Thyrotropin-releasing hormone deficiency

Introduction Thyroid stimulating hormone releasing hormone deficiency means that the thyroid stimulating hormone releasing hormone is lower than the normal range: 14 to 168 picomoles per liter (5 to 60 picograms per milliliter). Thyroid stimulating hormone releasing hormone (thyrotropin-releasing hormone, TRH) is a peptide hormone (Peptide Hormone) produced by the hypothalamus (Hypothalamus), which regulates the secretion of thyrotropin in the anterior pituitary gland. Aphrodisiac, thyroid stimulating hormone, TSH) and prolactin. In addition to the brain, TRH can also be detected in the digestive tract and islets. Synthetic TRH is utilized to check whether the hypothalamus and thyroid function are normal. Thyroid stimulating hormone is secreted by the hypothalamus, and thyroid stimulating hormone is secreted by the pituitary gland.

Cause

Congenital single TRH deficiency, brain trauma and other reasons.

Reduced in congenital simple TRH deficiency. Hypothalamic dysfunction TRH decreased. Brain trauma can cause a decrease in hormone release from the hypothalamus and a decrease in TRH. Sedatives acting on the central nervous system, such as barbiturates, can inhibit hypothalamic secretion and reduce blood TRH; central nervous system stimulants can promote TRH release.

an examination

Related inspection

Total triiodothyronine serum total thyroxine (TT4) anti-centromere antibody plasma thyroid stimulating hormone releasing hormone (TRH) cyclic guanosine monophosphate

Thyroid stimulating hormone releasing hormone (TRH) is a hormone of three peptides secreted by the hypothalamus. It reaches the pituitary gland through the portal system and stimulates the thyroid-stimulating hormone secreting cells of the pituitary to secrete thyroid-stimulating hormone. Since the half-life of thyroid stimulating hormone releasing hormone is very short, the concentration reaching the blood circulation is extremely low, and it is difficult to directly measure it clinically. The level of serum free thyroid hormone is estimated indirectly by dynamic testing (injection of TRH) to observe the response of thyroid stimulating hormone. The specific method of thyroid stimulating hormone releasing hormone test is as follows: venous blood is taken before injection, followed by intravenous injection of thyrotropin releasing hormone 300-500pg, injection within 15-20 seconds, blood sampling before injection and 30, 60 minutes after injection Thyroid stimulating hormone.

Normal people in the thyroid stimulating hormone release hormone 20 to 30 minutes after the thyroid stimulating hormone response peak, thyroid stimulating hormone ( thyroid stimulating hormone = thyroid stimulating hormone peak - thyroid stimulating hormone based value) is 2 ~ 30 bucket U / Ml. The response of the TRH test was affected by age and gender. The male response was lower than that of females, and the normal response of women was thyroid stimulating hormone > 6 uU / ml. Men over 40 years old thyroid stimulating hormone > 2 uU / ml. The thyrotropin-releasing hormone test for primary hypothyroidism is too strong; patients with hyperthyroidism, some patients with diffuse goiter with normal thyroid function, some immediate family members of patients with hyperthyroidism, or patients with oral excess glucocorticoid have poor thyroid stimulating hormone response . The thyroid stimulating hormone releasing hormone stimulation test is valuable for distinguishing the cause of secondary hypothyroidism in the hypothalamus or in the pituitary gland. Hypothalamic hypothyroidism has a delayed response to the thyroid stimulating hormone releasing hormone stimulation test; and the thyroid stimulating hormone releasing hormone stimulation test for pituitary hypothyroidism is reduced and absent.

In addition, some drugs may also affect the thyroid stimulating hormone releasing hormone test, estrogen, theophylline, anti-thyroid drugs can enhance the thyrotropin-releasing hormone response; while glucocorticoids, thyroid hormone preparations, levodopa can inhibit the release of thyroid stimulating hormone Hormone response. Clinically, the thyroid stimulating hormone releasing hormone stimulation test has little adverse reaction, and half of the patients have a transient facial flushing, nausea or urgency. The thyroid stimulating hormone releasing hormone stimulation test is suitable for patients of all age groups. At present, the ultra-sensitive thyroid stimulating hormone test can completely replace the thyroid stimulating hormone releasing hormone stimulation test.

Differential diagnosis

Congenital gonadotropin deficiency, the name of the disease: also known as simple pituitary infertility, gonadotropin-deficient type without testicular disease, sexual naive-olfactory loss syndrome. It refers to the lack of single gonadotropin secretion in the anterior pituitary, but no other hormone secretion disorders. It is possible that the hypothalamus does not selectively secrete LH-RH. It is a congenital disease with a family genetic predisposition. More common in men, manifested by congenital midline craniofacial abnormalities, loss of smell, small testicles, lack of sperm. Female nipples, breasts, vagina, and uterus are naive-like, with a tall body and delayed fusion of the epiphysis. The bone age is lower than the actual age. It is advisable to use gonadotropin for a long time - chorionic gonadotropin and menopausal gonadotropin. Hypothyroidism, referred to as hypothyroidism, is due to the accumulation of hypothalamic-pituitary-thyroid axis function in various diseases, inhibition of thyroxine deficiency, or clinical syndrome due to defects in thyroxine receptors. According to the location of the lesion can be divided into:

1 Primary hypothyroidism is caused by diseases of the thyroid gland itself.

2 secondary hypothyroidism, the lesion is located in the pituitary or hypothalamus, also known as central hypothyroidism, and most of the other hypothalamic-pituitary axis functional defects.

Most of the pediatric patients have primary hypothyroidism. According to their different pathogenesis and age of onset, they can be divided into congenital and acquired. The acquired hypothyroidism is mainly caused by chronic lymphocytic thyroiditis in pediatrics. Caused by Hashimoto's thyroiditis. This section mainly introduces congenital hypothyroidism.

Congenital hypothyroidism is a disease caused by insufficient synthesis of thyroid hormones. According to the cause of the disease can be divided into two categories:

1 sporadic congenital thyroid dysplasia, caused by enzyme defects in ectopic or thyroid hormone synthesis pathway, the incidence rate is 14-20/100,000.

2 The locality is more common in the mountainous areas where goiter is prevalent. It is caused by iodine deficiency in water, soil and food in the area. With the widespread application of iodized salt in China, its incidence rate has dropped significantly.

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