ECE2007 Poster Presentations (1) (659 abstracts)
Myasthenia gravis and autoimmune Addison’s disease in a patient with thymoma
Mesut Seker , Hulya Iliksu Gozu , Berkant Sonmez , Fatih Yavuz , Taflan Salepci , Ekrem Orbay , Mehmet Sargin , Haluk Sargin , Mahmut Gumus , Ulku Turk Boru , Mustafa Yaylaci & Ali Yayla
Dr. Lutfi Kirdar Kartal Education Hospital, Istanbul, Turkey.
The association of thymoma with myasthenia gravis is well known, however association of these two syndromes (Thymoma+Myasthenia gravis) with Addison’s disease is very rare. In here we report myasthenia gravis and autoimmune Addison’s disease in a patient with thymoma.
A 32-year-old man was admitted to our hospital with symptoms of weakness, anorexia, nausea, vomiting, pigmentation of skin and mucous membranes for 2 years. He had undergone to the operation because of thymoma 17 months before to admission.
On physical examination, generalized pigmentation, especially in oral mucosa, and tongue, was observed. Except ptozis in the right eye, neurologic examination was normal. Unexplained pigmentation and other symptoms suggested possibility of diagnosis of adrenal insufficiency. He was diagnosed as Addison’s disease on the basis of the findings of a high plasma ACTH level; >185 pmol/L (normal; <125 pmol/L), low plasma cortisol level; 1.85 ug/dl (normal; 5–25 ug/dl). ACTH stimulation test revealed that cortisol levels were not stimulated upon stimulation by ACTH (Basal ACTH level: 2.97 ug/dl, stimulated ACTH level: 2.84 ug/dl. Anticorticosurrenal antibodies was measured as 640 (N:<5). Thyroid stimulating hormone (TSH), free thyroxine (FT4) were normal. Anti TSH reseptor antibody was measured as 3.00 U/L (normal; 0.00–10.00 U/L).
He had complaint of ptozis in the right eye for 2 years. Skull radiographs and orbita MRI were normal. Although electromyography and edrophonium test were negative; myasthenia gravis was diagnosed on the basis of findings of a high titer of acetylcholin receptors levels (2.4 nmol/l; normal: 0.00–0.50 nmol/l). Prednisolon (7.5 mg/day) and prostigmine (180 mg/day) tablets have been started. Symptoms and signs were improving by this treatment.
In here we report another example of this rare syndrome in which myasthenia gravis, autoimmune Addison’s disease and thymoma ocurred together.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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