Search

Aim: To Aim: evaluate various stages of Hashimoto thyroiditis (HT) with ultrasonographic and scintigraphic findings. Material and methods: Material and methods: Eighty-six patients (14 M/72 F) with HT were included in the study. The mean age of the patients was 39 yr (range, 14-73 yr). Thyroid scintigraphy was performed with Tc-99m pertechnetate and serum TSH, free T4, free T3, thyroid peroxidase antibody (TPO Abs), TSH receptor antibody levels were obtained in all patients. Ultrasonography was available in 41 patients (48%). Results: Results: Thyroid TPOAbs were elevated in 86 (100%) and TSH receptor antibodies were elevated in 29 (33%) patients. USG revealed diffuse hyperplasia, multinodular goiter and solitary nodule in 16 (39%), 21 (51%) and 4 (10%) patients respectively. In Hashimoto disease, variable scintigraphic appearances were also seen. 9%, 35%, 42%, 5% and 9% of patients had normal scan, diffuse hyperplasia, multinodular gland, solitary nodule, and suppressed glands respectively. Scintigraphic findings were not correlated with TPOAb levels (p > 0.05). A significantly higher prevalence of hyperthyroidism was observed in patients with diffuse goiter in comparison with those with multinodular gland (63% vs. 22%). The relation between scan findings and clinical presentation is shown on Table 1. Conclusions: Conclusions: The scintigraphic findings in HT are highly variable and can mimic a wide range of thyroid disorders. Our data suggest that diffuse radiopharmaceutical uptake among hyperthyroid patients is suggestive of Graves disease or Hashitoxicosis. In early stage Hashimoto disease TSH stimulation results in increased radionuclide activity throughout the thyroid. Consequently, as more thyroid parenchyma is replaced by fibrous tissue, a multinodular goiter develops. [ABSTRACT FROM AUTHOR]

Carney Complex (CNC) is a multiple neoplasia syndrome characterized by skin tumors and pigmented lesions, myxomas, and various endocrine tumors. The aim of this case report was to describe a case of CNC with a novel PRKAR1A mutation. A man aged 46 years with a medical history of surgery for cardiac myxomas at the age of 39 was admitted to our hospital because of four newly-developed heart masses. The histologic examination confirmed cardiac myxomas. He had many presentations of CNC such as growth hormone (GH) and prolactin (PRL)-secreting mixed pituitary adenoma, benign thyroid nodule, large-cell calcifying Sertoli cell tumor (LCCST), and superficial angiomyxoma. A bilateral adrenalectomy was performed because the laboratory findings suggested primary pigmented nodular adrenocortical disease (PPNAD). The pathologic examination revealed a focal unilateral PPNAD, unilateral nonpigmented adrenocortical nodule, and bilateral adrenal medullary hyperplasia. Two years after the second cardiac operation, an interatrial septum-derived tumor was detected. An atrial myxoma was confirmed with histologic studies. Based on these findings, the patient was confirmed to have CNC. A novel insertion mutation in the type 1A regulatory subunit of the cAMP-dependent protein kinase A gene (PRKAR1A) in exon 2 was detected in our patient through genetic analysis. The presence of multiple myxomas and endocrine abnormalities should be an indication to physicians to further investigate for CNC. Herein, we described a case of CNC with a novel mutation in exon 2 of the PRKAR1A gene with typical and atypical clinical features.

Objectives: Pituitary apoplexy is a rare clinical syndrome associated with rapid enlargement of a pituitary mass. We report the initial presentation, subsequent course and outcome of an acromegalic patient who developed spontaneous remission following pituitary apoplexy with pathologic findings of tumor infarction., Clinical Presentation: A 38 year-old man with typical acromegalic features was referred to our hospital. He had been diabetic and hypertensive. His basal GH and IGF-1 levels were high (80 µg/L and 747 ng/mL respectively). Sella MRI showed a macroadenoma about 19×20 mm in size. He admitted to emergency department with complains of severe frontal headache accompanied by nausea and vomiting two days after MRI was taken. His neurological examination and visual field test were normal. Emergent MRI of the sella disclosed an enhancing intrasellar mass of 24×23 mm compressing the optic chiasm. The patient underwent transsphenoidal decompression of the lesion. Histological examination revealed an adenomatous tissue showing nonhemorrhagic coagulation necrosis. Before surgery, his GH levels declined to 2.72 µg/L spontaneously and after surgery he was in remission even leading to a state of growth hormone deficiency., Conclusion: When apoplexy occurs in functioning adenomas, it may cause spontaneous remission. However pituitary apoplexy due to tumor infarction is very rare. Various precipitating factors have been reported in 25-30% of pituitary apoplexy patients. Diabetes mellitus and diabetic ketoacidosis are one of these. The presence of contrast media induced endothelial swelling with the result of hypoperfusion and diabetes mellitus associated vasculopathy might be a precipitating factor in this patient.

Nonalcoholic fatty liver disease is increasingly recognized as a condition that may progress to chronic liver disease. Most cases of fatty liver are asymptomatic and often are detected during routine medical or laboratory examinations. There also are some rare genetic diseases such as abetalipoproteinemia and familial hypobetalipoproteinemia that may cause fatty liver disease. Both are inherited disorders of lipoprotein metabolism. Although abetalipoproteinemia and homozygous familial hypobetalipoproteinemia patients present with severe manifestations, heterozygotes are usually asymptomatic. In the last several years, case reports or studies indicating a relationship between hepatosteatosis and familial heterozygote hypobetalipoproteinemia (FHBL) have been reported. Here, we report three cases of FHBL with characteristic lipid profile, mildly elevated liver enzymes and hepatosteatosis confirmed by ultrasonography.

The aim of this study is to compare clinical characteristics, management, complications, in-hospital outcome and mortality of diabetic and nondiabetic patients after the first episode of acute myocardial infarction (MI). This retrospective case-matched study included 60 diabetic and 55 non-diabetic patients. Medical information about patients was retrieved from the hospital recordings. Diabetic patients were older, were more hypertensive and had more coronary artery disease history than nondiabetic patients. The frequency of use of acute reperfusion therapy modalities was not statistically different between the two groups. Diabetes was a significant determinant against the use of beta blockers (OR=0.26; 95% CI 0.06-0.95) but in favor of angiotensin converting enzyme inhibitors (OR=3.3; 95% CI 1.17-9.36), whereas diabetes did not influence the use of other drugs. Diabetic patients had more complications than nondiabetic patients (40.0% and 16.3%, respectively, p=0.005). In-hospital mortality rate for diabetic patients was comparable to nondiabetic patients (16.7% and 10.9%, respectively, p=0.373). Pharmaceutical treatment regimens, particularly beta blockers, are underutilized after acute MI in diabetic patients. More frequent use of these regimens will improve the high complication and mortality rates in diabetic patients as well as in nondiabetic patients.

Background: Graves' disease (GD) is an autoimmune disease affecting the thyroid gland and eyes and is treated with three therapeutic modalities. This prospective study was designed to find out the outcome of patients with GD treated with thionamides, radioactive iodine (RAI) or surgery in an iodine deficient region., Materials and Methods: Fifty-six nonsmoking patients (mean age 38.9 +/- 13.7 years) with GD were enrolled and followed for a mean period of four years. They were analyzed with respect to their treatment options and their outcome., Results: Remission rate by thionamides was 74.4% in the first year but decreased to 65.1% in the following four years (p=0.0001). Remission rate achieved in the second year did not predict long-term remission with thionamides. Long-term remission rates for RAI and surgery were 100% during about seven years of follow-up. These remission rates for RAI and surgery were reached in the first year and did not reveal a statistically significant change in the following years. Thyroidectomy, both subtotal and total, was carried out without any complication. Graves' ophthalmopathy emergence and progression were not found to be correlated with the preferred therapeutic modality of thyrotoxicosis., Conclusion: Long-term thionamide therapy offered a relatively low rate of long-term remission in a region with iodine deficiency. Two years of remission achieved by thionamides did not predict long-term remission in patients living in iodine-deficient areas. RAI and thyroidectomy in experienced hands proved to be better therapeutic alternatives that can be carried out safely.