Endocrine assays in female patient with relapsing thymus cyst and myasthenia gravis

Mara Carsote; Dana Terzea; Ionela Baciu; Alexandra Mihai; Dan Peretianu; Florina Vasilescu; Mihaela Popescu; Raluca Trifanescu; Anda Dumitrascu; Catalina Poiana

doi:10.1530/endoabs.37.EP1344

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Endocrine Abstracts (2015) 37 EP1344 | DOI: 10.1530/endoabs.37.EP1344

ECE2015 Eposter Presentations Clinical Cases–Thyroid/Other (101 abstracts)

Endocrine assays in female patient with relapsing thymus cyst and myasthenia gravis

Mara Carsote ^1, , Dana Terzea ^2, , Ionela Baciu ^1, , Alexandra Mihai ² , Dan Peretianu ⁴ , Florina Vasilescu ³ , Mihaela Popescu ² , Raluca Trifanescu ^1, , Anda Dumitrascu ² & Catalina Poiana ^1,

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¹C.Davila University of Medicine and Pharmacy, Bucharest, Romania; ²C.I.Parhon National Institute of Endocrinology, Bucharest, Romania; ³Monza Oncoteam Hospital, Bucharest, Romania; ⁴SCM Povernei Medical Centre, Bucharest, Romania.

Introduction: The congenital cystic neck masses underlie various diagnosis including tymic cysts. Even they are an embryological defects, the adult onset might be seen. The aetiology is not clearly established. The malignant behaviour or infections are correlated to the cysts. Aim: we present a female case with a complicated history of cysts.

Case report: 42-year old female is known with the following medical history. Seven years ago she was operated for a pericardia cyst. The computed tomography was normal after surgery until 2014 when she accused breathing difficulties. The computed tomography was performed and a tymic cyst was discovered (of 7 cm). Thoracotomy was chosen as procedure for the cyst: the cyst was partial evacuated during the procedure and then removed but the tymus was conserved. The pathological exam confirmed a simple tymic cyst, with no atipia. After surgery, the patient felt well for about 6 months when she accused again troubles in breathing, and also persistent asthenia. The computed tomography found again the tymic cyst of 4.89 by 4.1 by 6.4 cm, with no other thoracic or cervical anomalies. The patient was referred for an endocrinological check up. The blood pressure was 100 by 65 mmHg. The normal TSH (of 1.5 μUI/ml) was associated with negative thyroid antibodies. The morning plasma cortisol was of 19 μg/dl (normal levels <21 μg/dl). The calcium levels and parathormone, as well as basal plasma metanephrines/normetanephrines were also normal. The prolactin levels were mildly increased (of 28 ng/ml, normal levels <21 ng/ml). The patient was referred to neurological tests and myasthenia gravis was confirmed. A second procedure for the tymus cyst is soon to be done, including the entire organ resection.

Conclusion: The mildly increased prolactin levels are most probably associated to the thoracic surgery. The complete resection of the tymus is encouraged in case of cysts, especially large ones, because of relapse risk.