Searchable abstracts of presentations at key conferences in endocrinology
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15th European Congress of Endocrinology

Poster Presentations

Clinical case reports – Pituitary/Adrenal

ea0032p213 | Clinical case reports – Pituitary/Adrenal | ECE2013

Case report: chronic adrenergic stimulation induces brown adipose tissue differentiation in visceral adipose tissue

Sondergaard Esben , Gormsen Lars C , Pedersen Steen B , Christiansen Peer , Nielsen Soren , Poulsen Per L , Jessen Niels

Introduction: The presence of brown adipose tissue (BAT) in humans has recently been demonstrated by histology and positron emission tomography (PET). In previous reports, BAT in adults is primarily confined to the upper chest and neck. Here, we report a case of massive BAT infiltration of the visceral adipose tissue in a patient with catecholamine secreting paraganglioma.Methods: The patient was evaluated with [18F]-FDG PET/CT at three occasi...

ea0032p214 | Clinical case reports – Pituitary/Adrenal | ECE2013

An unusual case of Cowden-like syndrome, neck paraganglioma and pituitary adenoma

Efstathiadou Zoe , Anagnostis Panagiotis , Sapranidis Michalis , Kita Marina

Introduction: The description of a rare case of papillary thyroid cancer, neck paraganglioma, pituitary adenoma and Cowden-like syndrome.Case report: A 43-year-old woman presented with enlargement of her right thyroid lobe and a palpable ipsilateral neck mass. The pathology examination after operation of the two lesions revealed the synchronous presentation of a papillary thyroid carcinoma and a neck paraganglioma. Patient’s medical history included...

ea0032p215 | Clinical case reports – Pituitary/Adrenal | ECE2013

Follicle-stimulating hormone-secreting pituitary macroadenoma: a rare cause of abnormal menstrual cycles in a teenage girl

Arici Birsen , Motov Stefan , Kelly Christopher , Zulewski Henryk , Mariani Luigi

Introduction: Gonadotroph adenomas usually present as clinically non-functioning sellar masses. They are extremely infrequent in children. Only some case report of children and adolescents with clinical manifestations of high serum gonadotrophin levels have been published. As in adult patients most of the gonadotroph adenomas have a silent growth, and therefore a late presentation as macroadenoma with mass effects.Case report: This 16-year-old girl prese...

ea0032p216 | Clinical case reports – Pituitary/Adrenal | ECE2013

Long-term treatment with octreotide in a patient with malignant pheochromocytoma: impact on survival and time to tumor progression

Gruszka Anna , Zieleniewski Wojciech , Kotecka-Blicharz Agnieszka , Jarzab Barbara , Kunert-Radek Jolanta

Introduction: Pheochromocytomas are rare neuroendocrine tumors arising from chromaffin cells of the adrenal medulla. Approximately 10% of all pheochromocytomas are malignant. There is no effective therapy for malignant pheochromocytoma (MAL-PHEO) and the overall prognosis is poor.Case report: We report 22-year survival with MAL-PHEO in a patient treated with several surgeries, 131I-metaiodobenzylguanidine and, subsequently, with long-acting fo...

ea0032p217 | Clinical case reports – Pituitary/Adrenal | ECE2013

Histologically surprising nasal polyps

Boscolo Marina , Devuyst France , Corvilain Bernard

Pituitary macroadenomas usually present with symptoms due to a local mass effect or to hormone abnormalities. Acromegaly is due an excessive GH production, usually caused by a slow-growing pituitary adenoma. Acromegaly is an insidious disease. An average delay of 7 years is reported between the time of symptoms onset and diagnosis. According to main symptoms, acromegaly is usually diagnosed by internists, ophthalmologists or rheumatologists. It may be suspected by pneumologist...

ea0032p218 | Clinical case reports – Pituitary/Adrenal | ECE2013

Hypopituitarism and pituitary masses in patients with non-pituitary malignancy

Kassim Saifuddin , Wright Josh , Foran Bernie , Sinha Saurabh , Newell-Price John , Ross Richard

The commonest cause of acquired hypopituitarism is a benign pituitary adenoma. However, in patients with non-pituitary malignancy different diagnoses need to be considered. We describe three oncology patients presenting with hypopituitarism and/or a pituitary mass where the cause was related either to malignant disease or its treatment.Case 1: A 56-year-old man with known metastatic melanoma presented with increasing lethargy. Investigation showed a larg...

ea0032p219 | Clinical case reports – Pituitary/Adrenal | ECE2013

Wegener granulomatosis as an uncommon cause of panhypopituitarism in childhood

Demirel Fatma , Kara Ozlem , Acar Banu Celikel , Cakar Nilgun

Wegener granulomatosis is an antineutrophil cytoplasmic antibody (cANCA)-associated, multi-system, necrotizing granulomatous vasculitis. Inflammation of nasal or oral mucosa, lung and kidney involvements are typical in the course of the disease. It was first described by Friedrich Wegener in 1939, and has an incidence rate of 1 in 100 000 people, often observed in individuals aged between 25 and 50 years, but uncommon in children and adolescent. In rare cases, pituitary involv...

ea0032p220 | Clinical case reports – Pituitary/Adrenal | ECE2013

Adequate timing for adrenalectomy in pheochromocytoma multisystem crisis: can early biochemical diagnosis be the key?

Cayon Manuel , Garcia-Figueras Carolina , Gil Anselmo , Mateos Francisco

Introduction: Pheochromocytoma multisystem crisis (PMC) is the most fulminant clinical expression of pheochromocytoma. The appropriate timing and judgment for the start of surgery and the adequate preoperative medical treatment are unclear. We report a case of PMC successfully treated with elective adrenalectomy after doxazosin blockade. The importance of an early biochemical diagnosis is discussed.Case report: A 47-year-old healthy man consulted for sud...

ea0032p221 | Clinical case reports – Pituitary/Adrenal | ECE2013

Complex hypothalamic disorder after childhood histiocytosis X

Gheorghiu Monica Livia , Caragheorgheopol Andra , Dumitrascu Anda , Poiana Catalina

Introduction: Histiocytosis X is a rare disease involving clonal proliferation of Langerhans cells, abnormal cells deriving from bone marrow and capable of migrating from skin to lymph nodes. Its manifestations range from isolated bone lesions to multisystem disease. Seen mostly in children, multifocal histiocytosis may involve in 50% of cases the pituitary stalk, leading to diabetes insipidus and usually permanent pituitary deficiencies. We present an adult patient with a com...

ea0032p222 | Clinical case reports – Pituitary/Adrenal | ECE2013

Morphologial and functional abnormalities of the hypofyse in patients with diagnose of CFS or fibromyalgia. An example of misdiagnosis by Belgian chronic fatigue centres

Coucke Francis , Lammens Heidi , Coucke Laurens , Vogter Anne-Birgitte

Aim: In consultation, we check a lot of patients who present with diagnose of FM (fibromyalgia) and chronic fatigue syndrome (CFS). Most of these patients have a underlying diagnosis that causes chronic pain or fatigue. These causes are pathologies not easily detected.Endocrine failure is one of the candidates, with hypofyse dysfunction as a possible candidate.Methods: During 1 year: from October 11, 487 patients presented at the c...

ea0032p223 | Clinical case reports – Pituitary/Adrenal | ECE2013

Pineal gland tumor and panhypopituitarism in an adult male

Ngalob Queenie , Jasul Gabriel

Background: Pineal germ cell tumors are rare in adulthood. It usually comes to medical attention due to mass effect. Endocrine manifestations are also prominent in the clinical presentation and may precede neurologic symptoms.Clinical case: We report the case of a 30-year old male who presented with a 6-month history of bitemporal headache, doubling of vision and nonprojectile vomiting. Recall revealed that he exhibited symptoms of panhypopituitarism as ...

ea0032p224 | Clinical case reports – Pituitary/Adrenal | ECE2013

Antepartum pituitary insufficiency in type 1 diabetes

Balasuriya Chandima N D , Fougner Stine Lyngvi , Bjorgaas Marit Rokne

Introduction: Postpartum necrosis of the anterior pituitary gland is well-described, but antepartum pituitary insufficiency (API) is reported only in a few women with type 1 diabetes (T1D). API has an abrupt onset and may have fatal outcome.Case report: A 36-year-old woman with T1D and laser-treated retinopathy became pregnant after repeated IVF. In gestational week (GW) 10, she used insulin 34–42 U/day, HbA1c was 6.2% and cortisol (0800 h)...

ea0032p225 | Clinical case reports – Pituitary/Adrenal | ECE2013

Delivery of health child in acromegaly patient with McCune–Albright syndrome treated with lanreotide and pegvisomant during pregnancy

Weiss Vladimir , Hana Vaclav , Marek Josef

Introduction: Acromegaly with GH excess affects up to 20% of the patients with McCune–Albright syndrome (MAS). Surgical treatment for acromegaly in MAS is often difficult because of skull-base dysplasia. Somatostatin analogs are frequently only partially effective and GH receptor antagonist – pegvisomant is more potent in normalizing IGFI levels. Radiotherapy is controversial. Pregnancy in MAS patients is described in literature but no case of successful delivery in ...

ea0032p226 | Clinical case reports – Pituitary/Adrenal | ECE2013

Intrasellar plasmacytoma: an unusual presentation of multiple myeloma

Akkurt Aysen , Sisman Pinar , Ersoy Canan , Erturk Erdinc , Tuncel Ercan , Imamoglu Sazi

Multiple myeloma is a neoplastic disorder arising from plasma cells in the bone marrow. Plasma cell tumors, plasmacytomas, are uncommon in the brain and occur usually in the leptomeninges with or without parencymal involvement. Extramedullary plasmacytomas are very rarely located in the sella and can be misdiagnosed as a nonfunctioning pituitary adenoma. We report an illustrative case with multiple myeloma who was diagnosed having sellar plasmacytoma resembling a nonfunctionin...

ea0032p227 | Clinical case reports – Pituitary/Adrenal | ECE2013

Corticomedullary mixed adrenal tumor

Ivovic Miomira , Vujovic Svetlana , Tancic-Gajic Milina , Marina Ljiljana , Arizanovic Zorana , Micic Dragan

Introduction: Adrenal glands consist of two parts: adrenal cortex and adrenal medulla acting as two separate organs due to distinct structure, function and embryologic origin. Corticomedullary mixed tumor is an adrenal tumor mass which consists of mixed population of both adrenal cortical cells and medullar chromaffin cells.Case report: A 36-year-old woman was admitted to our Clinic with hypertensive episode, headache and palpitation. Ultrasound and CT c...

ea0032p228 | Clinical case reports – Pituitary/Adrenal | ECE2013

Xanthomatous hypophysitis as a cause of cluster headache: a case report

Csajbok Eva , Magony Sandor , Sepp Kirsztian , Valkusz Zsuzsanna , Barzo Pal , Tiszlavicz Laszlo

Introduction: Hypophysitis is an inflammatory disease of the pituitary gland that may mimic pituitary tumors clinically and radiologically. Primary hypophysitis has traditionnaly been classified as lymphocytic (LH), granulomatous (GH), and xanthomatous (XH).Case description: We report on a case of a xanthomatous hypophysitis initially diagnosed as pituitary adenoma. A 23-year-old men suffered from typical cluster type headache. Two years after the first ...

ea0032p229 | Clinical case reports – Pituitary/Adrenal | ECE2013

Primary adrenal insufficiency in a case of bilateral adrenal hemorrhage secondary to anti-phospholipid syndrome masquerading as chronic abdominal pain

Chen Abel Weiliang , Seow Cherng Jye , Dalan Rinkoo

Background: Primary adrenal insufficiency due to adrenal hemorrhage from anti-phospholipid syndrome (APS) is an uncommon and life threatening disorder. We present a case, highlighting the challenges in the diagnosis and management of this disorder.Case presentation: A 59-year-old Chinese lady presented with a 2-year history of bilateral flank pain, lethargy, poor appetite and weight loss. Initial blood investigations were unremarkable except for a choles...

ea0032p230 | Clinical case reports – Pituitary/Adrenal | ECE2013

Very late growth acceleration in a man with hypopituitarism

Sawicka Agnieszka , Boniek-Poprawa Dorota , Kawalko Agnieszka , Wegrzyn-Bak Marta , Marczewski Krzysztof

Introduction: Very late step growth is quite rare, and probably very rare, if there is, 10 years after the end of treatment with GH. Therefore, we would like to present our patient, even though we cannot yet give a full pathomechanism of his disorders.Case report: A man 28 years, was admitted to us to assess hormonal status before elective hip surgery. He had congenital brain toxoplasmosis. From 8 to 16 years he was treated with GH without a good effect....

ea0032p231 | Clinical case reports – Pituitary/Adrenal | ECE2013

Differential diagnosis of aggresive macroprolactinoma, adenoma or atypical adenoma: a case report

Cuhaci Fatma Neslihan , Baser Husniye , Ozveren Mehmet Faik , Irkkan Sultan Cigdem , Dogan Hayriye Tatli , Ersoy Reyhan , Cakir Bekir

Atypical tumors were identified in 15% of pituitary adenomas, and they tended to be aggressive, invasive macroadenomas. WHO classification of atypical pituitary adenomas include; Ki-67 proliferative index >3%, excessive p53 immunoreactivity, and ≥ 2 mitotic figures per 10 high-powered fields. Pituitary carcinomas are extremely rare tumors with cerebrospinal or extracranial metastasis.Case: A 31 years old man with symptoms of stuffy nose and sno...

ea0032p232 | Clinical case reports – Pituitary/Adrenal | ECE2013

Bilateral third nerve palsy secondary to an apoplexy in a pituitary macroadenoma causing Cushing’s disease: a very rare complication of a rare entity

Juszczak Agata , Worth Claudia , Karavitaki Niki , Grossman Ashley B

Introduction: Bilateral 3rd nerve palsy is known in conditions such as diabetes mellitus, neurosarcoidosis, Guillain-Barre syndrome, multiple sclerosis, anterior or posterior communicating artery aneurysm or mesencephalic bleed/trauma. There are only single cases reported in association with pituitary adenoma or carcinoma, usually in the context of apoplexy. We describe a patient with Cushing’s disease and bilateral 3rd nerve palsy secondary to apoplexy in pituitary macro...

ea0032p233 | Clinical case reports – Pituitary/Adrenal | ECE2013

Good response to temozolamide therapy in a man with a prolactin secreting pituitary carcinoma

Bilbao Ismene , Coca Mariano Alvarez , Garcia Cristina , Egana Nerea , Aranburu Maite , Yoldi Alfredo , Antunano Luisa , Goena Miguel

Introduction: Pituitary carcinomas are rare and their management is difficult, because they exhibit a continued growth and metastatic dissemination despite of multimodal and aggressive treatments. Temozolamide, has shown a substantial response rates in pituitary carcinomas.We report the case of a patient with a malignant prolactinoma successfully treated with temozolamide.Case report: The patient, a 62-year-old male, consulted with...

ea0032p234 | Clinical case reports – Pituitary/Adrenal | ECE2013

Combined choroidal neovascularization and hypopituitarism in a patient with homozygous mutation in methylenetetrahydrofolate reductase gene

Aydogdu Aydogan , Haymana Cem , Baskoy Kamil , Durukan Ali Hakan , Ozgur Gokhan , Azal Omer

Introduction: Hypopituitarism is defined as either partial or complete deficiency of anterior or posterior pituitary hormone secretion or both. Hypopituitarism itself may increase the risk of thromboembolism/hypercoagulopathy, and underlying mechanisms of hemostatic dysfunctions in hypopituitarism are mostly unknown. Reduced enzymatic activity due to methylenetetrahydrofolate reductase (MTHFR) gene mutations are associated with hyperhomocysteinemia and have been linked to both...

ea0032p235 | Clinical case reports – Pituitary/Adrenal | ECE2013

Acute pulmonary edema as the initial presentation of a pheochromocytoma: case report

Resende Eduarda , Sa Maritza , Ferreira Margarida , Abreu Silvestre

Introduction: The acute onset of pulmonary edema and severe congestive heart failure secondary to catecholamine overproduction from a pheochromocytoma is a rare entity, especially in the absence of other signs or symptoms suspicious of this tumour. Myocardial involvement can include angina pectoris, acute heart failure, dilated cardiomyopathy, myocardial infartion and arrhytmias. Here, we present the case of a young man with no significant medical history who presented with ac...

ea0032p236 | Clinical case reports – Pituitary/Adrenal | ECE2013

Pleuropericarditis effusion secondary to chronic bromocriptine intake

Belhimer Faiza , Chentli Farida

Introduction: Dopamine agonists are commonly used for the treatment of Parkison’s disease and prolactinomas. Sometimes high doses are needed in mixed pituitary adenomas. This medical treatment usually induces gastrointestinal troubles and/or low blood pressure, and sometimes psychiatric disorders. Pleuropercarditis effusion (PPE) is rarely related to dopamine agonist side effects.Case report: Our aim is to report a man aged 29 years old whose PPE is...

ea0032p237 | Clinical case reports – Pituitary/Adrenal | ECE2013

Suppurative meningitis as a life threatening primary presentation of macroprolactinomas

Akkache Lina , Daffeur Katia , Kalafate Nadia , Haddad Meriem , Chentli Farida

Introduction: Suppurative meningitis (SM) is a life threatening disease. It is rarely observed as a primary presentation in large pituitary tumours (PT) destroying the sellar floor and/or invading the skull base. Our aim is to report 3 SM revealing macroprolactinomas.Case No. 1: A man aged 22, consulted for vomiting and fever. The diagnosis of SM was confirmed by lumbar puncture and blood cultures. Cerebral MRI showed multidirectional PT invading caverno...

ea0032p238 | Clinical case reports – Pituitary/Adrenal | ECE2013

Craniofacial fibrous dysplasia and pituitary gigantism in a 10-year-old boy: clinical case

Gusova Anna , Mazerkina Nadezhda

Introduction: The combination of poly/monostotis fibrous dysplasia, café-au-lait pigmentation of the skin and endocrine hyperfunction (mostly precocious puberty) is known as McCune–Albright syndrome (MAS), a genetic origin syndrome with low incidence. The molecular basis of MAS is a mosaic activating mutation of the α subunit of the G protein (Gsα) gene.We present a clinical case of a 10-year-old boy with partial MAS and GH-secreting ...

ea0032p239 | Clinical case reports – Pituitary/Adrenal | ECE2013

Functional and transient effect of sodium excretion in combined pituitary failure with central and peripheric diabetes insipidus

Gomes Ana , Martins Ana , Martins Joao , Vale Sonia , Carmo Isabel

Introduction: Central and Peripheral Diabetes Insipidus are both rare conditions. Combined they may result in serious hypernatremia and water deficit that may pose a therapeutic challenge.Case report: MHBCR, a caucasian female aged 52, was admitted to the Endocrine Department because of serious hypernatremia. A previous diagnosis of pituitary failure and central diabetes insipidus was established 4 years before, after pituitary surgery for a non-secretin...

ea0032p240 | Clinical case reports – Pituitary/Adrenal | ECE2013

Management of resistant prolactinoma: case report

Gusova Anna

Introduction: Prolactinomas are the most common tumors among hormonally active pituitary adenomas. Therapy with dopamine agonists (DA) remains the first treatment choice. However there remain definite numbers of prolactinomas resistant to standard DA therapy. The underlying mechanisms of this phenomenon, management and prognosis are still poorly understood. The search of treatment options for overcoming DA-resistance is an important object in practical endocrinology. We presen...

ea0032p241 | Clinical case reports – Pituitary/Adrenal | ECE2013

Addisonian crisis: rapid correction of hyponatriemia leads to osmotic myelinolysis

Parhimovich Richard

Chronic hypovolemic hyponatriemia is typical for Addisonian crisis and may provoke brain edema but its rapid correction may lead to myelinolysis. We report 2 newly diagnosed cases of primary adrenal insufficiency (PAI) associated with severe hyponatriemia which correction was complicated by osmotic myelinolysis.Case 1: Twenty four-year-old female was admitted with vomiting, sopor, shock. Serum sodium was 83, glucosae 3.6 mmol/l. Serum cortisol 34 nmol/l ...

ea0032p242 | Clinical case reports – Pituitary/Adrenal | ECE2013

Pituitary apoplexy after suppression test in a patient with Cushing’s disease due to macroadenoma

Kuzu Fatih , Bayraktaroglu Taner , Erdogan Ayfer Altas , Ilikhan Sevil Uygun , Bilici Muammer , Gul Sanser , Tokgoz Ozlem

Introduction: Cushing’s disease is not likely to be pituitary apoplexy or macroadenoma. We present a case of pituitary apoplexy after dexamethasone suppression test for Cushing’s disease due to macroadenoma.Case report: A 30-year-old man complained of headache and closure of the left upper eyelid. Two years ago he had a headache, and was diagnosed with non-functional macroadenoma of pituitary. In follow, insuppressibly serum levels of cortisol ...

ea0032p243 | Clinical case reports – Pituitary/Adrenal | ECE2013

Osteoporotic fractures as manifestation of Cushing’s disease

Nogueira Claudia , Souto Selma , Quinaz Joao , Braga Daniel , Vinha Eduardo , Rios Elisabete , Bernardes Irene , Pereira Josue , Carvalho Davide

Introduction: Cushing’s syndrome (CS) is a well-known cause of bone loss and osteoporotic fractures, which may be the initial manifestation of the disease and may present 2 years before CS diagnosis. Trabecular bone is usually the most seriously affected, and vertebrae and ribs are the typical fracture locations.Case report: A 37-year-old man with dyslipidemia and obesity was observed due to uncontrolled hypertension and osteoporosis. He complained ...

ea0032p244 | Clinical case reports – Pituitary/Adrenal | ECE2013

Cerebrospinal meningitis in 30-year-old man as first manifestation of pituitary macroadenoma

Andrysiak-Mamos Elzbieta , Sagan Leszek , Sowinska-Przepiera Elzbieta , Poblocki Jakub , Kazmierczyk-Puchalska Agnieszka , Zajac-Marczewska Malgorzata , Kojder Ireneusz , Syrenicz Anhelli

Introduction: The most frequent clinical manifestations of pituitary macroadenoma include headache, vision disturbances and cranial nerve paralysis.Case study: Thirty-year-old man was admitted to intensive care unit at regional hospital. On admission, he was unconscious, with convulsions, spasms and 3-day long history of headache as well as body temperature up to 41.5 °C. The patient was transferred to the Department of Infectious Diseases, with the...

ea0032p245 | Clinical case reports – Pituitary/Adrenal | ECE2013

Ectopic acth dependent Cushing syndrome diagnosed with octreotide scan

Onal Eda Demir , Oguz Oguzhan , Polat Burcak , Kandemir Zuhal , Karaoglanoglu Nurettin , Ersoy Reyhan , Cakir Bekir

Ectopic secretion of corticotropin(ACTH) by nonpituitary tumors accounts for 10–15% of ACTH dependent Cushing’s syndrome (CS). Generally it is difficult to localize the ACTH secreting tumor by conventional imaging methods because these tumors are often small in size. Here we present a case of ectopic ACTH syndrome diagnosed with octreotide scan.Case: A 26-year-old male patient presented with moon face, purplish striae, supraclavicular fat pads ...

ea0032p246 | Clinical case reports – Pituitary/Adrenal | ECE2013

Thalassemia minor associated with multiple pituitary hormone deficiency

Szanto Zsuzsanna , Kun Imre Zoltan , Oltean Galafteon

Regular red blood cell transfusions for thalassemia major leads to iron overload in endocrine glands, inducing deficient function of the pituitary, thyroid, parathyroid etc. In thalassemia intermedia these endocrine disturbances may appear due to increased intestinal iron absorption and occasional transfusions, but are less frequent and milder. We have no data about their presence in thalassemia minor.We present the case of a young woman known with mild ...

ea0032p247 | Clinical case reports – Pituitary/Adrenal | ECE2013

Occurrence of De Quervain’s thyroiditis after resolution of hypercortisolism following SOM230 treatment for Cushing’s disease and surgery for an adrenocortical adenoma: report of two cases

Efstathiadou Zoe , Sykja Albana , Anagnostis Panagiotis , Panagiotou Athanasios , Kita Marina

Introduction: Increased prevalence of thyroid autoimmunity has been described in few cases after successful treatment for Cushing’s syndrome. In De Quervain’s thyroiditis (DQT) autoimmunity does not seem to play a primary pathogenetic role.We describe two cases of DQT coinciding with the resolution of hypercortisolism, after successful treatment of Cushing’s syndrome/disease.Case 1: A 41-year-old female with Cushing&...

ea0032p248 | Clinical case reports – Pituitary/Adrenal | ECE2013

Nephrogenic systemic fibrosis: potential aetiology of pituitary stalk thickening post- commencement of dialysis: case report

Wijetilleka Sajini , Kong Chantal

Non-neoplastic pituitary stalk thickening is rare in patients without infiltrative disorders and diabetes insipidus. We present a non-diabetic patient with end stage renal failure with hyperprolactinaemia and pituitary stalk thickening.A 53-year-old Nigerian gentleman presented with reduced libido, erectile dysfunction and painful gynaecomastia. He denied galactorrhea, headaches or visual disturbances. He previously received spironolactone for resistant ...

ea0032p249 | Clinical case reports – Pituitary/Adrenal | ECE2013

Extraadrenal paraganglioma: case report

Payer Juraj , Teliarova Zuzana , Jackuliak Peter , Kollerova Jana , Breza Jan

The presence of pheochromocytoma/paraganglioma can be characterized by typical clinical signs, due to hemodynamic and metabolic activity of circulating catecholamines or less a consequence of other amines or neuropeptides produced simultaneously. But the clinical picture can be also very different and can play a clinical picture of other diseases.The authors present a case report from a patient with retroperitoneal paraganglioma. The patient was admitted...

ea0032p250 | Clinical case reports – Pituitary/Adrenal | ECE2013

Newly discovered adrenal tumor and pituitary microadenoma in a patient known with classical congenital adrenal hyperplasia

Kun Imre Zoltan , Szanto Zsuzsanna , Albert Karola , Patocs Attila

Introduction: Congenital adrenal hyperplasia (CAH) is an autosomal recessive disorder, most commonly caused by CYP21A2 mutations, and characterized by disturbed cortisol and androgen synthesis. Clinical manifestations of classical 21-hydroxylase deficiency are virilisation and salt-waisting syndrome in both sexes. Adrenal tumors may appear in untreated CAH patients, but very rarely following adequate long-term therapy.Case report: The 17-years-old male p...

ea0032p251 | Clinical case reports – Pituitary/Adrenal | ECE2013

Malignant schwannoma in a patient with hypopituitarism, congenital hydrocephalus, atrial septal defect and agenesis of right kidney

Marina Ljiljana , Vujovic Svetlana , Barac Marija , Ivovic Miomira , Tancic-Gajic Milina , Arizanovic Zorana , Micic Dragan

Introduction: Schwannomas are tumors derived from myelin sheat of nerves which can displace and compress nerves causing pain, weakness and numbness. Very rarely they become malignant.Case report: Thirty-one years old patient was hospitalized at our Department to evaluate hypopituitarism. He was born at term by cesarean section, with hydrocephalus and did not start to breath spontaneously. A few months later, he was diagnosed with scoliosis thoracalis dup...

ea0032p252 | Clinical case reports – Pituitary/Adrenal | ECE2013

Non-Hodgkin’s lymphoma presenting as anterior hypopituitarism

Lee Shang Ming Samuel , Abel Chen Weiliang , Gabriel Cher Liu Yuan , Lee Wei Feng , Seow Cherng Jye , Kon YC

Introduction: Panhypopituitarism is a known but rare presentation of lymphoproliferative disease. We describe a patient with newly diagnosed advanced diffuse large B-cell lymphoma who presented with anterior hypopituitarism and concomitant adrenal gland involvement.Case report: A 72 year-old Chinese woman presented with a few weeks’ duration of lethargy, weight loss and functional decline. A hormonal screen done at admission suggested central hypoth...

ea0032p253 | Clinical case reports – Pituitary/Adrenal | ECE2013

A case of ACTH producing oat cell carcinoma cause of ectopic Cushing’s syndrome and life threatening hypokalaemia

Ahmeti Irfan , Pemovska Gordana , Krstevska Branka , Jovanoska Biljana , Rexhepi Arben

Introduction: Ectopic Cushing’s syndrome caused by ectopic ACTH secretion are under-diagnosed.Case report: A 50 years old male patient is hospitalized for severe hypokalaemia and diabetes. Last 6 months he had a history of chest pain, prolonged cough, general weakness, difficulties climbing stairs, confusion, loss of consciousness. Previously, he was hospitalized in psychiatric hospital for psychotic alterations, in cardiology for high blood pressur...

ea0032p254 | Clinical case reports – Pituitary/Adrenal | ECE2013

Recurrent pituitary tumor: the importance of a functional classification at diagnosis

Moreno Carolina , Paiva Isabel , Gomes Leonor , Ruas Luisa , Gouveia Sofia , Saraiva Joana , Guelho Daniela , Carvalheiro Manuela , Carrilho Francisco

Introduction: Pituitary tumors can be classified according to their endocrine function, starting from the clinical phenotype to establish a diagnosis. The histological analysis can confirm the clinical suspicion. A thorough classification is essential in the therapeutic approach with an important influence in the disease-free survival.Case report: We report a case of a 16-year-old male, with loss of visual acuity and headache, attended by an Ophthalmolog...

ea0032p255 | Clinical case reports – Pituitary/Adrenal | ECE2013

Congenital trans-sphenoidal meningocele: an uncommon cause of pituitary insufficiency

Belhimer Faiza , Bey Abderrahim , Chentli Farida

Introduction: Congenital trans-sphenoidal meningocele (TM) is a rare clinical entity. It can be traumatic, congenital or from tumour origin. It results from a defect in the sphenoid bone ontogenesis. In its classical form, the TM is revealed in adults, frequently in women in the fourth or fifth decade by rhinorrhea or cerebrospinal fluid leak through a bony defect in the sphenoid floor. Our aim is to report a case of large TM without rhinorrhea, and as a part of midline abnorm...

ea0032p256 | Clinical case reports – Pituitary/Adrenal | ECE2013

Isolated ACTH deficiency with Brugada syndrome: a combination increasing the risk of fatal arrhythmia

Kumagai Naoko , Honda Kazufumi , Muroya Yohei , Shimodaira Masanori , Tsuzawa Kaoru , Sorimachi Erisa , Imamura Akira , Ishii Keita

Introduction: Brugade syndrome (BS) is a cardiac disorder characterized by typical electrocardiograph (ECG) alterations and is known to have a high risk of sudden cardiac death (SCD). Isolated ACTH deficiency (IAD) is often associated with fetal arrhythmia. Previous reports have suggested that certain endocrine diseases might cause Brugada-like ECG forms. We present a case of IAD with BS who died suddenly.Case presentation: Forty-one year-old man was ref...

ea0032p257 | Clinical case reports – Pituitary/Adrenal | ECE2013

A case of primary adrenal failure diagnosed in postpartum period

Anaforoglu Inan , Kose Mustafa , Algun Ekrem

Introduction: The prevalence of primary adrenal insufficiency (Addison disease; AD) in pregnancy is unknown. Female patients with adrenal insufficiency are usually infertile and once get pregnant are at increased risk for preterm deliveries, Cesarean section and babies with low birth weights. Recognition of AD during pregnancy may be difficult as many of the clinical complaints like weakness, lightheadness, syncope, nausea, vomiting, hyponatremia, and increased pigmentation ca...

ea0032p258 | Clinical case reports – Pituitary/Adrenal | ECE2013

TSH secreting pituitary adenoma: a case report

Ozturk Feyza Yener , Selvinaz Erol R , Kuzu Idris , Canat M Masum , Karatas Savas , Altuntas Yuksel

Introduction: Thyrotropin secreting pituitary adenomas are rare constituting <2% of pituitary adenomas. Thirty percent of these tumors may be plurihormonal. Most common cosecreted hormone is GH and the least one is PRL. We report here a case of plurihormonal pituitary adenoma symptomatic for TSH secretion.Case report: A 35-year-old female admitted to hospital because of fatigue, heat intolerance, headache, galactorrhea and menstrual irregularity. Her...

ea0032p259 | Clinical case reports – Pituitary/Adrenal | ECE2013

Gastrointestinal bleeding associated with Dabigatran in a patient with panhypopituitarism

Gunes Fahri , Asik Mehmet , Sen Hacer , Binnetoglu Emine , Akbal Erdem , Bilen Ogun Irem , Ukinc Kubilay , Adam Gurhan

Introduction: Dabigatran is a direct thrombin inhibitor which is used for reducing the risk of stroke or systemic embolism in patients with atrial fibrillation. Although INR monitoring is not required in the course of treatment, it may be complicated with spontaneous systemic bleeding. Sheehan’s syndrome is characterized with panhypopituitarism which is caused by necrosis of the pituitary gland. Recent studies have demonstrated that panhypopituitarism is associated with b...

ea0032p260 | Clinical case reports – Pituitary/Adrenal | ECE2013

Therapeutic dilemmas in a young male patient with macroprolactinoma complicated by hypogonadism

Lee Wei Feng , Cher Liu Yuan Gabriel , Lee Shang Ming Samuel , Chen Weiliang Abel , Seow Cherng Jye , Hoi Wai Han

Introduction: Hypogonadism is known to persist after treatment of hyperprolactinemia, necessitating androgen therapy in young male patients. Aromatisation of testosterone to estradiol can result in tumor expansion. We report a patient with persistent hypogonadism post treatment of macroprolactinoma and discuss challenges involved in the management.Case report: A 51-year-old gentleman was admitted for streptococcal meningitis. Brain imaging revealed a pit...

ea0032p261 | Clinical case reports – Pituitary/Adrenal | ECE2013

Baraitser Winter’s syndrome and GH deficiency

Zellagui Hadjer , Chentli Farida

Introduction: Baraitser–Winter syndrome (BWS) is a rare brain malformation leading to droopy eyelids and intellectual disabilities. This syndrome, first reported in 1988, is probably due to genetic abnormalities that are still not well defined, although eight gene abnormalities are already discovered and de novo missense changes in the cytoplasmic actin-encoding genes ACTB and ACTG1 have been recently discovered (Riviere Nature Genetic 2012). The syndrome combine...

ea0032p262 | Clinical case reports – Pituitary/Adrenal | ECE2013

Beer potomania masquerading as adrenal insufficiency

Hopkins Louise , Stokes Victoria , Chatterjee Sudesna

A 71-year-old male ex-publican presented to the Medical Emergency Unit suffering from lethargy, weight loss, dizziness on standing and dyspnoea on exertion. He had a past medical history of hypertension, ischaemic heart disease and alcoholic liver disease and he admitted to drinking 100 units of beer per week. His anthihypertensive medications included lisinopril and hydrochlorthiazide. On examination BMI was 35 kg/m2, blood pressure 85/65 mmHg and there was no bucc...

ea0032p263 | Clinical case reports – Pituitary/Adrenal | ECE2013

Isolated ACTH deficiency associated with Hashimoto’s disease

Binnetoglu Emine , Ask Mehmet , Sen Hacer , Gunes Fahri , Akbal Erdem , Tekeli Zeliha , Kizildag Betul , Ukinc Kubilay

Introduction: Isolated ACTH deficiency (IAD) is a rare disease which is characterized by secondary adrenal insufficiency with low cortisol production and normal secretion of pituitary hormones except ACTH. Isolated ACTH deficiency has rare association with Hashimoto’s disease which is characterized by autoimmune origin. This suggests the possibility of common autoimmune process affecting both the pituitary and the thyroid gland. We report a case of IAD with Hashimoto&#146...

ea0032p264 | Clinical case reports – Pituitary/Adrenal | ECE2013

Cases with adrenocortical carcinoma

Ecemis Gulcin Cengiz , Kan Elif Kilic , Bahadir Cigdem Tura , Atmaca Aysegul , Atmaca Hulusi , Colak Ramis

Introduction: Adrenocortical carcinoma (ACC) is a rare cancer (estimated incidence, 0.7 to 2.0 cases per 1 million population per year) with a poor prognosis. Even after seemingly complete surgical resection, most patients develop recurrence within 5 years. The 5-year survival rate is <15% among patients with metastatic disease.Methods: We present the results of six patients with adrenocortical carcinoma followed in our clinic....

ea0032p265 | Clinical case reports – Pituitary/Adrenal | ECE2013

Differential diagnosis of an incidental pituitary lesion detected with PET-CT in a patient with a known history of metastatic maxillary sinus tumor

Baser Husniye , Cuhaci Neslihan , Ozdemir Elif , Saglam Fatma , Ersoy Reyhan , Cakir Bekir

Introduction: Metastatic pituitary tumors are seen rarely and it is hard to differentiate them from the benign lesions of the gland. We have reported a case, with a known maxillary sinus tumor, detected to have a pituitary lesion coincidentally on PET-CT.Case: 45 years old male patient with a known history of relapsed maxillary sinus tumor has been referred to our clinics because of the pituitary lesion detected to have increased FDG involvement on PET-C...

ea0032p266 | Clinical case reports – Pituitary/Adrenal | ECE2013

Secondary hypertension and hirsutism as a clinical manifestation of the tumor duplicity: case report

Frysak Zdenek , Karasek David , Hartmann Igor , Kucerova Ladislava

Differential diagnostic search for the pathogenetic causes of hirsutism and the combination of hypertension can provide very interesting results for the clinicians. The case report demonstrates a patient suffering from two hormonally active tumors – adrenal adenoma with primary aldosteronism and primary Leydig cell ovarian tumor with hyperandrogenism. The task of the authors was easier due to the perimenopausal age of the proband. Selective venous sampling was very helpfu...

ea0032p267 | Clinical case reports – Pituitary/Adrenal | ECE2013

Treatment dilemmas of Cushing disease: case report

Saraiva Joana , Paiva Isabel , Alves Marcia , Gouveia Sofia , Moreno Carolina , Guelho Daniela , Gomes Leonor , Carvalheiro Manuela , Carrilho Francisco

Introduction: Cushing’s disease (CD) is a Grave disease that requires a multidisciplinary and individualized treatment approach.Case report: We describe the case of a 31-years old female patient with Cushing disease diagnosed in 2007. She initially complained of weight fluctuations, amenorrheia, rounded face with plethora and acne, for 1 year duration. Analytically: 0800 h plasma cortisol of 14 μg/dl (5–25) and 2300 h 15 μg/dl, ACTH 1...

ea0032p268 | Clinical case reports – Pituitary/Adrenal | ECE2013

Adrenocortical carcinoma: a case report

Popovic-Pejicic Snjezana , Pejicic Anja

Adrenocortical carcinoma (ACC) is a rare (incidence 1–2 per 1 million population) and heterogeneous malignancy with incompletely understood pathogenesis, unknown etiology and poor prognosis. ACC tends to grow and metastasize rapidly if untreated. The majority of cases are incidental diagnoses of advanced stage disease that metastasizes precociously due to its tendency to invade vascular structures. Among adults presenting with hormonal syndromes due to tumor excess secret...

ea0032p269 | Clinical case reports – Pituitary/Adrenal | ECE2013

Fountain of steroid deep within: a case report of an ectopic ACTH-producing tumor

Lo Tom Edward , Antonio Imelda , Jimeno Cecilia

Background: Cushing’s syndrome is defined as a hormonal disorder resulting from elevated serum cortisol leading to specific physical and biochemical abnormalities that might be detrimental to life itself. Majority is caused by steroid intake while endogenous sources although representing only a minority of patients often lead to delay in diagnosis. Ectopic ACTH syndrome considered a rare entity are usually found as small cell lung cancer and carcinoid tumors. Rare types o...