. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Klimchuk</surname><given-names>A. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Климчук Анастасия Васильевна, к.м.н</p><p>295051, Симферополь, бульвар Ленина, д. 5/7</p></bio><bio xml:lang="en"><p>Anastasia V. Klimchuk, PhD</p><p>295051, Lenin boulevard 5/7, Simferopol</p></bio><email xlink:type="simple">anastasiya-klim@mail.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-5486-7262</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Яцков</surname><given-names>И. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Yatskov</surname><given-names>I. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Яцков Игорь Анатольевич</p><p>295051, Симферополь, бульвар Ленина, д. 5/7</p></bio><bio xml:lang="en"><p>Igor A. Yatskov</p><p>295051, Lenin boulevard 5/7, Simferopol</p></bio><email xlink:type="simple">egermd@yandex.ru</email><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-8960-602X</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Бублей</surname><given-names>К. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Bubley</surname><given-names>K. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Бублей Константин Викторович</p><p>295051, Симферополь, бульвар Ленина, д. 5/7</p></bio><bio xml:lang="en"><p>Konstantin V. Bubley</p><p>295051, Lenin boulevard 5/7, Simferopol</p></bio><email xlink:type="simple">bubley.99@mail.ru</email><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-0263-6040</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Энзель</surname><given-names>Д. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Enzel</surname><given-names>D. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Энзель Дарья Анатольевна </p><p>295051, Симферополь, бульвар Ленина, д. 5/7</p></bio><bio xml:lang="en"><p>Darya A. Enzel</p><p>295051, Lenin boulevard 5/7, Simferopol</p></bio><email xlink:type="simple">darya.enzel@yandex.ru</email><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-7365-5014</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Щербаков</surname><given-names>А. С.</given-names></name><name name-style="western" xml:lang="en"><surname>Sherbakov</surname><given-names>A. S.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Щербаков Аким Сергеевич</p><p>295051, Симферополь, бульвар Ленина, д. 5/7</p></bio><bio xml:lang="en"><p>Akim S. Sherbakov</p><p>295051, Lenin boulevard 5/7, Simferopol</p></bio><email xlink:type="simple">akim.sherbakov2000@gmail.com</email><xref ref-type="aff" rid="aff-2"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>Крымский федеральный университет им. В.И. Вернадского; Республиканская клиническая больница им. Н.А. Семашко</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Crimean Federal University named after V.I. Vernadsky;&#13;
Republican Clinical Hospital named after N.А. Semash</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-2"><aff xml:lang="ru"><institution>Крымский федеральный университет им. В.И. Вернадского</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Crimean Federal University named after V.I. Vernadsky</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2022</year></pub-date><pub-date pub-type="epub"><day>09</day><month>03</month><year>2022</year></pub-date><volume>68</volume><issue>3</issue><fpage>44</fpage><lpage>49</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Климчук А.В., Яцков И.А., Бублей К.В., Энзель Д.А., Щербаков А.С., 2022</copyright-statement><copyright-year>2022</copyright-year><copyright-holder xml:lang="ru">Климчук А.В., Яцков И.А., Бублей К.В., Энзель Д.А., Щербаков А.С.</copyright-holder><copyright-holder xml:lang="en">Klimchuk A.V., Yatskov I.A., Bubley K.V., Enzel D.A., Sherbakov A.S.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://www.probl-endojournals.ru/jour/article/view/12860">https://www.probl-endojournals.ru/jour/article/view/12860</self-uri><abstract><p>Опухоли гипофиза, продуцирующие тиреотропный гормон (ТТГ), встречаются редко и составляют около 1–3% всех аденом гипофиза, наиболее часто наблюдаются у лиц молодого и трудоспособного возраста. Статья представляет клинический случай тиреотропиномы, которая была диагностирована через 6 лет после первичного обращения к эндокринологу у 44-летней женщины. В дебюте заболевания тиреотропинома проявила себя изолированным подъемом уровня ТТГ при нормальных уровнях свободного тироксина (Т4) и свободного трийодтиронина (Т3). Больная постоянно принимала β-блокаторы из-за беспокоящей ее тахикардии. Поставлен диагноз: субклинический гипотиреоз, по поводу чего она периодически наблюдалась, контролируя уровень ТТГ и принимая препараты левотироксина в дозе до 175 мкг, что сопровождалось повышенным уровнем ТТГ. Через 6 лет выявлено повышение уровней, кроме ТТГ, свободного Т3 и свободного Т4. На магнитно-резонансной томографии с внутривенным контрастным усилением обнаружена микроаденома гипофиза размером 4 мм, при лабораторном исследовании всех тропных гормонов выявлено изолированное повышение ТТГ. При диагностировании ТТГ-продуцирующей аденомы гипофиза выполнена транссфеноидальная аденомэктомия. За время 3-летнего послеоперационного наблюдения рецидив аденомы отсутствует, развился вторичный гипотиреоз, больная в настоящий момент постоянно принимает левотироксин 75 мкг в сутки.</p></abstract><trans-abstract xml:lang="en"><p>Tumors of the pituitary gland producing thyrotropin hormone (TSH) are rare and account for about 1–3% of all pituitary adenomas, most frequently occurring in persons of young and working age. This article presents a clinical case of thyrotropinoma in a 44-year-old woman, which was diagnosed 6 years after her initial visit to an endocrinologist. At the debut of the disease, thyrotropinoma manifested as an isolated elevation of TSH, with normal levels of free T4 and free T3. The patient was constantly taking β-blockers due to her disturbing tachycardia. She was diagnosed with subclinical hypothyroidism, for which she was periodically observed, controlling her TSH level and taking levothyroxine drugs in a dose of up to 175 mcg, which was accompanied by elevated TSH levels. After 6 years, there was an increase in free T3 and free T4 in addition to TSH. Magnetic resonance imaging with intravenous contrast enhancement revealed a pituitary microadenoma 4 mm in size, and laboratory examination of all tropic hormones revealed an isolated increase in TSH. Transsphenoidal adenomectomy was performed at the diagnosis of TSH-producing pituitary adenoma. During the three-year postoperative follow-up there was no adenoma recurrence, secondary hypothyroidism developed, the patient currently takes levothyroxine 75 mcg per day continuously</p></trans-abstract><kwd-group xml:lang="ru"><kwd>микроаденома гипофиза</kwd><kwd>тиреотропинома</kwd><kwd>ТТГ-продуцирующая аденома</kwd><kwd>многоузловой зоб</kwd><kwd>тиреотоксикоз</kwd></kwd-group><kwd-group xml:lang="en"><kwd>microadenoma of the pituitary gland</kwd><kwd>TSH-secreting adenoma</kwd><kwd>thyrotropinoma</kwd><kwd>thyrotoxicosis</kwd></kwd-group></article-meta></front><back><ref-list><ref id="cit1"><mixed-citation publication-type="commun" publication-format="web"><name><surname>Kalinin</surname> <given-names>P.L.</given-names></name>, <name><surname>Fomichev</surname> <given-names>D.V.</given-names></name>, <name><surname>Kutin</surname> <given-names>M.A.</given-names></name>, i dr. <article-title>Endoskopicheskaya endonazal'naya khirurgiya adenom gipofiza (opyt 1700 operatsii)</article-title> // <source>Zhurnal «Voprosy neirokhirurgii» imeni N.N. Burdenko.</source> — <year>2012</year>. — T. <volume>76</volume>. — №<month>3</month>. — S. <fpage>26</fpage>-<lpage>33</lpage>.</mixed-citation></ref><ref id="cit2"><mixed-citation publication-type="commun" publication-format="web"><name><surname>Kalinin</surname> <given-names>P.L.</given-names></name>, <name><surname>Kadashev</surname> <given-names>B.A.</given-names></name>, <name><surname>Fomichev</surname> <given-names>D.V.</given-names></name>, i dr. <article-title>Klinicheskie rekomendatsii «Khirurgicheskoe lechenie adenom gipofiza».</article-title> M.: <source>NII neirokhirurgii im. akad. N.N. Burdenko</source>; <year>2014</year>.</mixed-citation></ref><ref id="cit3"><mixed-citation publication-type="commun" publication-format="web"><name><surname>Aflorei</surname> <given-names>ED</given-names></name>, <name><surname>Korbonits</surname> <given-names>M.</given-names></name> <article-title>Epidemiology and etiopathogenesis of pituitary adenomas.</article-title> <source>J Neurooncol.</source> <year>2014</year>;<issue>117(3)</issue>:<fpage>379</fpage>-<lpage>394</lpage>. doi: https://doi.org/<object-id pub-id-type="doi" specific-use="metadata">10.1007/s11060-013-1354-5</object-id></mixed-citation></ref><ref id="cit4"><element-citation><name><surname>Önnestam</surname> <given-names>Lisa</given-names> </name> <name><surname>Berinder</surname> <given-names>Katarina</given-names> </name> <name><surname>Burman</surname> <given-names>Pia</given-names> </name> <name><surname>Dahlqvist</surname> <given-names>Per</given-names> </name> <name><surname>Engström</surname> <given-names>Britt Edén</given-names> </name> <name><surname>Wahlberg</surname> <given-names>Jeanette</given-names> </name> <name><surname>Nyström</surname> <given-names>Helena Filipsson</given-names> </name> <article-title>National Incidence and Prevalence of TSH-Secreting Pituitary Adenomas in Sweden</article-title> <source>The Journal of Clinical Endocrinology &amp; Metabolism</source> <year>2013</year> <month>01</month> <fpage>626</fpage> <lpage>635</lpage> <volume>98</volume> <issue>2</issue> <object-id pub-id-type="doi" specific-use="metadata">10.1210/jc.2012-3362</object-id></element-citation></ref><ref id="cit5"><element-citation><name><surname>Fernandez</surname> <given-names>Alberto</given-names> </name> <name><surname>Karavitaki</surname> <given-names>Niki</given-names> </name> <name><surname>Wass</surname> <given-names>John A. H.</given-names> </name> <article-title>Prevalence of pituitary adenomas: a community-based, cross-sectional study in Banbury (Oxfordshire, UK)</article-title> <source>Clinical Endocrinology</source> <year>2009</year> <month>07</month> <fpage>377</fpage> <lpage>382</lpage> <volume>72</volume> <issue>3</issue> <object-id pub-id-type="doi" specific-use="metadata">10.1111/j.1365-2265.2009.03667.x</object-id></element-citation></ref><ref id="cit6"><mixed-citation publication-type="commun" publication-format="web"><name><surname>Astaf'eva</surname> <given-names>L.I.</given-names></name>, <name><surname>Kadashev</surname> <given-names>B.A.</given-names></name>, <name><surname>Shishkina</surname> <given-names>L.V.</given-names></name>, i dr. <article-title>Klinikomorfologicheskie kharakteristiki, diagnosticheskie kriterii i rezul'taty khirurgicheskogo lecheniya TTG-sekretiruyushchikh adenom gipofiza</article-title> // <source>Zhurnal «Voprosy neirokhirurgii» imeni N.N. Burdenko</source>. — <year>2016</year>. — T. <volume>80</volume>. — №<month>6</month>. — S. <fpage>24</fpage>-<lpage>35</lpage>.</mixed-citation></ref><ref id="cit7"><element-citation><name><surname>Yamada</surname> <given-names>Shozo</given-names> </name> <name><surname>Fukuhara</surname> <given-names>Noriaki</given-names> </name> <name><surname>Horiguchi</surname> <given-names>Kentaro</given-names> </name> <name><surname>Yamaguchi-Okada</surname> <given-names>Mitsuo</given-names> </name> <name><surname>Nishioka</surname> <given-names>Hiroshi</given-names> </name> <name><surname>Takeshita</surname> <given-names>Akira</given-names> </name> <name><surname>Takeuchi</surname> <given-names>Yasuhiro</given-names> </name> <name><surname>Ito</surname> <given-names>Junko</given-names> </name> <name><surname>Inoshita</surname> <given-names>Naoko</given-names> </name> <article-title>Clinicopathological characteristics and therapeutic outcomes in thyrotropin-secreting pituitary adenomas: a single-center study of 90 cases</article-title> <source>Journal of Neurosurgery</source> <year>2014</year> <month>09</month> <fpage>1462</fpage> <lpage>1473</lpage> <volume>121</volume> <issue>6</issue> <object-id pub-id-type="doi" specific-use="metadata">10.3171/2014.7.jns1471</object-id></element-citation></ref><ref id="cit8"><mixed-citation publication-type="commun" publication-format="web"><name><surname>Przhiyalkovskaya</surname> <given-names>E.G.</given-names></name>, <name><surname>Gazizova</surname> <given-names>D.O.</given-names></name>, <name><surname>Grigor'ev</surname> <given-names>A.Yu.</given-names></name>, i dr. <article-title>Tireotropinoma: trudnosti differentsial'noi diagnostiki (klinicheskii sluchai)</article-title> // <source>Klinicheskaya i eksperimental'naya tireoidologiya.</source> — <year>2011</year>. — T. <volume>7</volume>. — №<month>2</month>. — S. <fpage>68</fpage>-<lpage>73</lpage>.</mixed-citation></ref><ref id="cit9"><element-citation><name><surname>Wang</surname> <given-names>Elaine Lu</given-names> </name> <name><surname>Qian</surname> <given-names>Zhi Rong</given-names> </name> <name><surname>Yamada</surname> <given-names>Shozo</given-names> </name> <name><surname>Rahman</surname> <given-names>Md Mustafizur</given-names> </name> <name><surname>Inosita</surname> <given-names>Naoko</given-names> </name> <name><surname>Kageji</surname> <given-names>Teruyoshi</given-names> </name> <name><surname>Endo</surname> <given-names>Hideko</given-names> </name> <name><surname>Kudo</surname> <given-names>Eiji</given-names> </name> <name><surname>Sano</surname> <given-names>Toshiaki</given-names> </name> <article-title>Clinicopathological Characterization of TSH-Producing Adenomas: Special Reference to TSH-immunoreactive but Clinically Non-functioning Adenomas</article-title> <source>Endocrine Pathology</source> <year>2009</year> <month>09</month> <fpage>209</fpage> <lpage>220</lpage> <volume>20</volume> <issue>4</issue> <object-id pub-id-type="doi" specific-use="metadata">10.1007/s12022-009-9094-y</object-id></element-citation></ref><ref id="cit10"><mixed-citation publication-type="commun" publication-format="web"><name><surname>Beck-Peccoz</surname> <given-names>P</given-names></name>, <name><surname>Lania</surname> <given-names>A</given-names></name>, <name><surname>Persani</surname> <given-names>L.</given-names></name> <article-title>TSH-producing adenomas</article-title>. In: Jameson JL, Degroot LJ, editors. <source>Endocrinology.</source> 7th ed. USA: W.B. Saunders Pub.; <year>2015</year>.</mixed-citation></ref><ref id="cit11"><element-citation><name><surname>Arimura</surname> <given-names>Hiroshi</given-names> </name> <name><surname>Askoro</surname> <given-names>Rofat</given-names> </name> <name><surname>Fujio</surname> <given-names>Shingo</given-names> </name> <name><surname>Ummah</surname> <given-names>Fauziah C.</given-names> </name> <name><surname>Takajo</surname> <given-names>Tomoko</given-names> </name> <name><surname>Nagano</surname> <given-names>Yushi</given-names> </name> <name><surname>Nishio</surname> <given-names>Yoshihiko</given-names> </name> <name><surname>Arita</surname> <given-names>Kazunori</given-names> </name> <article-title>A Thyroid-stimulating Hormone (TSH) Producing Adenoma in a Patient with Severe Hypothyroidism: Thyroxine Replacement Reduced the TSH Level and Tumor Size</article-title> <source>NMC Case Report Journal</source> <year>2019</year> <month>12</month> <fpage>17</fpage> <lpage>21</lpage> <volume>7</volume> <issue>1</issue> <object-id pub-id-type="doi" specific-use="metadata">10.2176/nmccrj.cr.2018-0323</object-id></element-citation></ref><ref id="cit12"><element-citation><name><surname>Beck-Peccoz</surname> <given-names>P.</given-names> </name> <name><surname>Lania</surname> <given-names>A.</given-names> </name> <name><surname>Beckers</surname> <given-names>A.</given-names> </name> <name><surname>Chatterjee</surname> <given-names>K.</given-names> </name> <name><surname>Wemeau</surname> <given-names>J.-L.</given-names> </name> <article-title>2013 European Thyroid Association Guidelines for the Diagnosis and Treatment of Thyrotropin-Secreting Pituitary Tumors</article-title> <source>European Thyroid Journal</source> <year>2013</year> <month>09</month> <fpage>76</fpage> <lpage>82</lpage> <volume>2</volume> <issue>2</issue> <object-id pub-id-type="doi" specific-use="metadata">10.1159/000351007</object-id></element-citation></ref><ref id="cit13"><mixed-citation publication-type="commun" publication-format="web"><name><surname>Fadeev</surname> <given-names>V.V.</given-names></name> <article-title>Po materialam klinicheskikh rekomendatsii Evropeiskoi Tireoidnoi Assotsiatsii po diagnostike i lecheniyu TTG-produtsiruyushchikh opukholei gipofiza</article-title> // <source>Klinicheskaya i eksperimental'naya tireoidologiya.</source> — <year>2016</year>. — T. <volume>12</volume>. — №<month>4</month>. — S. <fpage>39</fpage>-<lpage>45</lpage>.</mixed-citation></ref><ref id="cit14"><element-citation><name><surname>Molitch</surname> <given-names>Mark E.</given-names> </name> <article-title>Diagnosis and Treatment of Pituitary Adenomas</article-title> <source>JAMA</source> <year>2017</year> <month>02</month> <fpage>516</fpage> <volume>317</volume> <issue>5</issue> <object-id pub-id-type="doi" specific-use="metadata">10.1001/jama.2016.19699</object-id></element-citation></ref><ref id="cit15"><mixed-citation publication-type="commun" publication-format="web"><name><surname>Petrik</surname> <given-names>G.G.</given-names></name>, <name><surname>Kosmacheva</surname> <given-names>E.D.</given-names></name>, <name><surname>Polyakova</surname> <given-names>Yu.I.</given-names></name>, i dr. <article-title>Tireotropinoma: pozdnii diagnoz i effektivnost' terapii</article-title> // <source>Problemy endokrinologii.</source> — <year>2017</year>. — T. <volume>63</volume>. — №<month>1</month>. — S. <fpage>39</fpage>-<lpage>45</lpage>.</mixed-citation></ref><ref id="cit16"><element-citation><name><surname>Malchiodi</surname> <given-names>Elena</given-names> </name> <name><surname>Profka</surname> <given-names>Eriselda</given-names> </name> <name><surname>Ferrante</surname> <given-names>Emanuele</given-names> </name> <name><surname>Sala</surname> <given-names>Elisa</given-names> </name> <name><surname>Verrua</surname> <given-names>Elisa</given-names> </name> <name><surname>Campi</surname> <given-names>Irene</given-names> </name> <name><surname>Lania</surname> <given-names>Andrea Gerardo</given-names> </name> <name><surname>Arosio</surname> <given-names>Maura</given-names> </name> <name><surname>Locatelli</surname> <given-names>Marco</given-names> </name> <name><surname>Mortini</surname> <given-names>Pietro</given-names> </name> <name><surname>Losa</surname> <given-names>Marco</given-names> </name> <name><surname>Motti</surname> <given-names>Enrico</given-names> </name> <name><surname>Beck-Peccoz</surname> <given-names>Paolo</given-names> </name> <name><surname>Spada</surname> <given-names>Anna</given-names> </name> <name><surname>Mantovani</surname> <given-names>Giovanna</given-names> </name> <article-title>Thyrotropin-Secreting Pituitary Adenomas: Outcome of Pituitary Surgery and Irradiation</article-title> <source>The Journal of Clinical Endocrinology &amp; Metabolism</source> <year>2014</year> <month>02</month> <fpage>2069</fpage> <lpage>2076</lpage> <volume>99</volume> <issue>6</issue> <object-id pub-id-type="doi" specific-use="metadata">10.1210/jc.2013-4376</object-id></element-citation></ref></ref-list><fn-group><fn fn-type="conflict"><p>The authors declare that there are no conflicts of interest present.</p></fn></fn-group></back></article>
