Multiple papillary thyroid carcinomas and hepatic cysts in a patient with a microprolactinoma

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: MON 167-198-Hypothalamus-Pituitary Development & Biology
Monday, June 17, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board MON-177
Clįudia Nogueira*1, Ana Isabel Oliveira1, Elsa Fonseca2, Joćo Pedro Couto1, Irene Bernardes1, Eduardo Vinha1 and Davide Carvalho1
1Centro Hospitalar Sćo Joćo, Porto, Portugal, 2University of Porto
Introduction: Prolactinomas are the most common hormone-secreting pituitary adenomas. Differentiated thyroid cancer (DTC) accounts for the vast majority of thyroid cancers. Of these, papillary cancer (PTC) comprises about 85% of cases, 10% have follicular histology, and 3% are Hürthle cell or oxyphilic tumors. Apparently prolactinomas and DTC are not related.

Clinical case: A 40-year-old man was referred to our department for erectile dysfunction. His past medical history was irrelevant and he was taking no medications. Physical examination showed normal sexual development. Hormonal study revealed hyperprolactinemia (238 ng/mL) and low testosterone levels (0.0 ng/mL). The other pituitary hormones were normal. MRI showed a right-sided microadenoma. Microprolactinoma was diagnosed and he was initiated on bromocriptine therapy, with normalization of prolactin levels and resolution of symptoms. In 2003 a thyroid nodule, with 3 cm length, was detected on the left lobe. Cytology was nondiagnostic, so he was submitted to total thyroidectomy. Histology showed a Hürthle cell variant of PTC (1.3 cm), a follicular variant of PTC (2.5 cm), a classical PTC (1.2 cm) and lesions of lymphocytic thyroiditis. Vascular invasion was not detected. He was submitted to radioiodine remnant ablation and suppressive therapy with levothyroxine was initiated. Last pituitary MRI in 2008 showed a right-sided microadenoma (6.6 mm). On November 2012, for complaints of abdominal pain, an abdominal ultrasound was performed and revealed multiple hepatic cystic formations, the highest measuring 14.8 cm, which are still in study. He was oriented to Gastroenterology department to clarify the nature of the cysts. On the last analytical study, under treatment with bromocriptine and suppressive treatment with levothyroxine, he had normal prolactin levels, thyroglobulin <0.2 ng/mL, negative antithyroglobulin antibodies and normal liver function. Neck ultrasound showed no signs of thyroid cancer relapse.

Discussion: This is an unusual case of a patient with a microprolactinoma, PTC and liver cysts. Although it seems that prolactinoma and PTC are unrelated, it is now recognized that prolactin is a cytokine which has an anti-apoptotic effect, enhances proliferative response to antigens and mitogens and enhances the production of immunoglobulins and autoantibodies. Prolactin receptors have also been identified on thyroid tissue. Whether there is an association between prolactin and its receptor in thyroid malignancy it’s not yet determined.

Shelly S, Boaz M, Orbach H, Autoimmunity Reviews 11 (2012) A465 A470. Costa P et al, Endocrine Pathology, vol. 17, no. 4, 377–386, Winter 2006. American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2009 Nov;19(11):1167-214. doi: 10.1089/thy.2009.0110.

Nothing to Disclose: CN, AIO, EF, JPC, IB, EV, DC

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