Pheochromocytoma associated with thyroid papillary carcinoma: a report of an unusual case
Ozen Oz Gul, Oguz Kaan Unal, Soner Cander, Erdinc Erturk & Sazi Imamoglu
A 50-year-old man admitted to our institution with labile hypertension. His blood pressure was 150/90 mmHg and the pulse rate was 96 beats per minute. He had hypertensive attacks every 23 days. His blood pressure was found 210/110 mmHg at hypertensive attact. He had palpable thyroid nodule. Ultrasonography of the thyroid gland showed a 2.6 cm sized, irregularly marginated, calcified thyroid nodule. His serum free thyroxine (fT4), free triiodothyronine (fT3), thyrotropin stimulating hormone (TSH) and thyroglobulin levels were 0.89 ng/dl, 2.5 pg/ml, 1.586 μIU/ml and 116.7 ng/ml respectively. His parathyroid hormone and calcium levels were found in normal reference range (42 pg/ml and 9.2 mg/dl respectively). Since the fine needle aspiration biopsy revealed papillary thyroid carcinoma total thyroidectomy was performed. A 24-h urine metanephrine excretion was significantly elevated of approximately 100 times the upper limit of normal. 5×3 cm left adrenal mass was found and resected laparoscopically. Pathological examination proved pheochromocytoma. The relationship between papillary thyroid carcinoma and pheochromocytoma which was rarely reported is unclear. Although pheochromocytomas secrete mainly catecholamines and their metabolites, they can also secrete many other peptides such as insulin-like growth factor II, hypotalamic like and pituitary-like hormones. These peptides might cause the development and growth of papillary thyroid carcinoma.