A rare case of ectopic ACTH syndrome originating from malignant renal paraganglioma

SUMMARY Ectopic adrenocorticotropic hormone (ACTH) syndrome is characterized by hypercortisolism due to the hypersecretion of a non-pituitary ACTH-secreting tumor leading to Cushing’s syndrome. Only a few cases have been reported previously as causing ectopic ACTH related to paraganglioma. Herein, we present a case of Cushing’s syndrome, in who was proved to be attributable to an ACTH-secreting renal malignant paraganglioma. A 40-year-old woman presented with a five-month history of newly diagnosed hypertension and diabetes, weakness, hyperpigmentation, oligomenorrhea, hirsutism, and acneiform lesions. She showed cushingoid features, including moon face, facial hirsutism, facial and truncal acne, hyperpigmentation, and severe muscle weakness of the limbs. She did not have other findings such as striae, supraclavicular fat accumulation, and buffalo hump. Laboratory examination showed the presence of hypopotasemia, hyperglycemia, hyperthyroidism, and leukocytosis. The serum levels of ACTH, cortisol, and urine-free cortisol were markedly elevated. Results of an overnight 2-mg dexamethasone suppression test included a basal serum cortisol of 61.1 mcg/dL (normal range: 4.6-22.8 mcg/dL) and a cortisol value of 46.1 mcg/dL after dexamethasone administration. There was no suppression found after 2-day 8-mg dexamethasone administration. Magnetic resonance imaging (MRI) of the pituitary gland indicated two microadenomas. An abdominal MRI scan revealed horseshoe kidney, bilateral adrenal hyperplasia, and masses with dimensions of 35 x 31 mm in the left kidney. Inferior petrosal sinus sampling showed no evidence of a central-to-peripheral gradient of ACTH. A positron emission tomography/computed tomography scan showed intense increased activity in the lower pole of the left kidney. Left adrenalectomy and left partial nephrectomy were performed. The resected tumor was diagnosed as the ACTH-secreting paraganglioma in the pathological examination, which was confirmed by immunohistochemical studies with chromogranin A, synaptophysin, and ACTH. Only a few cases of paragangliomas as a cause of ectopic ACTH syndrome have been reported. To our knowledge, this is the first case of renal paraganglioma resulting in Cushing’s syndrome due to ectopic ACTH hypersecretion

Erkek Sprague-Dawley ratlarda doksorubisin nefropatisinde fetal rat böbreği kökenli mezenkimal kök hücre uygulamasının etkilerinin araştırılması

The potential protective effects of mesenchymal stem cells (MSCs) on some kidney diseases have been reported. However, the effect of the fetal kidney–derived (FKD)MSCs on doxorubicin-induced nephropathy has not been studied yet. This study aimed to treat rats with doxorubicin-induced kidney injuries by transplantation of –FKD-MSCs. Twenty-four Sprague-Dawley rats were divided into three groups as control, doxorubicin nephropathy (Sham), and doxorubicin + MSC treated group. Serum biochemistry analysis was performed at the beginning and the end of the study. Functional changes in kidneys were evaluated by scintigraphy. In the doxorubicin nephropathy group, histopathological findings such as mesangial cell proliferation, tubular cast, and glomerular hypertrophy were observed, whereas in the MSC group these findings were significantly reduced. CD133 and CD24 positive immunoreactions were the most severe and frequently observed in the MSC group. While positive staining was detected in the tubular epithelium, there was no immunostaining observed in the glomerulus. The results showed that both functional and histological improvements were achieved in the MSC group compared to the Sham group. In conclusion, transplantation of fetal kidney - derived MSCs into patients with renal damage is thought to contribute to the healing of the renal tissue.Mezenkimal kök hücrelerin (MKH) bazı böbrek hastalıklarındaki potansiyel koruyucu etkileri bildirilmiştir. Bununla birlikte, fetal böbrek kaynaklı (FBK) MKH'ların doksorubisin ile indüklenmiş nefropati üzerindeki etkisi henüz araştırılmamıştır. Bu çalışmanın amacı, doksorubisin kaynaklı böbrek hasarı olan ratlara FBK-MKH'ların transplantasyonu yapılarak hasarın tedavi edilmesidir. Çalışmada yirmi dört adet Sprague–Dawley ırkı rat üç gruba ayrılmıştır. Bunlar: kontrol grubu, doksorubisin nefropatisi (Sham) grubu ve doksorubisin + MKH ile tedavi edilen gruptur. Çalışmanın başında ve sonunda serum biyokimya analizleri gerçekleştirilmiştir. Böbreklerdeki fonksiyonel değişiklikler sintigrafi ile değerlendirilmiştir. Doksorubisin nefropatisi grubunda mezanjiyal hücre proliferasyonu, tübül içi kast birikimi ve glomerüler hipertrofi gibi histopatolojik bulgular gözlenirken, MKH grubunda bu bulgular anlamlı olarak azalmıştır. CD133 ve CD24 pozitif immünreaksiyonlar, en şiddetli ve en sık olarak MKH grubunda gözlenmiştir. Tübüler epitelde pozitif boyanma tespit edilirken glomerulusta immün boyanma gözlenmemiştir. Sonuçlar, Sham grubuna kıyasla MKH grubunda hem fonksiyonel hem de histolojik iyileşmelerin sağlandığını göstermiştir. Sonuç olarak, böbrek hasarı olan hastalara fetal böbrek kaynaklı MKH transplantasyonunun böbrek dokusunun iyileşmesine katkıda bulunduğu düşünülmektedir

Sentinel Lymph Node Detection By 3D Freehand Single-Photon Emission Computed Tomography In Early Stage Breast Cancer

We herein present our first experience obtained by 3D freehand single-photon emission computed tomography (SPECT) (F-SPECT) guidance for sentinel lymph node detection (SLND) in two patients with early stage breast cancer. F-SPECT guidance was carried out using one-day protocol in one case and by the two-day protocol in the other one. SLND was performed successfully in both patients. Histopathologic evaluation showed that the excised nodes were tumor negative. Thus, patients underwent breast-conserving surgery alone.PubMe

Protective/restorative role of the adipose tissue-derived mesenchymal stem cells on the radioiodine-induced salivary gland damage in rats

To analyze protective/regenerative effects of adipose tissue-derived mesenchymal stem cells (ADMSC) on 131I-Radioiodine (RAI)-induced salivary gland damage in rats