Endocrine Abstracts

Introduction

Multiple endocrine neoplasia type 1 (MEN-1) is a hereditary condition with neoplastic lesions in multiple endocrine organs, which most frequently involves pituitary, parathyroid gland, and pancreas.

Case report

A 53 y/o male visited endocrine clinic with the chief complaint of foreneck swelling for 1 month. He had history of renal stone for years. He had normal fT4 (1.13 ng/dl, reference 0.93–1.7), normal TSH (0.3 μIU/ml, reference 0.27–4.2), elevated PTH (125.3 pg/ml, reference 18.4–80.1) and elevated serum calcium (11.9 mg/dl, reference 8.6–10.2). Thyroid echo revealed a cystic lesion at the right thyroid lobe but no definite parathyroid lesion. Aspiration from the cystic lesion got 17 ml chocolate-colored fluid. Levels of PTH and thyroglobulin in the washout fluid were b 3000 pg/ml and 211 ng/ml respectively. Cytology revealed sheet of follicular cells with macrophages and colloid. Sestamibi parathyroid scan with SPECT revealed focal hot spots at left upper and right lower thyroid beds, and a large cold area at right lobe of thyroid. Pituitary and adrenal endocrine survey revealed hormone levels within normal reference ranges. A 0.4 cm hypoenhanced nodule in posterior portion of the pituitary gland was identified by MRI. Further studies to screen possible pancreatic neoplasms and parathyroidectomy are scheduled.

Conclusions

Hemorrhagic thyroid cyst is one of common causes of foreneck swelling. With detailed history taking and logically reasoning, the patient with foreneck swelling was finally diagnosed as MEN-1. Patients with MEN-1 may have manifestations of various endocrine disorders in different lifetime. Genetic study and long-term follow-up are warranted.