Endocrine Abstracts

Background: Multiple endocrine neoplasia (MEN) are rare and are characterized by the association of a neoplasia or hyperplasia of at least two endocrine glands. Rare cases of atypical MEN were reported in the literature. We describe a rare combination of acromegaly, papillairy thyroid carcinoma and primary hyperaldosteronism.

Case presentation: We report a case of a 48-year old woman operated for papillary thyroid carcinoma. Five years later, she was diagnosed with acromegaly on the basis of typical clinical and hormonal characteristics (IGF1 plasma level of 836.7 ng/l and GH plasma level >103.8 mUI/l). The pituitary MRI revealed a pituitary macroadenoma of 20 mm of diameter invading the cavernous sinus, the posterior pituitary gland and the pituitary stalk. During the hospitalization, she presented high blood pressure and hypokalemia. A primary hyperaldosteronism was confirmed by a high aldosterone level and a high aldosterone to plasma active renin ratio. The CT scan showed a 13 mm adrenal adenoma. The association of papillary carcinoma of thyroid, acromegaly and primary hyperaldosteronism allowed retaining the diagnosis of MEN. The investigations for other endocrine neoplasia were negative. The patient was operated for the pituitary macroadenoma and was treated by spironolactone for the Conn’s adenoma pending the acromegaly’s control.

Conclusion: We have described an uncommon case of three endocrine tumors: acromegaly, papillary thyroid carcinoma and Conn’s adenoma. This combination could be part of the MEN1 syndrome or due to the mitogenic effect of the GH-IGF1 hyperactivation.