Endocrine Abstracts

JOINT991

Introduction: Papillary thyroid carcinoma, prolactinoma and nonfunctioning adrenal adenoma are relatively common endocrine tumors. However, their occurrence alongside cervical adenocarcinoma in a single patient is extremely rare. When such a combination is present, it is crucial to evaluate the nature of the multiple tumors—whether they are primary, metastatic or syndromic.

Case Report: A 45-year-old woman visited the clinic in 2023 with galactorrhea. Several years prior, she had been diagnosed with hyperprolactinemia at a local hospital and had been periodically treated with cabergoline. Her past medical history also revealed a nontoxic multinodular goiter. In 2022, she underwent a hysterectomy with bilateral salpingo-oophorectomy due to cervical adenocarcinoma, followed by radiation therapy. Subsequent studies, including a computed tomography (CT) scan (recommended by an oncologist), revealed a right adrenal incidentaloma—a 25 mm homogeneous, lipid-rich adrenal mass with unenhanced HU of -10. Adrenal hormonal tests were normal. Additional laboratory tests revealed normal levels of TSH, FT4, creatinine, ALT, AST, calcium, PTH, HbA1c, glucose and C-peptide. Serum prolactin was again elevated. The breast examination showed no abnormalities. A cranial MRI revealed a rounded 7×8×8 mm pituitary mass, with no compression of the optic chiasm. Additional pituitary hormonal tests were normal. All other causes of hyperprolactinemia were ruled out and cabergoline was restarted. A repeated ultrasound examination of the thyroid gland revealed multiple small, non-oval, markedly hypoechoic nodules with microcalcifications in the left lobe and isthmus. Cytological examination of the dominant nodule (9×6×8 mm) revealed papillary carcinoma. Thyroidectomy with lymphadenectomy was performed. Histological examination confirmed multifocal papillary microcarcinomas with microscopic invasion into the perithyroidal soft tissue. A multidisciplinary team recommended radioiodine therapy. Follow-up studies after 1 year showed an excellent response. After 1 year, the pituitary microadenoma remained unchanged. The patient feels better and continues taking levothyroxine and cabergoline.

Discussion: When two or more endocrine tumors are detected, it is essential to exclude multiple endocrine neoplasia (MEN) syndrome. According to current data, our patient does not have primary hyperparathyroidism (the most common and early manifestation in MEN-1 and MEN-4) or any enteropancreatic tumors. The family history is unremarkable. The patient was informed about genetic testing, which was not performed yet.

Conclusion: The combination of three primary endocrine tumors with concomitant non-endocrine cancer in a single patient is a rare occurrence that requires a multidisciplinary approach and regular follow-up.