Endocrine Abstracts

Introduction

Acromegaly is an endocrine disorder resulting from an excess of growth hormone (GH). The cause is almost always a pituitary adenoma, and it affects through the insulin-like Growth Factor 1 (IGF-1) the cellular proliferation, increasing therefore the risk of malignancy. Herein, we describe a case of coexistence of papillary thyroid carcinoma and primary hyperparathyroidism in a patient with acromegaly.

Case report

A 58-year-old woman was referred to our department for suspicion of acromegaly. Her past medical history included diabetes mellitus, hypertension and dysmorphic syndrome for last 4 years. On physical examination, she had a blood pressure of 120/80 mmHg, an acrofacial dysmorphia, a goiter with a firm left nodule. On laboratory investigations, she had a glycated hemoglobin of 8.28%, a calcemia level of 121 mg/l, a serum phosphate level of 22 mg/l, a PTH level of 209 pg/ml (nr: 15-68), an IGF-1 level of 646 ng/ml (3 times normal), GH level at 18.93 mUI/l. The pituitary hormonal evaluation revealed a corticotropin deficiency, without gonadotropin nor thyrotropin deficiency. The pituitary magnetic resonance imaging showed a 28 mm macroadenoma invading the cavernous sinuses. Cervical ultrasound found a 57 × 44 × 73 mm goitre with a 70 mm left nodule classified TIRADS 5. Parathyroid imaging investigation (ultrasound, CT-scan and scintigraphy) didn’t individualize any adenoma or hyperplasia. She had a total thyroidectomy and a parathyroidectomy of the right inferior gland containing an adenoma and parathyroidectomy of the right superior gland. The histopathological examination confirmed the diagnosis of papillary thyroid carcinoma and parathyroid adenoma.

Discussion and conclusion

This case highlights the importance of the screening for malignancies associated with acromegaly and the evaluation of other endocrine neoplasia. The coexistence of parathyroid and anterior pituitary tumors is part of either multiple endocrine neoplasia type 1 or type 4. In addition, papillary thyroid carcinoma is reported as a part of the clinical presentation of multiple endocrine neoplasia type 4. Genetic investigations are mandatory to assess the responsible mutation.