Endocrine Abstracts

We describe the clinical case of two childbearing age women with thyroid dysfunction, hypocalcemia, hyperphosphatemia, and high levels of PTH.Case 1: A 34-year-old woman with infertility for 3 years, microprolactinoma treated with low-dose dopamine agonists, autoimmune primary hypothyroidism and obesity. She had irregular menstrual cycles and fatigue. Weight 130 kg, height 155 cm, cervical acanthosis nigricans and round face. Calcium 6.6 mg/dl, phosphoro...

Introduction: Psoriasis is not only a skin disease, is a chronic inflammatory disease associated with serious comorbidities: psoriatic arthritis, metabolic syndrome (obesity, dyslipidemia and insulin resistance), Crohn’s disease, depression, ocular problems, cardio-vascular diseases (myocardial infarction), cancer.Methods: 1236 patients (male 54.13% and female 45.87%) with psoriasis were seen in an Outpatient Clinic over a period of 8 years (2004&#1...

Introduction: Resistance to thyroid hormone (RTH) is an inherited syndrome characterized by reduced responsiveness of target tissues to thyroid hormone (TH). It is characterized by high serum concentrations of free T4 (Ft4) and usually free T3 (Ft3) accompanied by normal or slightly high serum TSH concentrations. When RTH is suspected, the diagnosis should be confirmed by direct sequencing of the TR-β gene to identify mutations....

Introduction: Primary hyperparathyroidism (PHPT) commonly goes unrecognized due to the physiological changes of pregnancy.PHPT is associated with significant maternal and fetal morbidity and mortality. Current evidence supports parathyroidectomy is the main treatment, performed preferably during the second trimester, when the serum calcium is above 11–mg/dl. We report the clinical course of a woman with newly diagnosed gestational PHPT who refused minimally invasive parat...

We present a case report of a young female patient with hypercalcemia-induced acute necrotizing pancreatitis as first manifestation of a benign parathyroid adenoma.Case: A 46-year-old female presented at the emergency room with a sudden attack of severe epigastric pain and vomiting. Clinical examination revealed a severely ill patient, a silent abdomen which was distended with painful percussion and palpation of the epigastrium. Blood analysis showed sig...

Background: It is disputable whether to repeat FNAB after the first one was nondiagnostic, or to submit the patient to operation.Methods: Indication for FNAB was a thyroid nodule of ≥1 cm or of a less size with clinical or ultrasound features of malignancy. In case of multinodular goiter each nodule was punctured and examined separately.3929 cases (8%) were noninformative out of 49 419 FNAB of thyroid nodules performed in Nor...

Background: Fine needle aspiration biopsy is generally acknowledged as a «gold standard» for diagnostics of thyroid malignancies. However, data on FNAB vary considerably in publications from different centers. In this study we have analyzed the results of more than 40 000 FNAB of thyroid nodules performed in North-West Regional Endocrine Center during 2010–2012 years.Subjects and methods: Indication for FNAB was a thyroid nodule of ≥...

Background: Unintented parathyroidectomy during thyroid surgery – is one of typical complications, especially when an operation is augmented by lymphodissection. In this work, we present the results of calcium metabolism analysis in such patients.Subjects and methods: 3929 operations of patients with different thyroid diseases were performed during 2010–2012 years. 82 inadvertently excised parathyroid glands were revealed at histological examin...

Scleredema diabeticorum is an infrequently seen connective tissue disorder that effects upper part of the body. The affected skin is thick, hard and painless. A 51-year-old male Type 2 diabetic patient was referred to our department for infected foot ulcer. On physical examination erythematous, hard, painless, wide-reaching skin lesion on his upper back and shoulders except from draining diabetic foot ulcer on his right foot first and second fingers. Multipl subcutanously insu...

A 21-year-old female (height: 148 cm, weight: 38 kg, and BMI: 17) was referred to our endocrinology outpatient polyclinic with the complaints of severe abdominal pain and severe hypertriglyceridemia. The patient’s medical history revealed diabetes and FMF. Physical examination revealed a marked loss of subcutaneous fat from the extremities leading to prominence of muscular contours and veins, with excess fat around the face, submental and dorsocervical region. Despite the...

Aspergillosis is a major problem in immunosupressed patients. We report a 65-year-old male patient with chronic renal failure (CRF) due to diabetic nephropathy who had arthralgy, malaise and high C-reactive protein level. Chest computed tomography revealed that thyroid nodule in the left thyroid lobe. Fine-needle aspiration biopsy of the thyroid revelead thyroidal invasion of Aspergillus. High-resolution computed tomograghy (HRCT) of the chest showed no evidence of intrapulmon...

Introduction: Hyponatraemia is one of the most common electrolyte abnormalities that may be drug-induced either as a result of inappropriate antidiuretic hormone secretion (SIADH) or excessive sodium loss. SIADH is diagnosed on the basis of low plasma osmolarity associated with inappropriately concentrated urine.Case report: A 67-year-old woman was admitted to hospital because of progressive confusion and perseveration. Her medical history included bipol...

Introduction: Heparin is extensively used amongst different medical and surgical specialities for prophylaxis and treatment of venous thromboembolism and suspected coronary syndromes. Hyperkalaemia is known to occur as an effect of heparin treatment through its action on the renin-angiotensin system, especially when used at treatment doses. Hyperkalaemia is a serious electrolyte disturbance, which may precipitate potentially fatal cardiac arrhythmias. We describe a case of a p...

Introduction: Warthin-like papillary thyroid carcinoma (WLPTC) is a rare variant of thyroid papillary carsinoma (TPC). We present these cases to point out this rare variant.Case reports: Case 1: A 38-year-old woman admitted to outpatient clinic with a thyroid nodule. Ultrasonography of thyroid gland revealed bilateral multinodular goiter with microcalcifications. Thyroid autoantibodies were elevated. Thyroid function tests (TFT) were normal. Fine-needle ...

Introduction: Despite having different embriogenic origins, thyroid medullary carcinoma and follicular carcinoma may be seen together as mixed medullary-follicular thyroid carcinoma. We present a rare case of mixed medullary-follicular cell carcinoma of thyroid which has a progressive and aggressive nature.Case report: A 68-year-old female patient admitted with complaint of a lump in her neck. Ultrasonography of thyroid gland revealed a 37×35 mm sol...

Introduction: Brown tumors are rare, destructive, osteolytic bone lesions, occurring in advanced stages of hyperparathyroidism, due to increased osteoclastic activity.Case report: A 25-year-old woman presented with recent, intractable pain on the right shoulder and with hypercalcemia (Ca, 3.93 mmol/l) related to severe primary hyperparathyroidism (PTH, 494 pg/ml). Multiple osteolytic lesions, detected on the upper extremity of the right humerus, distal r...

Gender dysphoria (GD) leading to hormonal treatment and sex reassignment surgery that spans two generations has not been reported so far.The mother was diagnosed with GD at the age of 47. As an only child she suffered from emotional, physical, and sexual abuse by her parents. From the age of 3, she fantasized being a boy and started behaving like one. During later youth the genderdysphoric feelings were repressed. She married at the age of 18. One year l...

Primary hyperparathyroidism (PHPT) is rarely caused by parathyroid adenoma with cystic degeneration, especially by the cyst localized in mediastinum. Both differential diagnosis of mediastinal cyst and management of the patient can be challenging.Case presentation: A 57 years old woman was transferred from district hospital where her urosepsis and nephrolithiasis had been treated successfully. A liquid collection in left hemithorax had also been found du...

Background: Differentiated thyroid cancer is the most frequent thyroid tumor. Combinations of follicular carcinoma and papillary carcinoma are seen. Functional pituitary adenoma coexisting with differentiated thyroid carcinoma was reported previously in literature. We report a 47-year-old women with three different synchronous endocrine tumors; papillary thyroid cancer, follicular thyroid cancer, and prolactinoma.Case: A 47-years-old female patient was a...

Case report: A 52-year-old woman had an appointment at the dermatology department for a previous diagnosis of melasma. She was seen in October and her pigmentation had appeared somewhere during summer. She did not recall any drug intake, she denied sun exposure in the recent past, and she was a social employee working indoor.At the clinical examination intense hyperpigmentation around the eyes was noted. In contrast with the rest of the skin of normal as...

Introduction: The cases of paragangliomas (PGLs) mimicking thyroid nodules were also reported in literature rarely. We will present a case of PGL (a carotid body tumor) that we initially evaluated as a thyroid nodule, and then diagnosed as a PGL.Case report: A 74-year-old woman was admitted due to a mass in the right side of neck growing rapidly within the last 1 month. Physical examination revealed a hard and painless mass with smooth surface, extending...

Introduction: Riedel’s thyroiditis, also known as invasive fibrous thyroiditis, is a rare disorder of unknown etiology in which characterized by invasive fibrosis that partially destroys the thyroid gland and extends into adjacent neck structures. The diagnosis of Riedel’s thyroiditis is clinically difficult because this form of thyroiditis can mimic lymphoma or Hashimoto’s thyroiditis during preoperative radiologic, and pathologic examination. Sonographic featu...

Introduction: About 1% of primary hyperparathyroidism is due to parathyroid carcinoma. The affected gland is often indistinguishable from atypical adenoma. The proper diagnosis is usually made when the disease recurs or metastases are present and then is connected with poor prognosis.Case report: A 49-year-old man, after resection of parathyroid adenoma (postoperatively with normalization PTH concentrations and hungry bone syndrome), with limbs’ fra...

Background and aim: HDR syndrome, is a rare disease characterized with hypoparathyroidism, sensorineural deafness, and renal disease. Patients usually present with hypocalcaemia, tetany, or afebrile convulsions. Hearing loss is usually bilateral. Renal disease includes renal dysplasia, hypoplasia or aplasia. We report a Turkish family of HDR syndrome.Cases: A 56-year-old hypocalcemic deaf male patient and his daughter (25 years) and son (21 years) with h...

Introduction: Anaplastic thyroid carcinomas (ATCs) are sometimes accompanied by well-differentiated carcinomas (WDCs), and ATCs have been speculated to be dedifferentiated from the preexisting or coexisting WDCs. We will present two cases determined with both ATC and papillary thyroid carcinoma (PTC.)Case 1: A 82-year-old woman was investigated due to a painful neck mass. Thyroid function tests were normal. Thyroid ultrasonography revealed isohypoechoic ...

Introduction: Tadalafil 5 mg once daily (T5od) has been recently approved by the Food and Drug Administration for the treatment of lower urinary tract symptoms (LUTS), along with erectile dysfunction (ED). Recent pooled data analyses demonstrated that T5od–International Prostate Symptom Score related improvements were significant regardless of confounders. In addition, PDE5 inhibitors exert a positive effect on ejaculatory latency. We assessed the clinical outcome of 30 d...

Introduction: Hypoglycemia is the most frequent metabolic complication observed in patients with type 2 diabetes mellitus (T2DM). Moreover, rare insulinomas are the most common cause of endogenous hyperinsulinemic hypoglycemia in adults. The coincidence of insulinoma in a patient with pre-existing T2DM is an extremely rare condition and there are few case reports in the medical literature.Case report: A 76-year-old woman diagnosed with T2DM 6 years ago, ...

Introduction: Parathyroid adenoma is the most common cause of primary hyperparathyroidism (PHPT) resulting in hypercalcemia and hypercalciuria due to autonomous secretion of PTH. Ectopic parathyroid adenoma, as a consequence of variability in the glandular tissue migration during the embryologic life or a supernumary fifth parathyroid gland, has an incidence of 25% among patients with PHPT. The incidence of deeply mediastinal ectopic parathyroid adenoma is 1–3%.<p cla...

Ever since the approval of recombinant human TSH (rhTSH) prior to remnant ablation and whole body scans, usage of levothyroxine withdrawal for TSH elevation is decreasing. However the readily unavailability of rhTSH in some countries and the cost are its disadvantages. Withdrawal of levothyroxine, however, exposes the subjects to hypothyroidism.A 26-year-old male patient admitted to our hospital for a routine checkup with no symptoms. His TSH level was 7...

Klinefelter’s syndrome (KS) is the most frequent form of sex chromosome aneuploidy. The classic form of KS is associated with a 47,XXY karyotype. Mosaic forms of KS are thought to occur in approximately 10% mainly in the form of 46,XX/47,XXY. Other forms of mosaicism are rare among which the 46,XX/47,XXY form is very rare and can manifest as an ambiguous genitalia at birth as reported in our case.A full term child presented at birth an hypospadias w...

Introduction: Ectopic parathyroid adenomas are detected 16% of patients operated for primary hyperparathyroidism and 22% of them may be located in the anterosuperior mediastinal region. Herein we present a rare case of primary hyperparathyroidism with severe long-term elevated parathormone (PTH) levels due to ectopic parathyroid adenoma in mediastinal region that was successfully treated by using video-assisted thoracic surgery (VATS).Case report: A 38-y...

Insulinoma is the most common cause of hypoglycemia related to endogenous hyperinsulinism in adults. It is very rare in pregnancy, fewer than 30 cases of insulinoma presenting in pregnancy have been reported so far and it’s managment is very challenging. We raported here the case of a pregnant women aged 35 years presenting an insulinoma.The diagnosis was made 1 year ago in the presence of hypoglycemia, high levels of inulin and C-peptide and a 10 m...

We are presenting a female, aged 34, who underwent two pregnancy miscarriages, in the 7th and 8th weeks. The first studies of thyroid hormones were made during the second pregnancy, and pointed to hyperthyroidism.After the loss of her second pregnancy, she was diagnosed for thyroid disease and miscarriages. TSH, FT3, FT4, antibodies TPO, TG, and TRAB were normal. Ultrasound examination showed symmetrical thyroid, not enlarged, with ...

Introduction: Brown tumor–well circumscribed lytic lesion is one of the complication of advanced stage of primary and secondary hyperparathyroidism. It may be also a first clinical sign of primary hyperparathyroidism. Nowadays this is rare manifestation in developed countries due to increased use of routine screening laboratory examinations. Brown tumors may also mimic true neoplasm and lead to misdiagnosis if close attention is not paid. We present three case reports and...

Introduction: Oncocytic (Hurthle cell) carcinoma is consisted of <5% of thyroid cancer but most metastasizing cancer type among differentiated thyroid cancer. We presented an oncocytic carcinoma with sternum metastasis.Case: A 68-year-old women admitted to endocrinology policlinic with complaint of a mass in her neck. She was diagnosed hyperthyroidism and she was using thionamid for 6 months. Her medical history revealed hypertension for 3 years and ...

Introduction: Individuals with Turner syndrome (TS) are prone to develop autoimmune conditions. The most frequently found are Hashimoto’s thyroiditis, type 1 diabetes, coeliac disease, and inflammatory bowel disease. In patients with TS, Addison’s disease isolated or combined with other autoimmune disease as type 2 polyglandular autoimmune syndrome, is a rare finding.Case report: We report a case of a 41-year-old female patient, with severe ast...

Introduction: Squamous cell carcinoma (SCC) is a very rare thyroid carcinoma with aggressive behavior and poor prognosis. Diagnostic difficulties reside in differentiating SCC from other thyroid malignancies and also in establishing its primary or secondary nature, which are both important for treatment strategy.Case report: A 62-year-old woman, with unremarkable personal and family history, presented in October 2013 with progressive enlargement of a rig...

Introduction: Alopecia areata affects 0.1–0.2% of population. It’s pathogenesis has not yet been discovered, but genetic, autoimmune, vascular, psychogenic or neurological factors are being considered. It can occur in any age, but appears most commonly in late childhood, teenage or early adulthood. Alopecia areata commonly coexists with other diseases such as asthma, allergic rhinitis, atopic dermatitis, thyroid diseases and autoimmune diseases such as thyroiditis an...

Multiple endocrine neoplasia type 1 (MEN1) syndrome is an autosomal dominant familial tumor syndrome characterised by varying combinations of endocrine and non-endocrine tumors. Breast cancer is the most frequently diagnosed cancer in women, but presence of breast cancer in MEN1 is extremely rare.A 36-year-old patient has been diagnosed with primary hyperparathyroidism, breast cancer and hyperprolactinemia due to a pituitary macroprolactinoma. Treatment ...

Introduction: We describe the case of 35-year-old man in whom laboratory abnormalities in thyroid function were observed by chance.Case report: For the first time, the patient was examined in the local Department of Internal Medicine because of pre-arthroscopy examination in March 2002. Low level of total thyroid hormones (T3 0.76 nmol/l and T4 48.0 nmol/l) was observed by chance, while TSH value was normal (2.37 mIU/l). The patient...

Aim: Thyroid tissue originates from foramen cecum located in the base of the tongue and with embryonal development it descends through thyroglossal duct to its normal location. A total or partial failure in thyroid tissue descending causes ectopic thyroid tissue. One of this ectopic region is lingual region. We presented two case of ectopic thyroid tissue.Case 1: A 18-year-old female that uses levothyroxine 100 mcg/day for hypothyroidism admitted to endo...

Background: Familial partial lipodystrophy type 2 (Dunnigan syndrome and FPLD2) is a rare genetic disorder, associated with different metabolic abnormalities, especially insulin resistant diabetes mellitus, dyslipidaemia, hepatic steatosis, and cirrhosis, cardiovascular disease, and cardiomyopathy, kidney disease.Clinical case: A 20-year-old patient first presented with changed appearance due to abnormal subcutaneous fat tissue redistribution (lipodystro...

We report the case of 57-year-old man with end-stage renal disease, primary hyperparathyroidism and after an surgery of upper parathyroid glands with ectopic parathyroid localized in lung. Patient was directed to our hospital to perform diagnostics on hyperparathyroidism. Two years earlier (2011) patient was hospitalized because of weakness and weight loss, and was diagnosed with primary hyperparathyroidism. In 2012 he underwent the bilateral parathyroidectomy of upper glands ...

The prevalence of GD (Graves–Basedow disease) in adolescents with T1DM (type 1 diabetes mellitus) is around 0.5%. Most often the diagnosis of GD in T1DM patients is made many years after the onset of T1DM. The present clinical case describes an adolescent with GD and T1DM and highlights how difficult the management of this disease can be. 17-year-old male was referred to our Department for reevaluation of Graves–Basedow disease. Patient suffered from T1DM for 14 year...

When follicular thyroid carcinoma (FTC) is diagnosed, 25% of the patients extrathyroidal invasion, 5–10% lymphatic metastasis and 10–20% distant metastasis are determined. The most common site of distant metastases of FTC is the lung, followed by the bone. The incidence of skull metastasis of FTC is about 2.5–5.8%. Skull metastasis of FTC was located in the skull base and occipital area.Case: A 60-year-old man admitted at 2006. He was oper...

Background: Hyponatraemia is the most common electrolyte disorder seen in clinical practice. Even mild hyponatraemia can lead to gait disturbances and cognitive dysfunction in the elderly.Case history: A 83-year-old lady presented to acute admission unit with worsening of confusion. Her background medical history includes chronic obstructive pulmonary disease for which she is on inhalers. She was also having hyponatraemia for the last 3 years manifesting...

Frequently seen in connection with thyroid disease, exophtalmic syndrome has a much large spectrum of differential diagnosis including numerous local and general aetiologies. Conditions such as mucoceles of paranasal sinuses don’t have always nasal or sinus symptoms but may present with ophthalmological manifestations.A 50-year-old woman presented for a 2-months history of right eye proptosis with upper eyelid swelling, periorbital pain, occasionall...

Introduction: Testicular morphology and immunohistochemistry have never been reported in genetically documented adult patients with 5α-reductase type 2 deficiency (5α-R2 deficiency).Case report: We describe the testicular histopathology of a 17-year-old XY female with primary amenorrhea, failure of pubertal breast development, virilization, clitoromegaly, and bilateral cryptorchidism (testes located in the inguinal canals). The diagnosis of 5&#...

Vasopressin receptor 2 antagonist (V2RA) provide treatment option for patients with hyponatraeamia in the context of syndrome of inappropriate antidiuretic hormone secretion (SIADH).We report the results of seven patients (six males, one female, average age 65.7) with hyponatraemia secondary to SIADH treated with V2RA (Tolvaptan) in years 2011–2013. Six patients had underlying diagnosis of lung cancer, one patient was diagnosed with sarcoidosis. Fou...

Introduction: MTC originates from the parafollicular calcitonin secreting cells. One quarter of MTC patients have familial form of the disease with RET mutation.Case reports: First female patient underwent total thyroidectomy for MTC at the age 40. Further investigation showed elevated urinary catecholamine levels and MIBG scintiscan verified bilateral pheochromocytoma. Bilateral adrenalectomy was performed. On follow-up basal and stimulated calcitonin l...

Introduction: Cutaneous metastization of differentiated thyroid carcinomas is a rare event.Clinical case: MMS, a 69-year-old male was submitted to left hemithyroidectomy+isthmectomy on May 2006 after FNA of a left node revealed follicular tumor. Histology showed Hurthle cell adenoma. The patient maintained irregular follow-up by endocrinologist. In October 2011 he referred the appearance of small bilateral cervical skin nodules. Physical exam showed thre...

Introduction: Neonatal diabetes mellitus (NDM) is a rare disease diagnosed within the first months of life that is usually permanent in 50% of cases. Heterozygous mutations of KCNJ11 and ABCC8 genes encoding the two Kir6.2 and SUR1 subunits of the b-cell ATP-dependent potassium channel have been associated with NDM, which is characterized by a successful response to sulfonylureas.Case report: We present a 32-year-old woman diagnosed wit...

The co-secretion of GHRH and GH has been described previously in a patient with GHRH producing pituitary somatotroph adenoma. Here we present a patient with MEN1 and ectopic secretion of both GHRH and GH from a neuroendocrine lung tumor.A 52-year-old woman was diagnosed in 2009 with two lung tumors, 4 cm right upper lobe tumor, and 2 cm left lower lobe tumor. Owing to a mild coarsening of facial features, acromegaly was suspected. Endocrine studies showe...

Introduction: Graves’ ophthalmopathy (GO) is common in the course of Graves’ disease, but optic neuropathy is present in only ~5% of patients with GO. We present a case of recalcitrant Graves’ orbitopathy with late development of neuropathy, satisfactorily treated with rituximab.Case report: A 50-year-old female smoker was referred to our department for further management of Graves’ disease with associated GO. She complained of worsen...

Background: Incretin-based therapy is increasingly used in the management of type 2 diabetes mellitus. Although dipeptidyl peptidase-4 inhibitors (gliptins) are well tolerated, side effects can be observed in various body systems. Here we report three cases of drug-induced skin eruption with strong itching of the gliptins plus metformin combination therapy.Case reports: A 59-year-old woman and a 57-year-old man, who had been using vildagliptin plus metfo...

Introduction: The severe course of hyperandrogenism during the menopausal transition requires the exclusion of androgen-secreting tumors.Case report: A 60-year-old postmenopausal woman was referred to the Department of Endocrinology with a 3-year history of progressive development of hyperandrogenism with virilization (severe hirsutism, frontal balding, deepening of voice, increased muscle mass, and secondary polycythemia).Hormonal...

Introduction: Drug-induced lupus erythematosus (DILE) is a variant of systemic lupus erythematosus that resolves within days to months after withdrawal of the drug, in a patient with no previous history of SLE.Case report: A 60-year-old female presented at Mother Teresa Hospital with toxic multinodular goiter. She received treatment with propylthiouracil and atenolol for a month, and she developed symptoms like malaise, muscle pain, shortness of breath, ...

Introduction: Cardiovascular changes are rare but life-threatening consequences of primary hyperparathyroidism.Case report: A 53-year-old man, with past and family history of peptic ulcer, presenting with coronary heart disease and ischemic and dilated cardiomyopathy, treated with cardiac resynchronization. He was admitted to the emergency room due to sustained monomorphic ventricular tachycardia (MVT). Laboratory tests revealed primary hyperparathyroidi...

A 67-year-old male with PTC (pT3N0) underwent a total thyroidectomy in February 2004. Subsequently he was treated with I-131 and radiotherapy (RT). Combined therapy did not normalize the serum thyroglobulin (TG). Because of elevated TG and persistent I-131 uptake in thyroid bed the patient received a total activity of 21275 MBq of I-131 in 4 years. The treatment was stopped in March 2007 due to a lack of I-131 uptake in the last post-therapeutic whole body scan (WBS) with stil...

Case: A 46-years-old anaesthetist presented with 2 weeks history of general malaise, sore throat, and fever. Symptoms started while on holiday. A diagnosis of subacute thyroiditis was made overseas based on presentation and suppressed TSH level. He was started on betamethasone 4mg and ibuprofen for 2 weeks with rapid symptomatic improvement. He felt well enough to travel back to UK. He then presented to our hospital with recurrent symptoms as above.Inves...

Introduction: Hashimoto’s thyroiditis (HT) and Graves’ disease (GD) are two auto-immune diseases. They have different phenotypes and are generally believed to share a number of common etiological factors but the mechanisms leading to their dichotomy are unknown. An unusual outcome of HT is the conversion to GD.A mechanism that might be hypothesized to account for the change from HT to GD is the alteration in the biological activity of TSH recep...

Introduction: Obesity prevalence is growing every year. In most cases, origin is exogenous, a mixture of sedentary and overeating. However, some patients are trend to develop obesity caused by their genetics and other illness.Case report: A 62-year-old women with diabetes type 2, anxiety and osteoporosis was remitted to our center for obesity. She had been obese since childhood, with very low level of activity and snacking trend. On physical examination ...

A 20-year-old female patient with Graves’ disease was commenced on PTU 50 mg OD in June 2009 because of intolerance to carbimazole. She presented with jaundice within 5 months and was subsequently admitted when she started vomiting 2 months later.She had tenderness in the right upper quadrant. LFT on admission are alkaline phosphatase 268 μ/l (35–104), gamma glutamyl transferase 148 μ/l (5–36), aspartame transferase 194 μ/l ...

Tall cell papillary thyroid carcinoma is known to be associated with an adverse outcome, namely with the early development of locally recurrent or metastatic disease. Therefore the administration of therapeutic radioactive iodine is considered absolutely necessary in the management of such patients. A meningioma may occur in a patient with another neoplastic disease, having also been described in patients with thyroid carcinoma.The aim was to describe th...

Introduction: Factitious hypoglycemia results from surreptitious administration of insulin or insulin secretagogues. It can involve non-diabetic individuals with knowledge of hypoglycemiant drugs, or diabetics manipulating the doses.Clinical case: A 42-year-old women, type 1 diabetic since the age of 14, on intensive insulin therapy (A1C: 8.5%), was hospitalized for study of recurrent severe hypoglycemia in the last 2 months, despite successive insulin d...

Introduction: Congenital hypothyroidism (CH) is the most common congenital endocrine disorder. It occurs in Europe with an incidence of 1:3000–1:4000.Thyroid dysgenesis – agenesis, hypoplasia or ectopy – is responsible for 80–90% of CH cases. An ectopic thyroid gland is an uncommon inborn anomaly and is typically located along the thyroglossal duct. To date only few cases of CH due to lingual thyroid diagnosed in adulthood were reported in the literature.</...

Introduction: Insulin autoimmune syndrome or Hirata disease is a rare cause of hypoglycemia without prior insulin exposure. Approximately 400 cases were reported, mostly in Japan. It’s associated with other autoimmune diseases or exposure to sulfhydryl-containing drugs.Case report: A 56-year-old Caucasian woman presented with a 20-month history of hypoglycemia ameliorated by sugar intake. She had a past history of autoimmune thyroiditis, asthma and ...

Introduction: Gynecomastia is a frequent reason for endocrinology consultation and its correct investigation is pivotal towards a precise diagnosis. We present a clinical case of a rare cause of gynecomastia.Case report: A 56-year-old male was referred to the hospital setting for an endocrinology consultation. He noticed increased breast size for a year, initially tender to palpation, and unquantified weight loss. Neither galactorrhea, nor any nipple dis...

Introduction: Thionamides are important drugs in the treatment of hyperthyroidism. Despite that, they can be associated with rare but serious complications, which require drug discontinuation.Case report: Sixty-five-year-old woman with Graves’ disease, treated in 2002 with methimazole and in remission until 2012. Recurrence of Graves’ disease was diagnosed in March 2012 and she was started on propylthiouracil (PTU) 150 mg per day. She presented...

Papillary thyroid carcinoma is a disease associated with a very good prognosis. However, there are some subtypes of papillary thyroid cancer which are associated with aggressive biological behavior and worse outcome. The appearance of brain metastatic disease in the course of papillary thyroid carcinoma is rare and carries an unfavorable prognosis.The aim was to describe the case of a patient with tall cell papillary thyroid carcinoma who presented with ...

Differentiated thyroid carcinoma is the most common endocrine malignant tumor. Papillary carcinoma frequency in our country is 80% of thyroid neoplasia. Papillary thyroid carcinoma usually metastasizes to cervical lymph. Metastases to distant organs are rare and most often affect the lungs, liver and bones. Despite of its anatomical proximity, metastasis parotid have not been described in the existing papillary carcinomas literature. We report a case of parotid gland metastasi...

Introduction: Two tumors originating from different cells in the thyroid to metastasis same lymph nodes is very rare. We aimed to present that the same lymph node metastasis of medullary and papillary thyroid in a case.Case: A 4-year-old male presented with backache without a formerly known disease, has no other property in the patient’s history. Vertebra BT was taken and T2, T4, T6 vertebral metastasis have been det...