ISSN:1051-2144    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:1051-2144    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Cushing disease accounts for 80% to 85% of ACTH-dependent disease, whereas 15% to 20% is caused by ectopic sources. Cyclical Cushing syndrome is an unusual phenomenon and is frequently associated with a pituitary adenoma. Diagnostic and therapeutic problems arise when diagnostic tests are performed in the “quiescent phase” of the disease at a time when cortisol levels are normal, when the tests confirm a cyclic ectopic hypercortisolemic pattern but no tumor can be identified, or when radiologic evaluation reveals a coincidental pituitary abnormality.We present the case of a 29-year-old female with clinical Cushing syndrome caused by periodic hormonogenesis from an ectopic ACTH-secreting tumor, which was proved to be a bronchial carcinoid that responded to long acting somatostatin analogue (SM-a) treatment (Sandostatin LAR). The patient also had a coexisting pituitary microadenoma.Recently, the SM-a octreotide has been shown to be effective in reducing cortisol levels in several communications. Our case confirms previous data concerning the usefulness of this therapeutic regime in reducing cortisol and ACTH levels in patients with ectopic ACTH hormonogenesis. Moreover, to our knowledge this is the first report that shows such a beneficial effect using the new long acting SM-a (Sandostatin LAR).

ISSN:1051-2144    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

This case report describes a woman who had persistent I131 whole body scan uptake after thyroidectomy and two radioactive iodine ablation therapies for papillary cancer despite absence of thyroglobulin. The patient was a 44-year-old female who presented in another institution with a one cm right thyroid nodule. Fine needle aspiration biopsy was interpreted as a follicular neoplasm. A near total thyroidectomy was done revealing three foci of papillary carcinoma, follicular variant (0.8 cm tumor in the isthmus and two additional microscopic foci). The patient received ablation radiotherapy with 28.9 millicuries (mCi) one month after surgery. A follow up whole body scan six months later showed two or three foci of functioning thyroid tissue in the neck. A second ablation therapy with 100.9 mCi was administered. Seven days later, follow-up whole body scan showed large uptake in the mediastinum. Suppressed and stimulated thyroglobulin levels were undetectable. She then presented in our institution. Chest CT showed a possible mediastinal soft tissue density. Repeat chest CT 6 months later showed an increase in the anterior mediastinal soft tissue density. Thoracotomy and thymectomy were performed. Histopathology was consistent with thymic hyperplasia. No thyroid tissue was found and the tissue stained negative for thyroglobulin. Thymic hyperplasia can cause a false positive uptake in the mediastinum. In the absence of thyroglobulin elevation in a patient with well-differentiated thyroid carcinoma, a positive I131 scan may be of nonthyroidal origin.

ISSN:1051-2144    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

This article reports a 33-year-old woman with persistent active acromegaly following transsphenoidal pituitary surgery who was treated with octreotide long-acting release (LAR) for 4 months and then became pregnant. Octreotide LAR was stopped at the diagnosis of pregnancy. Throughout pregnancy, the patient experienced clinical well-being, and regression of skin thickening and enlargement of extremities. Glucose tolerance was normal and serum IGF-I concentrations remained within the normal range of nonpregnant women at 3, 6, and 9 months. The patient delivered a healthy newborn following an uneventful pregnancy. Postnatal development was normal. Serum IGF-I levels increased progressively after delivery and 3 months later reached prepregnancy levels. The literature on somatostatin analog therapy in women with acromegaly before or during pregnancy is reviewed. This report illustrates an unusual pattern of persistently normal IGF-I during the pregnancy without octreotide therapy, followed by a subsequent rise in the postpartum period.

ISSN:1051-2144    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:1051-2144    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

In 1981, study of the adrenal pathology in four cases of Cushing syndrome led to characterization of a unique disorder termed primary pigmented nodular adrenal disease (PPNAD). Review of the literature showed that the condition occurred in two families. In one, it had affected two siblings; a third sibling who did not have Cushing syndrome died of cardiac myxoma. To test the hypothesis that there was a connection between PPNAD and cardiac myxoma, the Mayo Clinic files and the world literature were searched for patients with both conditions. The search uncovered one Mayo Clinic patient with the two conditions. The patient’s record revealed that she was “covered in pigmented moles” and had a myxomatous tumor of the breast. A review of the literature on cardiac myxoma revealed that there were two types of the tumor, nonfamilial and familial, and that rare cases of the latter were variously associated with cutaneous pigmented spots, mammary and cutaneous myxomas, large-cell calcifying Sertoli cell tumor, and growth hormone-producing pituitary adenoma. In 1985, all these conditions were assembled into a unifying syndrome and reported as “the complex of myxomas, spotty pigmentation, and endocrine overactivity” (Carney complex).

ISSN:1051-2144    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Treatment options for patients with nontoxic, nodular goiter are thyroidectomy, L-thyroxine treatment, and radioiodine therapy. Thyroidectomy leads to rapid decompression of vital structures and provides tissue for pathologic examination. The efficacy of L-thyroxine treatment in patients with nontoxic, nodular goiter is, at best, modest and lifelong L-thyroxine treatment may cause bone loss and cardiac adverse effects.Radioiodine treatment is effective in more than 90% of patients with nontoxic, nodular goiter and results in a mean thyroid volume reduction of 40% after 1 year and of 50% to 60% after 3 to 5 years. In most patients compressive symptoms improve. Early side effects (radiation thyroiditis and esophagitis) are usually mild and transient. Exacerbation of compressive symptoms after radioiodine administration is rare. The development of autoimmune hyperthyroidism is the most important late complication, occurring several months after radioiodine therapy in approximately 5% of patients. The incidence of posttreatment hypothyroidism is 20% to 50% at 5 years.For each individual patient the estimated risks of both surgery and radioiodine therapy should be weighed carefully. At the moment surgery is preferred for younger patients, especially when the amount of radioiodine to be administered is high. However, for elderly patients, especially those with cardiopulmonary disease, the profits of radioiodine treatment will outweigh the lifetime risk for this mode of therapy.Recent data strongly suggest that recombinant human TSH may become a useful adjunct to radioiodine therapy, allowing a considerable reduction of the radioiodine dose needed to reduce thyroid volume. It is expected that administration of recombinant human TSH before radioiodine therapy will extend the indication for radioiodine therapy for nontoxic, nodular goiter to younger patients.

ISSN:1051-2144    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

The pituitary stalk and hypothalamus are susceptible to involvement by cystic, neoplastic, infectious, and inflammatory processes. The clinical features, diagnostic approach, and management of these lesions are reviewed. Patients may seek treatment for symptoms of anterior or posterior pituitary dysfunction, hyperprolactinemia, visual and neurologic symptoms because of mass effect, or hypothalamic impairment. The diagnostic evaluation includes assessment of pituitary and stalk function, magnetic resonance (MR) imaging, investigation for potential systemic disease, and, if necessary, pathologic examination. Imaging usually discloses a suprasellar or parasellar location, and certain specific etiologies may be suspected based on typical MR features. Although lesions involving the pituitary stalk and hypothalamus can present at any age, cystic lesions and most primary neuronal tumors are more typically seen in children, meningiomas and infectious and inflammatory processes are more common in young adults, and metastatic malignancy must be considered in older patients. In many cases management of stalk and hypothalamic masses is surgical. However, isolated, non-progressive lesions such as intrasellar Rathke’s cleft cysts or lymphocytic hypophysitis may be managed medically, and specific therapy for lesions associated with systemic diseases may be indicated before surgical consideration.

ISSN:1051-2144    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Hyperprolactinemia is a common disorder that occurs in both men and women. It is typically caused by a prolactin (PRL)-secreting microadenoma. However, other pathologic and physiologic processes and pharmacologic agents may cause hyperprolactinemia. Diagnostic imaging is recommended when physiologic and pharmacologic causes of excessive PRL secretion are excluded. Therapeutic goals for hyperprolactinemia include resolution of symptoms and normalization of PRL concentrations. If a tumor is present, goals also include tumor mass reduction. Pharmacotherapy with dopamine agonists is the treatment of choice, even in patients with macroprolactinomas. These agents are able to resolve galactorrhea, promote the resumption of menses, and reverse hypogonadism; in many cases, they also reduce tumor size. Currently, two medications are US Food and Drug Administration (FDA) approved for the treatment of hyperprolactinemia. Bromocriptine requires twice-daily dosing, and cabergoline requires once- or twice-weekly dosing. Surgery is considered second-line therapy for prolactinoma in patients who fail or cannot tolerate dopamine agonist therapy.

ISSN:1051-2144    

出版商:OVID    

年代:2003

数据来源: OVID