problendoПроблемы ЭндокринологииProblems of Endocrinology0375-96602308-1430Endocrinology Research Centre10.14341/probl13390problendo-13390Research ArticleКлиническая эндокринологияClinical endocrinologyСочетание феноменов макро-ТТГ и макропролактинемии у пациента с аутоиммунным тиреоидитом и витилигоCombination of macro-TSH and macroprolactinemia phenomena in a patient with autoimmune thyroiditis and vitiligohttps://orcid.org/0000-0001-6838-9487СазоноваД. В.SazonovaD. V.

Сазонова Дарья Вячеславовна - врач-эндокринолог.

Москва

Daria V. Sazonova - MD.

Moscow

sazonova_dv@mail.ruhttps://orcid.org/0000-0001-5824-6490ПерепеловаМ. А.PerepelovaM. A.

Перепелова Маргарита Александровна

117292, ул. Дмитрия Ульянова, д. 11 Москва

Margarita A. Perepelova, MD.

11 Dm. Ulyanova street, 117292 Moscow

margo.doktor@mail.ruhttps://orcid.org/0000-0003-0047-7223ШутоваА. С.ShutovaA. S.

Шутова Александра Сергеевна - к.м.н.

Москва

Aleksandra S. Shutova - PhD.

Moscow

shutova.aleksandra@gmail.comhttps://orcid.org/0000-0002-1120-8240НиканкинаЛ. В.NikankinaL. V.

Никанкина Лариса Вячеславовна - к.м.н.

Москва

Larisa V. Nikankina - MD, PhD.

Moscow

larisa.nikankina@yandex.ruhttps://orcid.org/0000-0002-4266-2171КолесниковаГ. С.KolesnikovaG. S.

Колесникова Галина Сергеевна - д.б.н.

Москва

Galina S. Kolesnikova – PhD.

Moscow

kolesnikova21@yandex.ruhttps://orcid.org/0000-0001-6539-466XПигароваЕ. А.PigarovaE. A.

Пигарова Екатерина Александровна - д.м.н.

Москва

Пигарова Екатерина Александровна - д.м.н.

Москва

kpigarova@gmail.comhttps://orcid.org/0000-0002-0327-4619ДзерановаЛ. К.DzeranovaL. K.

Дзеранова Лариса Константиновна - д.м.н.

Москва

Larisa K. Dzeranova - MD, Sc.D.

Moscow

dzeranovalk@yandex.ruНациональный медицинский исследовательский центр эндокринологииРоссияEndocrinology Research CentreRussian Federation2024051120247053439Copyright © Сазонова Д.В., Перепелова М.А., Шутова А.С., Никанкина Л.В., Колесникова Г.С., Пигарова Е.А., Дзеранова Л.К., 20242024Сазонова Д.В., Перепелова М.А., Шутова А.С., Никанкина Л.В., Колесникова Г.С., Пигарова Е.А., Дзеранова Л.К.Sazonova D.V., Perepelova M.A., Shutova A.S., Nikankina L.V., Kolesnikova G.S., Pigarova E.A., Dzeranova L.K.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.probl-endojournals.ru/jour/article/view/13390

Лабораторные методы диагностики являются основными инструментами в практике врача любой специальности, в том числе эндокринолога. Были определены факторы, способные изменять концентрацию биологически активной фракции исследуемого вещества, в последующем затрудняющие интерпретацию лабораторных результатов и принятие верного клинического решения. В литературе представлено описание множества циркулирующих аутоантител, участвующих в связывании с гормонами гипофиза (пролактином (ПРЛ), тиреотропным (ТТГ), соматотропным, лютеинизирующим, фолликулостимулирующим и адренокортикотропным гормонами), гипоталамуса (вазопрессином и окситоцином), поджелудочной железы (инсулином и глюкагоном), околощитовидных желез (паратиреоидным гормоном), а также с гормонами щитовидной железы. Как правило, образуемые макромолекулы приводят к повышению лабораторных показателей, в которых превалирующая фракция гормона не обладает биологической активностью, что и определяет основную проблему данного феномена. К наиболее часто встречаемым вариантам относят иммунные комплексы с ПРЛ и ТТГ, вызывающие феномены макропролактинемии и макротиротропинемии (макро-ТТГ-­емии/макро-ТТГ) соответственно. Большинство лабораторных тест-систем, используемых в клинической практике, способны определять лишь общее количество ПРЛ и ТТГ.

В представленном клиническом наблюдении описано сочетание феноменов макро-ТТГ и макропролактинемии у пациента с аутоиммунным тиреоидитом (АИТ) и витилиго.

Laboratory diagnostic methods are the main tools in the practice of a doctor of any specialty, including an endocrinologist. Factors were identified that could change the concentration of the biologically active fraction of the test substance, subsequently complicating the interpretation of laboratory results and making the right clinical decision. The literature describes a variety of circulating autoantibodies involved in binding to pituitary hormones (prolactin (PRL), thyroid-stimulating hormone (TSH), growth hormone, luteinizing, follicle-stimulating, and adrenocorticotropic hormones), hypothalamus (vasopressin and oxytocin), pancreas (insulin and glucagon) , parathyroid glands (parathyroid hormone), as well as with thyroid hormones. As a rule, the resulting macromolecules lead to an increase in laboratory parameters, in which the prevailing fraction of the hormone does not have biological activity, which determines the main problem of this phenomenon. The most common variants include immune complexes with PRL and TSH, causing the phenomena of macroprolactinemia and macrothyrotropinemia (macro-TSH-emia/macro-TSH), respectively. Most laboratory test systems used in clinical practice are capable of determining only the total amount of PRL and TSH. The presented clinical observation describes a combination of the phenomena of macro-TSH and macroprolactinemia in a patient with autoimmune thyroiditis (AIT) and vitiligo.

макротиротропин (макро-ТТГ)макропролактинмакропролактинемиямакротиротропинемия (макро-ТТГ-емия)аутоиммунный тиреоидитвитилигоmacro-thyrotropin (macro-TSH)macroprolactinmacroprolactinemiamacrothyrotropinemiaautoimmune thyroiditisvitiligoВыполнено в рамках гранта Министерства образования и науки, соглашение № 075–15–2022–310 от 20.04.2022Burch Henry B. Clement Stephen Sokol Michael S. 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The authors declare that there are no conflicts of interest present.