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Sunitinib inhibits numerous tyrosine kinase receptors involved in tumor growth, angiogenesis, and metastatic invasion. It is indicated in case of metastatic renal carcinomas and gastrointestinal stromal tumors (GIST) resistant to imatinib. Prospective and retrospective studies have shown association between use of sunitinib and hypothyroidism affecting more than 50% of patients in some series. More amazing, was the non-visualisation of thyroid tissue evaluated with thyroid ultrasonography in two cases. Mechanisms of this side effect are not elucidated. Some studies have suggested destructive thyroiditis but no evidence of autoimmunity has been demonstrated. Anti angiogenic effect could be another hypothesis. Recently antithyroperoxidase activity of sunitinib has been demonstrated. Because hypothyroidism is easily accessible to treatment, screening of thyroid abnormalities is mandatory every three months to improve quality of life of these patients. This unique thyroid side effect of sunitinib with the non-visualisation of thyroid suggests a possible and promising antitumor activity in thyroid cancer.

Sunitinib inhibits numerous tyrosine kinase receptors involved in tumor growth, angiogenesis, and metastatic invasion. It is indicated in case of metastatic renal carcinomas and gastrointestinal stromal tumors (GIST) resistant to imatinib. Prospective and retrospective studies have shown association between use of sunitinib and hypothyroidism affecting more than 50% of patients in some series. More amazing, was the non-visualisation of thyroid tissue evaluated with thyroid ultrasonography in two cases. Mechanisms of this side effect are not elucidated. Some studies have suggested destructive thyroiditis but no evidence of autoimmunity has been demonstrated. Anti angiogenic effect could be another hypothesis. Recently antithyroperoxidase activity of sunitinib has been demonstrated. Because hypothyroidism is easily accessible to treatment, screening of thyroid abnormalities is mandatory every three months to improve quality of life of these patients. This unique thyroid side effect of sunitinib with the non-visualisation of thyroid suggests a possible and promising antitumor activity in thyroid cancer.

Bilateral malignant polyadenomas of adrenals seem to be rare. They involve either a double primary adrenal tumour, or a metastasis of a controlateral tumour. In the observation reported here, the evolution is characterized by periods of central stimulation with partial autonomy, and periods of tumoral autonomy with central inertness. Pathological findings consist of coexistence of various histological aspects (atrophy, hyperplasia, benign adenoma, carcinoma) suggesting the successive steps of a very particuliar adrenal carcinogenesis. Such findings allow to discuss the following physiopathological mechanism: a stimulation by ACTH might have resulted initially in a preneoplasic hyperplasia, then in an incompletely autonomous tumour, and finally in an autonomous tumour. Accordingly, from a practical and therapeutic point of view, it would be suitable, after removal of an adrenal tumour, especially of one with demonstrated ACTH-dependance, to suppress totally endogenous ACTH by cortisol or cortisone therapy, in order to reduce the occurence of corticotropin stimulation of possibly remaining malignant adrenal cells.