ICEECE2012 Poster Presentations Clinical case reports - Thyroid/Others (81 abstracts)
Coimbras University Hospital- EPE, Coimbra, Portugal.
Introduction: Thymic hyperplasia has been described after hypercortisolism resolution. The natural history remains poorly defined: emergence ≧1 month after hypercortisolism resolution, variable duration, usually spontaneous resolution/benign course.
Case Report: ♂, 24, referred in 2000 for secondary hypothyroidism: TSH: 0.25 μUI/ml (0.255); FT4: 5.55 pmol/l (920). Clinical evaluation: insomnia, nocturnal sweating, facial erythema, myalgias, asthenia; acne, abdominal purple striae; BMI: 24.1 kg/m2. Total testosterone-1.8 ng/ml (2.711), ACTH-104 pg/ml (952), UFC-495 μg/24 h (1080); Cortisol-17 μg/dl (525).
CRH test: ACTH-51, 48, 52 pg/ml (baseline, 15, 30 min respectively); cortisol-110, 188, 211, 176 μg/dl (baseline, 15, 30, 45 min respectively).
Pituitary MRI (07/2000): dimensions slightly greater than expected, stalk without deviation; no hypothalamic alterations. He starts ketoconazole 400 mg/day; dose adjustments (UFC/clinical). Cervico-thoraco-abdominal CT (08/2000):normal. Octreotide scintigraphy (10/2000): Focus uptake in the right hemithorax. Bronchoscopy (01/2001): Normal. In Jan/2001 worsening of hypertension and hypokalemia: KCl+spironolactone were started; at that time UFC 60 μg/24 h, ACTH 159 pg/ml, cortisol 13 μg/dl. Lung surgery (04/2001): 2 lymph nodes without neoplastic aspects removed. Inferior petrosal sinuses catheterization (05/2001): no gradient. Octreotide scintigraphy (07/2001): more evident fixation. Thoraco-abdominal CT(07/2001): Nodular image in the area corresponding to scintigraphy. Lung surgery(octreotide-labeled probe; 08/2001):Bronchial carcinoid. Steroid substitution was done during 9 months, with progressive hypercortisolism stigmata regression. Chest CT (2002): anterior mediastinum retrosternal triangular formation; thymus? conglomerate adenopathy?. Chest CT (2003; 2006): mass probably related to thymus…31×16 mm. Chest CT (2011): normal appearing mediastinum, centered, no adenopathy. The patient maintains follow-up.
Conclusions: This case illustrates the frequent difficulty in localizing the source of ACTH production, and the possible association of a thymic hyperplasia occurring after the hypercortisolism resolution. A self-limiting evolution is to consider.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.
Cortisol (μg/dl) | ||
Dexamethasone suppression testing (06/2000) | Baseline | After |
1 mg (23 h) | 15 | |
0.5 mg every 6 h for 8 doses | 27 | |
8 mg (23 h) | 24 | 21 |