ECE2017 Eposter Presentations: Pituitary and Neuroendocrinology Pituitary - Clinical (145 abstracts)
“Toxic” Goiter Reveals Cushing’s Disease
Madalina Musat 1, , Dan Hortopan 2 , Luciana Oprea 2 , Andreea Duceac 2 , Dana Manda 2 , Andra Caragheorgheopol 2 , Carmen Iordachescu 2 , Claudiu Tupea 2 & Vasile Ciubotaru 3
1Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; 2C.I.Parhon National Institute of Endocrinology, Bucharest, Romania; 3Emergency Clinical Hospital Bagdasar Arseni, Bucharest, Romania.
Case presentation: Mrs. S presented in an endocrine clinic for fatigue, weight loss, restlessness and goiter. She was obese with a BMI of 51 kg/mp, hypertensive and had a medium size, nontender goiter. Lab test revealed hyperglycaemia, suppressed TSH (<0.03mUI/L), on two separate occasions, mid-normal fT4 and T3. Thyroid ultrasound revealed multinodular goiter. A diagnosis of polynodular goiter with subclinical hyperthyroidism was made and patient was commenced on thiamazole 30 mg/day. She was also scheduled for a RAIU. Three weeks later she was admitted in the endocrine unit with a BMI of 47kg/mp. At presentation she had plethora, purpura on her breasts and bruised easily at venipuncture sites. FBC revealed neutrophilia with lymphocytopenia, normal platelets. Thyroid function tests revealed suppressed TSH (0.0164 mUI/L) with low fT4. Thiamazole was stopped. RAIU revealed low radioiodine uptake in the thyroid. Midnight plasma and salivary cortisol were high, morning plasma cortisol was borderline high, with increased ACTH. Urine cortisol was 10 fold upper limit of normal, low dexamethasone suppression test was negative. MRI of the pituitary revealed left sided pituitary microadenoma of 7,5/7 mm. Diagnosis of Cushing’s disease has been made and transsphenoidal adenomectomy was perfomed. At 3 weeks postoperatively patient has returned to clinic with symptoms of cortisol withdrawal while on 30 mg of cortisone daily. She had a BMI of 42 kg/mp, no plethora and no purpura. Cortisol day curve was within the therapeutic range. Off therapy, morning plasma cortisol was 8.89 mcg/dL, normal ACTH, midnight plasma cortisol of 1.44 mcg/dL and lower normal range of urinary free cortisol. Thyroid function tests were normal.
Conclusion: Hypercortisolism is known to alter pituitary hormones, however it is not usual that mild Cushing’s disease to suppress TSH to ‘thyrotoxic’ level. In this case of unsuspected Cushing’s disease, thyroid function test alteration led to diagnosis.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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