EYES2019 7th ESE Young Endocrinologists and Scientists (EYES) Meeting Poster Presentations (46 abstracts)
Association of adrenal cortisol-producing adenoma and invasive papillary thyroid carcinoma in an older patient: coincidence or multiple endocrine neoplasia (MEN)?
Cristina Iancu 1 , Isabela Gaita 1 , Victor Tomulescu 3 , Radu Iorgulescu 4 , Cristina Capatina 1, , Serban Radian 1, & Catalina Poiana 1,
1Department of Pituitary and Neuroendocrine Disease, CI Parhon National Institute of Endocrinology, Bucharest, Romania; 2Department of Endocrinology, C. Davila University of Medicine and Pharmacy, Bucharest, Romania; 3Department of General Surgery and Liver Transplant, Fundeni Clinical Institute, Bucharest, Romania; 4Department of General Surgery, Emergency Clinical Hospital ‘St. John’, Bucharest, Romania.
Background: Association of differentiated thyroid carcinoma (DTC) and cortisol-producing adrenal adenoma is not part of the classical MEN syndromes. We present a clinical case raising the question of a common etiology for these tumours.
Case Presentation: A 58-year-old female presented in 2010 for the investigation of a 6 cm left adrenal tumour incidentally discovered by abdominal CT. Medical history included smoking, obesity, myocardial infarction, hypertension, cardiac insufficiency, coronary artery disease, diabetes mellitus, chronic obstructive pulmonary disease. Family history was negative for endocrine disease, including tumours. On physical examination the patient appeared Cushingoid. LDDST revealed unsuppressed cortisolemia=8.74ug/dL (N<1.8). Thyroid clinical examination revealed a right thyroid nodule, subsequent ultrasonography demonstrating a 2.4/1.2 cm hypoechoic nodule with multiple calcifications. The patient repeatedly refused FNAB. She underwent laparoscopic left adrenalectomy in 2012 and subsequent cortisolemia was suppressible by dexamethasone. 5 yrs later, FNAB of the right thyroid nodule revealed a follicular lesion (Bethesda IV). Total thyroidectormy was performed with selective lymphadenectomy. Pathological examination revealed stage IVA (pT3N1bM0) PTC. She received 100 mCi of radioiodine for remnant ablation and subsequent administration of 100 mCi. She currently presents with incomplete biochemical (unstimulated Tg=6.41 ng/mL) and structural therapeutic response (two right jugular tumoral lymph nodes). Surgery is not an option, due to severe cardiovascular disease.
Conclusion: Our case highlights apparent MEN combining adrenal Cushing’s and DTC, the underlying genetic cause being as yet unidentified. Long-term follow-up is required and patient compliance can lead to delayed therapy, as illustrated by our case.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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