Session: MON 167-198-Hypothalamus-Pituitary Development & Biology
Poster Board MON-191
CASE REPORT: 45-year-old woman, Jehovha’s witness, with medical history notable for autosomal dominant polycystic kidney disease, referred to Endocrinology in 2004 for amenorrhea since 37 years olf, headaches and increased volume of hands and feet. Diagnostic work-up revealed acromegaly secondary to pituitary macroadenoma (Hardy Grade II) and she was submitted to transsphenoidal surgery. Histology confirmed a GH secreting tumour. The patient started treatment with somatostatin analogue for persistence of the disease. In 2006 she started dialysis and because of multinodular goiter carried out a fine needle biopsy of the biggest nodule with result of follicular lesion of undetermined significance. Total thyroidectomy was performed, in association with parathyroidectomy because of secondary hyperparathyroidism due to renal failure. Histology revealed follicular variant of papillary carcinoma 1.2 cm (pT1NxMx) and right parathyroid glands (120mg and 130mg) with clear cell predominance. She was referred for radioactive iodine (RAI) ablation (100mCi) and one week post-therapy RAI whole-body scan was negative. In 2007, type 2 diabetes mellitus was diagnosed and the patient was proposed for kidney transplation and referred to immuno hemotherapy consultation because of history of miscarriages and primary arteriovenous fistula failure. Heterozygous MTHFR gene mutation was discovered. So far, the patient remains clinically stable on follow-up, in peritoneal dialysis and on therapy with levothyroxine and somastostatin analogue.
CONCLUSION: We describe this case because of the permanent diagnostic challenge and multiplicity of endocrine pathologies: acromegaly, thyroid carcinoma, diabetes mellitus, secondary and tertiary hyperparathyroidism.
Nothing to Disclose: JMN, ER, EV, MA, LC, JP, DC
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