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

Poster Presentations

Clinical case reports - Thyroid / Others

ea0032p270 | Clinical case reports - Thyroid / Others | ECE2013

Low TSH plasma levels and high fracture risk in postmenopausal osteoporosis and osteopenia patients

Pastore Renato , Mentuccia Daniela

Introduction: Bone loss in thyroid dysfunction was first described by von Recklinghausen. Elevated bone turnover and decreased bone mass result when thyroid hormone levels are high and TSH levels suppressed. The changes in bone mass are impressive even in patients whit subclinical hypertiroidism, where thyroid hormones are within the normal range, but TSH is low or undetectable. Evidence show that endogenous and exogenous TSH suppression is associated with an increased fractur...

ea0032p271 | Clinical case reports - Thyroid / Others | ECE2013

Malignancy rate of thyroid nodules, which defined as follicular lesion of undetermined significance and atypia of undetermined significance in thyroid cytopathology and relation with ultrasonographic features

Cuhaci Fatma Neslihan , Arpaci Dilek , Ucler Rifki , Kiyak Gulten , Yalcin Samet , Ersoy Pamir Eren , Guler Gulnur , Ersoy Reyhan , Cakir Bekir

Introduction: Fine needle aspiration cytology (FNAC) has been widely accepted the most accurate, safe and cost-effective method for evaluation of the thyroid nodules. The most challenging category in the FNAC is atypia of undetermined significance (AUS) and follicular lesion of undetermined significance (FLUS). Bethesda System (BS) recommends repeat FNAC in that category due to their low risk of malignancy. In our study, we aimed to investigate the malignancy rate of thyroid n...

ea0032p272 | Clinical case reports - Thyroid / Others | ECE2013

Recurrent pregnancy induced hypercalcaemia resulting in multiple terminations of pregnancy

Chockalingam Ganesh

Introduction: Pregnancy is characterized by increased intestinal calcium absorption, normal ionized or albumin-corrected calcium, high calcitriol, low PTH, gradually increasing PTHrP, and hypercalciuria. These differing hormonal changes can lead to nonclassic presentations of disorders of bone and mineral metabolism.Case report: First-trimester 34-year-old multigravida patient presented with hyperemesis, abdominal pain, polyuria, polydipsia, leg cramps a...

ea0032p273 | Clinical case reports - Thyroid / Others | ECE2013

Familial Graves’ disease: case report

Mota Ana , Martins Joao , Vale Sonia , Martins Ana , Gomes Ana , Miltenberger-Miltenyi Gabriel , Carmo Isabel

Introduction: Graves’ disease is an autoimmune condition with an estimated prevalence of about 2%, 5–10 times more frequent in females. A multifactorial nature is assumed, with genetic contribution accounting for up to 80% of the variability. Relevant genes includegeneral autoimmune risk loci, such as the HLA region, CTLA-4, PTPN22 and CD40, as well as thyroid-specific loci (thyroglobulin and TSH receptor genes). We report a particular case of Graves’ d...

ea0032p274 | Clinical case reports - Thyroid / Others | ECE2013

Paraganglioma, germline nonsense mutation in succinate dehydrogenase B gene (R27X) and response to sunitinib

Elezovic Valentina , Petakov Milan , Ognjanovic Sanja , Macut Djuro , Isailovic Tatjana , Ilic Bojana , Popovic Bojana , Antic Ivana Bozic , Bogavac Tamara , Ilic Dusan , Damjanovic Svetozar

A 36-years-old male with mild hypertension was diagnosed with pseudocystic tumor (67 mm) in pancreatic region and liver metastasis in April 2010. One month later, the extirpation of retroperitoneal mass and metastasis was performed in local medical centre. Pathohistological diagnosis was metastatic paraganglioma (Ki67, 3.5%). In June 2010, he was transferred to our Institution, and (131) I-metaiodobenzylguanidine (MIBG) scintigraphy was negative. However ((18) F) fluorodeoxygl...

ea0032p275 | Clinical case reports - Thyroid / Others | ECE2013

Submandibular ectopic thyroid gland

Dominguez-Lopez Marta , Gonzalez-Molero Inmaculada , Ruiz MSol , Soriguer Federico

Introduction: Ectopic thyroid glands are generally a rare entity appearing mostly in the cervical midline (90% of the cases) and even more rarely in other anatomical sites (10%).Clinical report: We present the case of an ectopic submandibular thyroid gland. A 31-year-old woman was referred to our department with a history of left submandibular swelling.A scintigraphy was performed, which showed an accumulation of activity in the ri...

ea0032p276 | Clinical case reports - Thyroid / Others | ECE2013

Barraquer-Simons syndrome

Baracho Maria Fatima , Santos Maria Goreti , Amaral Beatriz , Carmo Raissa , Rafael Renata , Melo Luciana , Araujo Maria Augusta , Santos Gemma , Oliveira-Filho Antonio , Nunes Adriana

The Barraquer-Simons syndrome is a rare form of partial symmetric lipodystrophy with involvement of the face and upper body, of unknown cause, characterized by loss of subcutaneous fat in the face and started stretching for the upper body.Case report: Female patient, 26 years old, presenting morphologic change in facies, chest, upper limbs, lower limbs and abdomen since she was 10 years old. Last year, she has increased weight at 30%, with apparent muscl...

ea0032p277 | Clinical case reports - Thyroid / Others | ECE2013

Dural ectasia accompanying a case of multiple endocrine neoplasia type 2B

Anaforoglu Inan , Algun Ekrem , Kose Mustafa

Introduction: Manifestations of MEN2B include medullary carcinoma of thyroid (MCT), pheochromocytoma, and a number of somatic mutations like marfanoid habitus, mucosal neuromas, ganglioneuromatosis of the bowel. Dural ectasia results from enlargement of the spinal canal, was identified in 63–92% of patients with Marfan syndrome, however, it was not previously described in MEN2B. We detected dural ectasia in our patient with MEN2B.Case report: A 28 y...

ea0032p278 | Clinical case reports - Thyroid / Others | ECE2013

Coexistence of euthyroid ophthalmopathy and isolated ocular myasthenia gravis in a patient with vitiligo: a challenging diagnosis of APS-3C

Duncea Ileana , Ilie Ioana R , Goia-Socol Monica , Gherghel Dana , Georgescu Carmen E

About 1% of the patients with Graves’ disease develop myasthenia gravis, however, euthyroid Graves’ ophtalmopathy has only rarely been associated with myasthenia gravis and especially with isolated ocular myasthenia gravis. A 63-year old, male patient with vitiligo presented double vision and right ptosis, shortly followed by left ptosis. On the ophthalmological examination there was bilateral ptosis and orbito-ocular ultrasonography yielded a thickening of the left ...

ea0032p279 | Clinical case reports - Thyroid / Others | ECE2013

Giant cell granuloma as initial presentation of primary hyperparathyroidism: a case report

Polat Sefika Burcak , Taskaldiran Isilay , Evranos Berna , Kilicaslan Aydan , Kaya Elif , Ersoy Reyhan , Cakir Bekir

Giant cell granuloma is a skeletal manifestation seen now rarely in hyperparathyroidism due to early recognition of the disease. Lesions usually occur in the areas of intense bone resorption. They can affect mandible, maxilla, clavicle, ribs and pelvic bones. Most of the patients who have primary hyperparathyroidism are asymptomatic and are discovered incidentally during laboratory examinations. Here, we represent a female patient who was referred to endocrinology clinics beca...

ea0032p280 | Clinical case reports - Thyroid / Others | ECE2013

Fibrous variant of Hashimoto’s thyroiditis: development of neck fibrosis and mediastinal fibrosis

Makarov Albert , Arzhakova Violetta , Neustroev Peter , Makarova Elena

Immunoglobulin G4-related disease (IgG4-RD) is now a widely recognised multi-organ system disease characterised by elevated serum and tissue concentrations of IgG4. Two forms of thyroid involvement in IgG4-RD have been described, including Reidel’s thyroiditis (IgG4-related thyroid disease) and the fibrous variant of Hashimoto’s thyroiditis.Objective: To describe a case of the development of massive neck fibrosis and mediastinal fibrosis in a p...

ea0032p281 | Clinical case reports - Thyroid / Others | ECE2013

Differentiated thyroid cancer presenting as chylothorax

Garcia-Figueras Carolina , Cayon Manuel , Gallego Pedro

Introduction: Initial presentation of thyroid carcinoma can range from a solitary thyroid nodule or cervical lymphadenopathy to symptoms related to local compression. Presentation as chylothorax due to compression of thoracic duct is exceptional. The aim of this case report is to describe an extremely rare case of follicular thyroid cancer presenting as chylothorax with special attention to therapeutic aspects.Case report: A 78-years-old woman was referr...

ea0032p282 | Clinical case reports - Thyroid / Others | ECE2013

A case of confirmed Smith–Lemli–Opitz syndrome

Kun Imre Zoltan , Szanto Zsuzsanna , Ludke Ibolya , Duka Gabriela , Plaiasu Vasilica

Smith–Lemli–Opitz syndrome (SLOS) is a 46,XY disorder of sex development, included in the subgroup of disorders in androgene synthesis. The disease is caused by mutations of 7-dehydrocholesterol reductase (DHCR7) gene, conducting to deficient synthesis of the correspondent enzyme and of cholesterol, with important role in embryogenesis, adrenal and gonadal steroidogenesis. Clinical manifestations includ facial dysmorphism, syndactyly, ambiguous external genitalia and...

ea0032p283 | Clinical case reports - Thyroid / Others | ECE2013

A case of generalized resistance to thyroid hormone with chronic thyroiditis

Shestakova Tatiana , Dreval Alexander , Komerdus Irina

Introduction: Resistance to thyroid hormone (RTH) is a rare disorder characterized by reduced tissues’s responsiveness to thyroid hormones (TH). Usually patients with RTH have not clinical signs except goiter. We describe a 70-years old woman with RTH and autoimmune thyroiditis simultaneously.Case report: Woman 70-years old was hospitalized in our department on August 2011 with suspicious of Thyrotropinoma because of high levels of TSH and fT4<...

ea0032p284 | Clinical case reports - Thyroid / Others | ECE2013

Autoimmune hypothyroidism converted to hyperthyroidism: is it a common phenomenon?

Furqan Saira , Islam Najmul

Introduction: Graves’ disease and Hashimoto’s thyroiditis are the two autoimmune spectrum of thyroid disease. Cases of conversion from hyperthyroidism to hypothyroidism have been reported but conversion from hypothyroidism to hyperthyroidism is very rare although reported. We report a case of hypothyroidism that converted to a hyperthyroid state needing treatment.Case report: A 36 years old female presented with a 3 months history of easy fatig...

ea0032p285 | Clinical case reports - Thyroid / Others | ECE2013

Maturity onset diabetes of youth (MODY) in a patient with VATER syndrome

Anagnostis Panagiotis , Efstathiadou Zoe , Poulasouchidou Maria , Kita Marina

Introduction: VATER syndrome is a rare, usually sporadic, entity, including ≥2 of the following: vertebral defects (V), anal atresia (A), tracheoesophegeal fistula, esophageal atresia (TE) and radial or renal dysplasia (R).Maturity onset diabetes of youth (MODY) is a usually non-insulin-dependent type of monogenic diabetes mellitus (DM), usually in adults <25 years, with autosomal dominant inheritance, without the features of metabolic syndrome...

ea0032p286 | Clinical case reports - Thyroid / Others | ECE2013

Plasmapheresis in rapid preparation of a patient with toxic multinodular goiter for surgery

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

Thyroidectomy is the definitive treatment for toxic multinodular goiter (TXMNG). Surgery should be performed when the patient is euthyroid which decreases perioperative cardiac risks. Plasmapheresis is a procedure that removes the thyroid hormones from the circulation. It is an alternative method in case of resistance or contraindications to anti thyroid drugs. Role of plasmapheresis in the treatment of TXMNG is not fully determined in the literature. We report a case with TXM...

ea0032p287 | Clinical case reports - Thyroid / Others | ECE2013

Postmenopausal hirsutism and hyperandrogenemia due to granulosa cell tumor of the ovary

Bahadir Cigdem , Atmaca Aysegul , Atmaca Hulusi , Colak Ramis

Inroduction: Progressive baldness and severe hirsutism associated with granulosa cell tumor of ovaries are rare conditions in women. Reported cases are usually pubertal girls and young women. Here, we report a case of postmenopausal baldness and hirsutism due to granulosa cell tumor of the ovary.Case report: A 62 year-old woman presented with baldness and hirsutism on her face, body and back for 3 years. She had menarche at 14 years and menopause at 52 y...

ea0032p288 | Clinical case reports - Thyroid / Others | ECE2013

Clinical case report: male patient with SRY-positive 46,XX testicular disorder of sex development

Dominguez-Lopez Marta , Gonzalez-Molero Inmaculada , Esteva Isabel , Gonzalo-Marin Montserrat , de Adana MSoledad Ruiz , Soriguer Federico

The 46 XX male syndrome (de la Chapelle syndrome or 46,XX testicular disorder of sex development -46,XX testicular DSD-) is a rare phenotype associated with disorder of the sex chromosomes. XX males exist in different clinical categories with ambiguous genitalia or partially to fully mature male genitalia, in combination with complete or incomplete masculinization.Clinical report: We describe the clinical, molecular, and cytogenetic findings of a 26-year...

ea0032p289 | Clinical case reports - Thyroid / Others | ECE2013

Insulin autoimmune syndrome, IAS (Hirata disease) case report

Chockalingam Ganesh , Wilson Dennis , Clifton-Bligh Roderick

Introduction: Insulin autoimmune syndrome was first described in 1973 by Hirata, characterised by recurrent spontaneous postprandial hypoglycaemia. Serum insulin is extremely high with elevated insulin autoantibodies. More than 170 cases reported worldwide. We report the first case of IAS in Australia.Case report: Eighty one-year old Argentinean woman with 3 month history of intermittent, late postprandial diaphoresis, tremors, palpitations, dizziness an...

ea0032p290 | Clinical case reports - Thyroid / Others | ECE2013

Neurogenic hypertension as a case report

Nisic Tanja , Stojkovic Mira , Stojanovic Milos , Ciric Jasmina , Beleslin Biljana , Lalic Tiana , Zarkovic Milos , Trbojevic Bozo

Introduction: Neurogenic hypertension is associated with unilateral neurovascular compression of the brainstem and cranial nerves V, IX-X, VII, VIII. Causes may include nerve injury, vascular compression, tumors. Symptomatology seems hyperactive dysfunction syndrome of the cranial nerves. In the clinical picture, it can be seen trigeminal neuralgia, vertigo, tinnitus, hemifacial spasm, and in some cases hypertension.Case report: Female patient, 45 years ...

ea0032p291 | Clinical case reports - Thyroid / Others | ECE2013

Immobilisation hypercalcaemia in a young man

Mlawa Gideon , Chinnasamy Eswari , Nageshwaran Saiji , Panoyiatis Theofanoyiannis

Background: Immobilisation hypercalcaemia is serious complication of prolonged immobility of any cause such as spinal cord injury, polio victims, burns victims, as well as trauma patients.Case: Eighteen-years old student was admitted to the hospital following road traffic accident. He sustained multiple fractures, skull, spine, chest and pelvis. He also sustained abdomen and pelvic haematoma. At scene of crash he had GCS 5/15, needing intubation and was ...

ea0032p292 | Clinical case reports - Thyroid / Others | ECE2013

Parathyroid carcinoma: an atypical case in a patient submitted to Bariatric surgery

Sobrino Paula Sanchez , Catalina Pablo A. Fernandez , Alvarez Carlos Alvarez

Background: Parathyroid carcinoma accounts for <1% of cases of primary hyperparathyroidism. Clinical presentation is usually related to severe hypercalcemia associated to elevated serum PTH (three times above the upper limit). These values are so much higher than in primary hyperparathyroidism due to a benign adenoma. Moreover, 30–75% of patients had a palpable neck mass.Clinical case: Fifty one-year-old male, submitted to bariatric surgery by a...

ea0032p293 | Clinical case reports - Thyroid / Others | ECE2013

Autoimmune polyglandular syndrome type IV with twins pregnancy: clinical, diagnostic, evolutive aspects and treatment

Radu Cristina Corina Pop

Autoimmune polyglandular syndromes (APS) are characterized by the association of two or more endocrine and/or nonendocrine autoimmune diseases with different immunologic features of their pathogenesis.Based on the clinical picture is divided into four different types. Type I APS comprises mucocutaneous candidiasis, hypoparathyroidism and Addison’s disease. Type II APS is defined by autoimmune Addison’s disease in association with chronic autoim...

ea0032p294 | Clinical case reports - Thyroid / Others | ECE2013

Hypercalcemia in patient five years after the diagnosis of gastrinoma

Ksela Ursa , Cokolic Miro

Introduction: We diagnosed multiple endocrine neoplasia type 1 (MEN1) based upon the occurrence of two primary MEN1 tumor types in patient without family history of MEN1. Hyperparathyroidism was diagnosed in patient five years after gastrinoma surgery. With hormone tests and morphologic investigation we excluded pituitary adenoma.Case report: Forty-nine year old patient was admitted with abdominal pain and vomiting. Laboratory testing revealed elevated v...

ea0032p295 | Clinical case reports - Thyroid / Others | ECE2013

Presence of Paget’s disease in a patient with endometrium carcinoma

Uzum Ayse Kubat , Yalin Gulsah Yenidunya , Gul Nurdan , Canbaz Bulent , Dogansen Sema Ciftci , Bilgic Bilge , Ozbey Nese Colak

Introduction: Isolated bone metastasis of endometrium carcinoma is rare; but if it occurs, pelvis and vertebrae are involved mostly. Co-existence of undiagnosed Paget’s disease in a patient with malignancy causes major problems in differential diagnosis.Case: A 77 year-old woman was admitted to our hospital with severe pelvic pain. She had been diagnosed with inoperable endometrium adenocarcinoma for over a year. Metastatic bone disease was suspecte...

ea0032p296 | Clinical case reports - Thyroid / Others | ECE2013

Parathyroid carcinoma

Adamska Agnieszka , Gorska Maria Zofia

Introduction: Parathyroid carcinoma is a rare endocrine malignancy accounting for <1% of all cases of hyperparathyroidism. Diagnosis and treatment is still difficult.Case report: A 32-year-old women was admitted to the hospital because of mental status changes, polyuria, polydipsia, musculoskeletal pain and weight loss (34 kg during last year). She had history of nephrolithiasis, pancreatitis, cholelithiasis, peptic ulcer disease, osteoporosis and di...

ea0032p297 | Clinical case reports - Thyroid / Others | ECE2013

Primary hyperparathyroidism associated with atrial septal defect, interatrial septal aneurisym and skeletal anomaly: a case report

Cuhaci Fatma Neslihan , Polat Sefika Burcak , Evranos Berna , Keles Telat , Ersoy Reyhan , Cakir Bekir

The classic clinic manifestation of primary hyperparathyroidism (PHPT) is osteitis fibrosa cystica, a severe skeletal disease characterized by brown tumors, bone cysts and deformities, due to extremely elevated bone resorption elicited by continuously high parathyroid hormone (PTH) levels. In cardiovascular system there may be shortened QT interval, deposition of calcium in heart valves, coronary arteries, and myocardial fibers. Here, we report a case with PHPT, who have anore...

ea0032p298 | Clinical case reports - Thyroid / Others | ECE2013

Hypercalciuria in a patient with central diabetes insipidus

Ginis Alexandros , Kostoglou-Athanassiou Ifigenia

Central diabetes insipidus is characterized by increased water excretion which is corrected by the administration of antidiuretic hormone. Hypercalciuria is known to be associated with osteoporosis. The aim was to describe the case of a patient with central diabetes insipidus, hypercalciuria, vitamin D deficiency and severe osteoporosis.The case of a patient, female aged 64 years, presenting with central diabetes insipidus, hypercalciuria, vitamin D defi...

ea0032p299 | Clinical case reports - Thyroid / Others | ECE2013

A recurrent case of subacute thyroiditis improved with the onset of pregnancy

Bayraktaroglu Taner , Kuzu Fatih , Salihoglu Yavuz Sami , Bilici Muammer , Ilikhan Sevil Uygun , Harma Mehmet Ibrahim

Introduction: Thyroid disorders such as subacute thyroiditis occur rarely in pregnancy. We report a recurrent case of subacute thyroiditis improved with the onset of pregnancy.Case report: A 32-year-old Turkish women who request pregnancy and planned insemination was referred due to malaise and neck pain in the left side a week ago. She was presented with low-grade fever, fatigue, pharingitis symptoms, neck pain and extremely tenderness in the right side...

ea0032p300 | Clinical case reports - Thyroid / Others | ECE2013

High rate of malignant disorders in patients with primary hyperparathyroidism

Kirana Stanley , Eggert Bettina , Oberwelland Kirsten , Schurmann Guido , Feldkamp Joachim

Introduction: Some new data suggest a coincidence of differentiated thyroid carcinoma in patients with primary hyperparathyroidism (pHPT).Methods & design: We performed a retrospective analysis of our patients (n=267) with primary hyperparathyroidism from 2007 until 2011.Results: Musculoskeletal pain was reported by 34.2% of the patients. Gastrointestinal discomfort was complained by 28.8%, and 21.1% had nephrolithiasi...

ea0032p301 | Clinical case reports - Thyroid / Others | ECE2013

Experience in the use of Tolvaptan in elderly patients with significant hyponatraemia

Swiecicka Agnieszka , Nayar Rahul , Joshi Ashwin

Introduction: Tolvaptan is an oral vasopressin V2 receptor antagonist which offers a novel treatment for euvolaemic and hypervolaemic hyponatraemia. Here, we report our experience with Tolvaptan in elderly patients.Case 1: Seventy sex-year-old lady with background of hypothyroidism, hypertension and alcohol excess presented with acute onset of confusion. Her admission Sodium [Na+] level was 117 mmol/l and represented an acute drop f...

ea0032p302 | Clinical case reports - Thyroid / Others | ECE2013

Hypercalcemia secondary to concomitant thyrotoxicosis and B cell lymphoma

Yuan Liu , Cher Gabriel , Lee Wei Feng , Chen Weiliang Abel , Lee Shang Ming Samuel , Jye Seow Cherng , Tan Alvin Wai Kit

Introduction: Mild hypercalcaemia can present in 10–15% of hyperthyroid patients. In contrast, its incidence in B cell lymphoma is considerably less (7–8%) but its levels are much higher. We report a patient with hypercalcemia secondary to both thyrotoxicosis and lymphoma.Case report: A 55 year-old lady presented with non specific symptoms of appetite loss and lower limb weakness. Comorbidities included hypertension, diabetes mellitus, hyperlip...

ea0032p303 | Clinical case reports - Thyroid / Others | ECE2013

Hyperthyroidism-induced heart block: a case series in the Philippine general hospital

Aguilar Anthony Harvey , Sandoval Mark Anthony

Cardiac arrhythmias in thyrotoxicosis are usually seen as sinus tachycardia and atrial fibrillation but conduction abnormalities in the form of heart blocks do occur in rare instances. We present here four hyperthyroid patients with complete heart blocks. Cases 1 and 2 are young women diagnosed with Graves’ disease who both experienced syncope and were seen to have 3rd degree atrio-ventricular block. Case 3 is a young woman who presented with palpitations, fever and short...

ea0032p304 | Clinical case reports - Thyroid / Others | ECE2013

A case with thyroid acropachy as the initial manifestation of thyrotoxicosis

Bal Serpil , Tutuncuoglu Pelin , Atar Emel , Sarikaya Nese Olmez , Yoleri Ozlem , Oz Bengi , Kocyigit Hikmet , Harman Ece

Thyroid acropachy is an uncommon and usually late complication of thyroid disease. The typical clinical presentation of thyroid acropachy includes clubbing, distal soft tissue swelling and periosteal reaction involving the tubular bones of the hands and feet. It is usually associated with exophthalmos and thyroid dermopathy. We present a case with thyroid acropachy as an initial manifestation of toxic adenoma.A 69-year-old man was admitted to our out-pat...

ea0032p305 | Clinical case reports - Thyroid / Others | ECE2013

Postmenopausal Sertoli–Leydig cell tumor in two patients

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

Introduction: Sertoli–Leydig cell tumours are rare tumours which account for <1% of all solid ovarian tumors. It mostly occurs in 2–4° decades of life. Rapidly progessing symptoms/signs of androgen excess suggest the presence of and androgen secreting tumor.Case: Two postmenopausal patients (50 and 57 year-old) were referred to our Endocrinology Clinic for evaluation of worsening hirsutism. Both of patients had manifestations of hypera...

ea0032p306 | Clinical case reports - Thyroid / Others | ECE2013

Adefovir diproxivil-induced acquired Fanconi’s syndrome presenting as hypokalemia

Lee Shang Ming Samuel , Seow Cherng Jye , Khee-Shing Leow Melvin

Introduction: Adefovir, commonly used for the treatment of hepatitis B, has dose-related nephrotoxicity, especially at doses of 60 mg daily and above. We describe a patient with Fanconi’s syndrome after being on low dose adefovir for more than 5 years.Case report: A 62-year-old Chinese man, a chronic carrier of Hepatitis B on adefovir 10 mg daily for over 5 years, presented with the incidental finding of profound yet asymptomatic hypokalemia (K 1.9 ...

ea0032p307 | Clinical case reports - Thyroid / Others | ECE2013

Prolonged ventilator dependence in myxedema coma: a case report and review of the literature

Cher Liu Yuan Gabriel , Jye Seow Cherng , Chew Daniel Ek Kwang

Introduction: Myxedema coma is a medical emergency and can be associated with respiratory failure. Intubated patients have been known to require persistent efforts in ventilator weaning, with one case reported to take 7 months before success.Case report: A 77-year-old gentleman with known primary hypothyroidism presented with chest infection. He had defaulted thyroxine for the past 6 months, relying instead on complementary health products. Thyroid funct...

ea0032p308 | Clinical case reports - Thyroid / Others | ECE2013

Graves’ disease associated with severe hypoalbuminemi

Sen Hacer , Binnetoglu Emine , Asik Mehmet , Gunes Fahri , Akbal Erdem , Bozkurt Neslihan

Introduction: The most common cause of thyotoxicosis is Graves’ disease. Thyroid storm mostly presents with fever, tachycardia, arrthyhmia, jaundice, congestive heart failure and consciousness. We report a rare case of severe hypoalbuminemia with thyroid storm. To our knowledge it is the first case of severe hypoalbunemia due to thyrotoxicosis in literature.Case: Forty one years old female had been followed up with the diagnosis of Graves’ dise...

ea0032p309 | Clinical case reports - Thyroid / Others | ECE2013

Graves’ disease associated with Alopecia areata developed after Hashimoto's thyroiditis

Asik Mehmet , Binnetoglu Emine , Sen Hacer , Gunes Fahri , Akbal Erdem , Tekeli Zeliha , Oguz Sevilay , Uysal Fatma , Ukinc Kubilay

Indroduction: Graves’ and Hashimoto’s thyroiditis are the most common autoimmune thyroid diseases. After Graves’, hypothyroidism can develop spontaneously or as a result of medical treatment, radioactive iodine therapy or surgery. Development of Graves’ after Hashimoto’s thyroiditis is a rare condition. Alopecia areata (AA) is an autoimmune disease. It has association with other autoimmune diseases such as thyroid disorders, anemias and other skin diso...

ea0032p310 | Clinical case reports - Thyroid / Others | ECE2013

Challenges in the management of hypogonadotropic hypogonadism

Seow Cherng Jye , Cher Liu Yuan Gabriel , Lee Shang Ming Samuel , Chen Weiliang Abel , Lee Wei Feng , Tan Alvin Wai Kit , Shakoor Shaikh Abdul Kader Kamaldeen Abdul

Introduction: One of the main challenges in the management of male hypogonadotropic hypogonadism (HH) is in the restoration of fertility. We describe 2 patients with HH and discuss the difficulties involved in their management.Case (1): A 23-year-old Chinese man presented with lack of secondary sexual characteristics. Examination revealed Tanner Stage 2 with descended testes measuring 6 ml bilaterally. Laboratory results: total testosterone (TT) <1 n...

ea0032p312 | Clinical case reports - Thyroid / Others | ECE2013

Report of a case of hyperandrogenism in a postmenopausal woman

Dominguez-Lopez M , Gonzalez-Molero I , Soriguer F , Gonzalo-Marin M , Ruiz de Adana MS

Objective: To report a case of hyperandrogenism attributable to the presence of an ovarian Leydig cell tumor secreting testosterone in a postmenopausal woman.Methods: The laboratory, radiologic, and pathologic findings in our case are described.Results: A 59-year-old woman presented with a history of gradual increase in facial and body hair, scalp hair loss, male pattern baldness, and deepening of her voice, beginning 5–6 year...

ea0032p313 | Clinical case reports - Thyroid / Others | ECE2013

Primary octreotide therapy in a patient with pituitary adenoma cosecreting GH and TSH

Polat Sefika Burcak , Onal Eda , Tuzun Dilek , Dirikoc Ahmet , Ersoy Reyhan , Cakir Bekir

Pituitary adenomas which co-secrete GH and TSH accounts for <0.2% of all adenomas of the pituitary. Symptoms of hypertyroidism are usually masked by clinical manifestations of acromegaly. Here, we have reported the result of the primary one year long medical therapy in a case who was diagnosed to have adenoma co-secreting GH and TSH.Case: Seventy-years-old female patient has admitted with the complaints of excessive sweating, enlargement of hands and...

ea0032p314 | Clinical case reports - Thyroid / Others | ECE2013

Follicular thyroid cancer with functioning lung metastasis

Ngalob Queenie , Ogbac Ruben , Buenaluz-Sedurante Myrna

Background: Functioning metastasis from a primary thyroid cancer are exceedingly rare. Failure to proceed to hypothyroidism after total thyroidectomy denotes remaining hormone production from functioning metastasis. Radioactive iodine ablation will ablate these remaining tissues. We present the case of a patient with follicular thyroid cancer, lung metastasis and detectable thyroid hormones after thyroidectomy.Clinical presentation: The patient is a 71-y...

ea0032p315 | Clinical case reports - Thyroid / Others | ECE2013

Wegener’s granulomatosis in a patient with vitamin D deficiency

Athanassiou Panagiotis , Kostoglou-Athanassiou Ifigenia , Xanthakou Eleni , Papadaki Anna , Basdragianni Dimitra

Wegener’s granulomatosis is characterized by necrotizing granulomatous vasculitis. It occurs initially in a localized form, disseminates in various degrees and particularly involves the respiratory tract and kidneys. It is an ANCA-associated vasculitis, a systemic disease of autoimmune aetiology. Recently vitamin D deficiency has been associated with the development of autoimmunity. The aim was to present a case of Wegener’s granulomatosis in a patient with vitamin D...

ea0032p316 | Clinical case reports - Thyroid / Others | ECE2013

Mixed medullary-follicular carsinoma of the thyroid: two case reports

Usluogullari Alper Celil , Onal Eda Demir , Balci Serdar , Ersoy Reyhan , Cakir Bekir

Mixed medullary-follicular carcinomas (MMFC) of the thyroid are rare tumors which represents <0.15% of all thyroid tumors showing the morphological and immunochemical properties of both parafollicular and follicular cell lineages. Cases were immunoreactive for both calcitonin and thyroglobulin.Case 1: A 25-year-old female patient referred us for evaluation of a thyroid mass located on the left lobe. Ultrasonography (US) revealed 38 mm solid isoechoic...

ea0032p317 | Clinical case reports - Thyroid / Others | ECE2013

Cyclosporine induced autoimmune thyroid disease: presentation of two cases

Onal Eda Demir , Usluogullari Alper Celil , Arpaci Dilek Karakaya , Ucler Rifki , Ersoy Reyhan , Cakir Bekir

Immune supressive patients due to any cause (disease, medication, etc.) rarely have autoimmune diseases. In this presentation, two patients diagnosed with Graves’ disease and subacute thyroiditis while taking cyclosporine therapy will be discussed.Case 1: A 47-year-old female patient applied with weight loss, sweating and tremor. She had been on cyclosporine therapy for 3 years because of hypoplastic anemia. In laboratory tests; TSH: 0.005 uIU/ml (0...

ea0032p318 | Clinical case reports - Thyroid / Others | ECE2013

Never too late to discover some extra thyroid tissue

Wessling Ana , Araguez Jose Maria , Ferreira Florbela , Carmo Isabel

Introduction: Ectopic thyroid is a rare entity, resulting from developmental defects at early stages of thyroid embriogenesis. It’s prevalence is 1/100 000–300 000 in general population and 1/4000–8000 in patients with thyroid disease. This condition is more common in females, in Asians and may occur at any age, although it’s most common at younger ages. The most frequent location of ectopic thyroid tissue is at the base of the tongue. In 70–75% of cas...

ea0032p319 | Clinical case reports - Thyroid / Others | ECE2013

Everolimus. a new therapeutic target in the metastatic neuroendocrine carcinoma

Rodriguez Jose Perez , Hernandez Tomas Martin , Hernandez Cristina , Baz David Vicente , Manzano Virginia Martin , Baldrich Alfonso Gentil , Perez Angel Sendon

Introduction: Everolimus is a drug selective inhibitor of mTOR and approved by the FDA in 2011 for treatment of neuroendocrine tumors of pancreatic origin unresectable. Our objective was to evaluate the efficacy and safety of everolimus in a patient with malignant pancreatic head insulinoma.Case: This is a 31 year old man who complains of epigastric pain, dizziness, sweating and syncope related to exercise. During admission is objectively severe hypoglyc...

ea0032p320 | Clinical case reports - Thyroid / Others | ECE2013

Torsade de pointes caused by gluten sensitive enteropathy leading to multiplex endocrine failure: case report

Csajbok Eva , Orosz Andrea , Hankovszky Peter , Rudas Laszlo , Lengyel Csaba

A 55 year-old man was brought to the emergency room because of hypotension, fatigue, fever and pain in the left shoulder. The blood glucose, sodium, potassium levels were normal. ECG showed 65/min sinus rhythm with negative T waves in the precordial leads. Blood pressure was 70/50 mmHg. Suddenly torsade des pointes occurred, which was converted to sinus rhythm with 300 mg amiodarone. Coronarography showed no significant stenosis on epicardial coronaries. During the interventio...

ea0032p321 | Clinical case reports - Thyroid / Others | ECE2013

Atypical parathyroid adenoma presenting with severe hypercalcemia: a case report

Baser Husniye , Karagoz Ali , Burnik Ferda Sevimli , Baser Salih , Cayci Mustafa , Okus Ahmet , Karanis Meryem Ilkay Eren

Introduction: Atypical parathyroid adenoma (APA) is a difficultly diagnosed tumor, including some histological features of parathyroid carcinoma (PC). In literature, no definite criteria are considered to be present to distinguish preoperatively APA from PC. It is difficult to distinguish APA and PC intraoperatively. Our report, a case applying with high levels of calcium (Ca) and intact parathyroid hormone (iPTH) and diagnosed with APA was presented.Cas...

ea0032p322 | Clinical case reports - Thyroid / Others | ECE2013

Severe hyponatraemia in patients admitted to acute medical unit

Sadeghi Mitra , Ahmed Abu , Dissanayake Sanjaya

In a retrospective cohort study, we reviewed the medical notes of patients with severe hyponatreaemia admitted to acute medical unit at Blackpool Hospital between January and March 2012. We assessed the severity, causes of hyponatraemia, length of stay and mortality in patients with hyponatraemia.We identified 25 patients with plasma sodium ≤120 mmol/l, 5 of whom were admitted twice during the study period. Their average age was 70 (range 30–9...

ea0032p323 | Clinical case reports - Thyroid / Others | ECE2013

Androgen abuse complicated by polycythemia in a man with acquired immunodeficiency syndrome (AIDS)

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

Introduction: Male hypogonadism secondary to AIDS is common and may present with non specific symptoms. Patients may self-diagnose hypogonadism and seek unauthorised androgen therapy. We report a male patient who developed polycythemia after receiving unauthorised sources of androgen therapy.Case report: A 42 years old man with AIDS diagnosed 10 years ago has repeatedly refused antiretroviral therapy. His most recent CD4 count was 314 cells/μl. His ...

ea0032p325 | Clinical case reports - Thyroid / Others | ECE2013

A rare presentation of DRESS-associated thyrotoxicosis and myocarditis: case report

Lee Wei Feng , Seow Cherng Jye , Jong Michelle

Introduction: Drug rash with eosinophilia and systemic symptoms (DRESS) is a severe drug eruption with systemic involvement. Visceral manifestations consisting of fulminant hepatic failure, myocarditis, interstitial nephritis, pneumonitis and autoimmune hypothyroidism are known sequela. We report a case of DRESS syndrome post Bactrim (sulfamethoxazole and trimethoprim) therapy complicated by both myocarditis and autoimmune thyrotoxicosis.Case report: A p...

ea0032p326 | Clinical case reports - Thyroid / Others | ECE2013

Radiation-induced primary hypothyroidism in patients with head and neck cancer

Trifanescu Raluca , Ion Oana , Carsote Mara , Poiana Catalina

Background: Hypothyroidism is a frequent side effect of external radiotherapy of the cervical region for head and neck cancer. Up to 33% of irradiated patients developed primary hypothyroidism within 2 years after radiation therapy. The risk of hypothyroidism increases with radiation dose.Patients and methods: Four patients (2M/2F), aged 53.3±13.9 years, resident both in iodine sufficient (n=2) and iodine deficient areas (n=2), wer...

ea0032p327 | Clinical case reports - Thyroid / Others | ECE2013

A case of type 1 diabetes represented by diabetic ketoacidosis after isotretinoin therapy: is it a result or coincidence?

Polat Sefika Burcak , Sacikara Muhammed , Evranos Berna , Kaya Cafer , Ersoy Reyhan , Cakir Bekir

Well-known environmental factors which can lead to type 1 diabetes are viral infections, vaccines, diet, exposure to cow milk in infancy, vitamin D deficiency, drugs, maternal age, preeclampsia and low birth weight. Isotretinoin is an effective drug for acne treatment. It can cause dyslipidemia, elevated liver enzymes, insulin resistance and type 2 diabetes. Our case is type 1 diabetes developed after the use of isotretinoin and represented with diabetic ketoacidosis.<p cl...

ea0032p328 | Clinical case reports - Thyroid / Others | ECE2013

Lithium-associated hyperparathyroidism: a case report

Altuntas Yuksel , Ozturk Feyza Yener , Yildiz M. Serdar

Introduction: Lithium carbonate therapy has continued to be a mainstay treatment for bipolar disease and schizoaffective disorders. Hypercalcemia and hyperparathyroidism (HPT) is an underappreciated, but relatively common occurence, with a prevalence ranging from 6.3 to 50% in patients requiring long-term lithium therapy. It is stil unclear whether lithium initiates HPT or promotes an underlying subclinical state. Lithium antagonizes the calcium-sensing receptor (CASR) resulti...

ea0032p329 | Clinical case reports - Thyroid / Others | ECE2013

Thyrotoxic periodic paralysis in young Caucasian

Simovic Nikola , Gluvic Zoran , Rasic-Milutinovic Zorica , Tica Jelena , Popovic-Radinovic Vesna , Vujovic Marina , Lackovic Milena

Thyrotoxic periodic paralysis (TPP) is uncommon complication of Graves’ disease mainly observed in young males of Asian origin. It is rarely seen among white hyperthyroid patients (0.1–0.2%), usually presented as lower extremities muscle weakness of sudden onset, probably cause by hypokalemia. Possible mechanism of hypokalemia is an increased sodium–potassium–adenosine triphosphatase pump activity with consequent massive shift og potassium from extracellula...

ea0032p330 | Clinical case reports - Thyroid / Others | ECE2013

Persimonious indications for thyroidectomy in chronic thyroiditis

Diaconescu Mihai Radu , Glod Mihai , Costea Ioan , Grigorovici Mirela , Diaconescu Smaranda

Background: Chronic inflammatory processes of the thyroid represents an important proportion of the gland’s pathology but the majority of them must be treated by nonsurgical methods, thyroidectomy remaining circumstantially indicated.Patients and methods: In 14 cases (3%) from 464 operations for different thyroid lesions lesions we have encountered authentic inflammatory processes in nine cases of Hashimoto’s thyroiditis (two associated with pa...

ea0032p331 | Clinical case reports - Thyroid / Others | ECE2013

The coexistence of vaginismus with arthritis after pharmacological treatment of hyperthyroidism: is it only a coincidence?

Marczewski Krzysztof , Maciejewski Marek

Introduction: Both thyroid dysfunction and sexual dysfunction in young women are relatively common. Even is described the correlations between various types of sexual dysfunction in women, and the severity of hyperthyroidism. However, it is known to us a description of the coexistence of vaginismus with arthritis, a relatively rare complication of antithyroid treatment.Case report: 25-year-old woman was admitted to hospital with symptoms of polyarthritis...