Cushing’s syndrome presenting with metastatic giant adrenocortical cancer: A case report

Adrenokortikal karsinom nadir görülen kötü prognozlu bir tümördür. En sık klinik prezentasyonu Cushing Sendromu’dur ama bunun tersine Cushing sendromunun nadir sebeplerindendir. Biz bu makalede nadir görülmesi nedeniyle kortizol salgılayan metastatik dev adrenokortikal karsinom tanıları olan bir vakayı sunduk. Kilo alımı, kıllanma artışı, adet düzensizliği ile başvuran 46 yaşındaki kadın hasta 15 yıl önce malign melanom tanısı almış, cerrahi ve kemoterapi sonrası kür kabul edilmişti. Hastada abdominal obezite, hirsutismus ve akneiform döküntüler mevcuttu. Gece serum kortizolü, 24 saatlik idrar kortizolü artmış, adrenokortikotropik hormon baskılı idi. Deksametazon 2mg ve 8mg supresyon testlerinde baskılanma olmadı. Adrenal Cushing sendromu tanısı ile çekilen surrenal magnetik rezonans görüntüleme sağ sürrenalde 7x8x9cm kitle saptandı. Sürrenalektomi patolojik incelemesinde adrenokortikal karsinom saptandı. Sisplatin, etoposid, mitotan kemoterapisi verilen hasta 36 ay sonra yaygın metastazlar nedeni ile öldü.Adrenocortical carcinoma is a rare tumor with poor prognosis. Cushing’s syndrome is the most common clinical presentation but adrenocortical carcinoma is one of the rare causes of Cushing’s syndrome. Because of the rarity, we report a patient who had cortisol-secreting metastatic giant adrenocortical carcinoma in the article. 46-year-old female with a history of malignant melanoma presented with weight gain, hirsutism, menstrual irregularities. She had abdominal obesity, hirsutism, and acneiform eruptions. Her midnight serum cortisol and 24-hour urinary cortisol were high; adrenocorticotropic hormone was low. 2mg and 8mg dexamethasone suppression tests were not suppressed. Adrenal magnetic resonance imaging showed 7x8x9cm right adrenal mass. The patient underwent adrenalectomy. Adrenocortical carcinoma was detected on pathological examination. Despite the chemotherapy (cisplatin+etoposide+mitotane) was given, she died 36 months later because of disseminated adrenocortical carcinoma

EVALUATION OF THE RELATION BETWEEN PRIMARY HYPERPARATHYROIDISM AND CONCOMITANT THYROID DISEASE

WOS: 000287017600006Objective. Thyroid diseases coexisting with primary hyperparathyroidism (PHPT) may individually change the diagnosis, treatment and follow-up of the patients. In our study, we aimed to investigate the thyroid diseases coexisting with PHPT and the relation between these two clinical situations. Methods. We retrospectively investigated 255 patients who were diagnosed as PHPT between 2004-2009 in our clinic. The general characteristics of the patients, laboratory tests, which were performed preoperatively, neck ultrasonography, thyroid and parathyroid scintigraphy and fine needle aspiration biopsy (FNAB) results were assessed. Cytological results of the nodules with preoperative FNAB were compared with the postoperative histological results. Results. Of the patients, 49 were male (19.2%) and 206 were female (80.8%). Mean age was 54.5+/-12.8. Bilateral neck exploration (BNE) was performed on 69 cases (27%), minimal invasive parathyroidectomy (MIP) on 78 cases (30.5%) and BNE plus thyroidectomy on 108 cases (42.5%). When all thyroid diseases were taken into account, prevalence of the coexisting thyroid disease was 65%, prevalence of nodular thyroid disease 52.1%, thyroid cancer 16.7% and thyroid dysfunction 11.8%. The mean age of the patients with a nodular goitre was significantly higher than of the patients who did not have nodules (p<0.001). General demographic data, calcium and PTH levels did not show any difference. Number of nodules was correlated with age (p<0.001, r=0.227). Conclusion. The relation between PHPT and nodular thyroid diseases is coincidental and this can be explained by the fact that both diseases occur in advanced age

Retrospective comparison of cabergoline and bromocriptine effects in hyperprolactinemia: a single center experience

WOS: 000351702500009PubMed: 25421155Introduction Patients with hyperprolactinemia who require medical therapy are typically treated with dopamine agonists (DAs). In most cases, DAs normalize prolactin levels, control symptoms, and substantially decrease tumor size. Here, we aimed to compare the efficacy of cabergoline (CAB) and bromocriptine (BRC) in patients with hyperprolactinemia at a single center. Methods Retrospective analysis of the clinical records of 498 patients with hyperprolactinemia [mean age 33.3 +/- 10.8 years (range 16-66), 450 women, and 48 men] who had received either CAB (n = 450) or BRC (n = 48) was performed. Results The mean age, gender distribution, and treatment duration were similar between the CAB and BRC groups (33.2 +/- 11 vs. 34.1 +/- 9.6 years, male/female 44/406 vs. 4/44, 18.7 +/- 12.1 vs. 17.8 +/- 6.0 months, respectively; p > 0.05 for all). Mean dosage was 1.5 +/- 1.6 mg/week for CAB and 3.8 +/- 2.7 mg/day for BRC. Baseline prolactin levels, frequency of galactorrhea, amenorrhea, oligomenorrhea, erectile dysfunction, infertility, and visual impairment were similar between the two groups, whereas the baseline tumor volume was higher in the CAB group. The prolactin normalization rate (87.4 vs. 41.4 %, p = 0.029) and tumor volume shrinkage (79.8 +/- 39.1 vs. 54.1 +/- 55.3 %, p = 0.015) were significantly higher in the CAB-treated patients than in the BRC-treated patients, while the tumor cure rates were similar. Symptom relief was higher in the CAB group than in the BRC group. More side effects were recorded in patients who took BRC (29.1 vs. 5.3 %, p < 0.001). Conclusion Our data revealed that CAB was more effective than BRC in controlling symptoms associated with hormone excess, normalizing serum prolactin levels, and shrinking prolactinomas

THYROID-RELATED FACTORS THAT INFLUENCE PREOPERATIVE LOCALIZATION OF PARATHYROID ADENOMAS

WOS: 000300805400004PubMed: 21742606Objective: To evaluate the effect that thyroid-related factors have on the preoperative localization of parathyroid adenomas. Methods: This retrospective study included adult patients who were referred for further evaluation of primary hyperparathyroidism between December 2005 and October 2009 at a teaching and research hospital in Turkey. High-frequency ultrasonography and sestamibi scintigraphy (MIBI) were performed in all patients. Surgical procedure involved focal or bilateral exploration on the basis of concordant or discordant imaging studies. Selection of patients for minimally invasive parathyroidectomy was made based on the presence or absence of a single parathyroid adenoma detected by both ultrasonography and MIBI scan. Patients with negative or discordant imaging studies and a concomitant thyroid nodule underwent bilateral neck exploration. Results: Two hundred and forty-eight patients with primary hyperparathyroidism who underwent parathyroidectomy were included in the study. Parathyroid gland abnormalities were successfully detected preoperatively by ultrasonography in 231 patients and by MIBI scan in 152 patients. When used together, ultrasonography and MIBI scan were unsuccessful in detecting an abnormality in 11 cases. MIBI scan visualized a lesion in 6 cases that remained undiagnosed by ultrasonography. Fifty-six of 85 patients with lesions detected by ultrasonography, but not by MIBI scan, had thyroid nodules. The frequency of thyroid nodules was higher in the 96 patients in whom a MIBI scan could visualize a parathyroid lesion than in the 152 patients in whom MIBI scan was successful (P = .004). No difference was observed regarding ipsilateral thyroid lobe involvement or nodule volume. Parathyroid adenomas were significantly smaller in patients with negative MIBI scans (P<.001). Conclusion: Our results suggest that ultrasonography is more sensitive than MIBI scan in the detection of parathyroid adenomas, particularly in the presence of small parathyroid adenomas or other thyroid related-factors. (Endocr Pract. 2012;18:26-33

Cutaneous Sinus Formation Is a Rare Complication of Thyroid Fine Needle Aspiration Biopsy

Fine needle aspiration biopsy (FNAB) is essential in the diagnosis and management of thyroid nodules. In this paper, we report a rare complication, cutaneous sinus formation, after diagnostic FNAB guided by palpation. Sixty-three-year-old female patient was admitted with the complaints of hoarseness and discharge from the anterior neck wall which were present for the last 6 months. The patient underwent a near total thyroidectomy 17 years ago. Recurrent nodular goiter was detected six months before and a diagnostic FNAB guided by palpation was performed. Two weeks later the patient had wound discharge and hoarseness. Physical examination of the patient revealed a sinus, which was located superior to the thyroidectomy incision. A 1 cm nodule was palpated in the left side of her neck. A cervical ultrasonography (USG) showed a 9 × 7 mm nodule in the remnant thyroid and a 9.5 × 3.5 mm fistulized fluid collection. The patient underwent sinus tract and remnant thyroid removal. This case report presents a cutaneous sinus formation deriving from the granulation tissue, probably due to the silk suture reaction in the previous surgery, by the FNAB guided by palpation procedure. We suggest USG guided FNAB to achieve more accurate and safe diagnosis in evaluating the thyroid nodules

Comparison of Preoperative Examinations in Patients with Primary Hyperparathyroidism: US, MIBI, SPECT and MRI.

92nd Meeting and Expo of the Endocrine Society (ENDO 2010) -- JUN 19-22, 2010 -- San Diego, CAWOS: 000281989402245…Endocrine Societ

A comparative study of pre-operative imaging methods in patients with primary hyperparathyroidism: Ultrasonography, Tc-99m sestamibi, single photon emission computed tomography, and magnetic resonance imaging

WOS: 000308045400003PubMed: 21623148Aim: This study compares the accuracy rates achieved in ultrasonography (US), 9(9m)Tc-sestamibi (MIBI), single photon emission computed tomography (SPEC), and magnetic resonance imaging (MRI) as imaging methods used in the pre-operative localization of the enlarged parathyroid glands. Subjects and methods: For the purposes of this study, US, MIBI, SPECT, and MRI were performed on 98 patients with primary hyperparathyroidism (pHPT). All patients underwent parathyroidectomy. Results: Pre-operative localization of an abnormal parathyroid gland was successfully performed in 82 of the cases scanned with US (83.7%), while the result was 66 in the cases scanned with MIBI (67.3%), 71 of the cases were successfully localized with SPECT (72.4%), while MRI revealed the diseased gland in only 60 of the total'cases (61.2%). In MIBI-positive and -negative patients there was a statistically significant difference among cases in terms of adenoma volume (1.30 +/- 1.51 vs 0.58 +/- 0.91, p < 0.05). Sensitivity, specificity and diagnostic accuracy values were 87.2%, 25.0%, and 83.0%; 70.2%, 50.0%, and 69.4%; 75.5%, 50.0%, and 74.5%; 63.8%, 50.0%, and 63.3% for US, MIBI, SPECT, and MRI, respectively. The respective values for sensitivity, specificity, and diagnostic accuracy were 94.9%, 25.0%, and 91.1% when US was combined with MIBI. Conclusions: Combining US and MIBI as imaging methods for pre-operative imaging of pHPT often produces more satisfactory results. While the accuracy of US is relatively low in the ectopic localizations, the size of the lesion can be an important factor in the accuracy achieved with MIBI. (J. Endocrinol. Invest. 35: 359-364, 2012) (c) 2012, Editrice Kurti

The frequency of malignancy and the relationship between malignancy and ultrasonographic features of thyroid nodules with indeterminate cytology (vol 45, pg 37, 2014)

WOS: 000331638200027Various approaches are available for the management of nodules that are evaluated to be indeterminate according to the results of thyroid fine needle aspiration biopsy. The present study aimed to determine the rate of malignancy and the ultrasonographic features that could be used as predictor of malignant pathologies at the nodules with indeterminate cytology. A total of 201 patients who underwent total thyroidectomy and whose fine needle aspiration biopsy results were evaluated to be Hurthle cell lesion (n = 99), follicular neoplasm (n = 61) or suspicious for malignancy (n = 41) were enrolled in this study. Of these patients, 178 were females (88.6 %) and 23 were males (11.4 %). The rates of malignancy were found to be 33.3 % in the Hurthle cell lesion group, 23.0 % in the follicular neoplasm group and 53.7 % in the suspicious for malignancy group (p = 0.006). The comparison of the ultrasonographic characteristics of the malignant and benign nodules revealed hypoechogenicity and microcalcification to be more common in malignant nodules (34.3 vs. 16.9 %, p = 0.005; 27.1 vs. 13.1 %, p = 0.014; respectively). While 92.3 % of the malignant nodules were =1 cm, 82.9 % of the benign nodules were =1 cm (p = 0.042). In the current study, malignancy was observed in 33.3 % of the Hurthle cell lesion group, 23 % of the follicular neoplasm group and 53.7 % of the suspicious for malignancy group. In addition, we detected that microcalcification and benign hypoechoic at patients with indeterminate cytology can be related with increased risk of malignancy. We believe that as the patients at Hurthle cell lesion group have higher risk of malignancy than the patients with Follicular Neoplasia, total thyroidectomy will be suitable for these patients