Endocrine Abstracts

Introduction: Papillary thyroid carcinoma is the most common type of thyroid cancer (70-80% of all thyroid cancer). It is a differentiated type of carcinoma, it affects women between 30-60 years old, 3 times more often than males. Clinical outcome in patients with differentiated thyroid carcinoma is often favorable. Glucocorticoids (GC) play major role in the physiologic stress response. However chronic exposure to glucocorticoids as seen in Cushing’s disease (CD) has detrimental effects on multiple systems: cardiovascular, metabolic, immune, psychological. CD, caused by a pituitary adrenocorticotropic hormone (ACTH)-secreting tumor, is probably underestimated at 1.2-.2.4 per million per year and it affects mostly women). Association of Cushing’s disease and papillary thyroid carcinoma is very rare and it appears that ACTH secretion is insufficient to cause typical cushingoid feature

Case report: 36 year old female, known to be hypertensive 4 years ago on BB, diuretics and ACEI. In 3/2018, she underwent thyroidectomy and was pathologically proved to have follicular variant of low grade papillary carcinoma. Thyroidectomy was followed by radioactive iodine ended at 2019 and she is on regular follow up with department of Radiotherapy and Nuclear Medicine, she is maintained on Thyroxine 300 mcg/day. Over the last 4 months, she noticed weight gain especially in upper chest and abdomen. She also noticed swelling of both hands and feet associated with generalized weakness.

Examination

Bp: 110/70, Pulse: 90/min, w: 95 kg, Height: 1.57 m. BMI: 38 kg/m². Acanthosis Nigerians, Fat accumulation has a central distribution (face, trunk, abdomen more than extremities).

Investigations: Urinary free cortisol (UFC) was (530.6 μg/24 h, N: 20.9- 292.3μg/24 h), Cortisol (am): 19.6 Mg/dl(6.2- 19.4), Low dose dexamethasone suppression test revealed autonomous hypercortisolemia, suggesting cushing disease. MRI of the pituitary revealed a microadenoma of 5 mm on the left side, IPSS on LF side ACTH 517.5 pg. At this point the patient was diagnosed with CD and referred for trans sphenoidal pituitary surgery that removed the tumor. After operation ACTH <10 pg, BMI droped to 32 kg/m², regular cycles she stopped antihypertensive medication

Conclusion: Association between papillary thyroid carcinoma and Cushing’s disease is very rare and so far there is no known genetic mutation to link the two neoplastic conditions, and no clear relationship between neoplastic thyroid and hypercortisolemia has been established in the current endocrine literature