Abstract
In normal children, TRH injection is followed by a constant significant rise of serum TSH. In view to investigate the hypothalamo pituitary thyroid axis in hypopituitarism, 200 μg/m2 of synthetic TRH were variously injected in children and adolescents with tumoral (n = 24) or idiopathic (n = 29) hypopituitarism.
In 26 patients with normal plasma T4, TRH induced 18 times a rise at serum TSH from 5.9 to a mean peak value of 18.2 μU/ml, similar to controls. However in 8, TSH failed to rise after TRH suggesting a peculiar type of hypothalamic deficiency.
12 hypopituitary patients with low T4 (6 idiopathic, 6 tumoral) had indetectable basal serum TSH and a prolonged rise after TRH with a peak value similar to that of controls (17,4 μU/ml), demonstrating a primary hypothalamic deficiency. 7 others, who had also indetectable basal TSH levels failed to respond to TRH, demonstrating a primitive pituitary failure.
In 4 others (2 tumoral, 2 idiopathic) with multiple deficiencies and low T4, the response to TRH was exagerated, suggesting a tertiary associated hypothyroidism.
In 4 hypopituitary children with low plasma T4, (3 idiopathic, 1 tumoral), TSH basal levels were definitely elevated and failed to rise after TRH. Anti-TSH antibodies were demonstrated in their sera.
These data demonstrate further that TRH test is a most valuable tool in the study of children with hypopituitarism leading to detection of different kinds of deficiency.
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Chaussain, J., Binet, E., Vassal, J. et al. VARIOUS TYPES OP PITUITARY RESPONSE TO THYROTROPIN RELEASTING HORMONE (TRH) IN HYPOPITUITARY PATIENTS. Pediatr Res 9, 682 (1975). https://doi.org/10.1203/00006450-197508000-00090
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DOI: https://doi.org/10.1203/00006450-197508000-00090