Endocrine Abstracts

Introduction: Amyloidosis is characterised by accumulation of amorph and proteinous substance in several tissues and organs. Thyroid, adrenal, and pituitary insufficiencies may rarely be observed due to accumulation of these substances. Here, we present a case to point out this rare condition.

Case report: A 19-year-old male patient admitted with complaints of swelling in the neck, abnormality in thyroid hormone levels and fatigue. He had been diagnosed with familial Mediterranean fever at the age of 5. At 13 years old, he had renal insufficiency due to amyloidosis and had undergone renal transplantation. Physical examination revealed systemic arterial blood pressure of 90/60 mmHg, pulse rate of 72 beats/min. Thyoid gland was found to be diffuse palpable (grade 2), secondary sex characteristics development was defined as stages 2–3. In laboratory evaluation, TSH level was elevated, FT₄ level was decreased, anti-TPO and anti-TG were negative. He had primary adrenal insufficiency and hypogonadothrophic hypogonadism. ACTH and GnRH stimulation tests were in concordance with primary adrenal failure and hypogonadothrophic hypogonadism. Thyroid ultrasonography revealed that right thyroid lobe was 24×23×54 mm and left thyroid lobe was 17×21×52 mm in diameters. Isthmus was 5.5 mm in diameter and there was heterogenic echogenity in thyroid parenchyma. Doppler ultrasonography revealed grades 1–2 increased thickness in thyroid parenchyma. Thyroid fine needle aspiration biopsy revealed homogenous eosinophyllic accumulation which was stained histochemically with congo red and methyl violet between thyroid follicullar cells. Pituitary magnetic resonance imaging was normal. In the light of these findings the patient was diagnosed with amyloid goitre, primary adrenal insufficiency, and partial pituitary insufficiency. Prednisolone 5 mg/day, levothyroxine 50 μg/day, and testesterone enanthate 125 mg every 3 weeks were administered.

Conclusions: Systemic amyloidosis may be accompanied with amyloid accumulation in thyroid gland as well as adrenal and pituitary insufficiencies. Thus, endocrinologic evaluation is necessary in these patients.