Metástasis cerebral de carcinoma diferenciado del tiroides / Brain metastases of a differentiated thyroid cancer: report of one case

Brain metastases are observed in approximately 1 percent of patients with differentiated thyroid cancer. We report a 56 years old woman subjected to a thyroidectomy due to a follicular thyroid cancer with lymph node involvement. The patient also received 79 mCi of radioiodine and levothyroxine was started. One year later a local relapse and lung dissemination was found. The patient was subjected to a surgical neck exploration and radioiodine in a dose of 250 mCi was given again. One year after this episode, a new local relapse was diagnosed and lung metastases increased in size and number. The patient presented a left hemiparesis and a brain CAT scan and magnetic resonance imaging showed multiple metastatic lesions. The patient was considered intractable and died eight months later.

Cortisol plasmático basal matinal como predictor de indemnidad del eje hipotálamo hipófisis suprarrenal / Basal morning serum cortisol for the assessment of hypothalamic, pituitary adrenal axis function

The study of hypothalamic, pituitary adrenal axis function requires complex tests. However, themeasurement of basal morning serum cortisol levels may be a simple measure to evaluate this axis. AIM: To determine if an isolated morning measurement of basal serum cortisol levels in the absence of stress, may predict the indemnity of the hypothalamic, pituitary adrenal axis. MATERIAL AND METHODS: Morning cortisol levels in the basal period and 30 minutes after the injection of 50 ug ACTH were measured in 76 patients with a mean age of 52 years (48 females), operated of a pituitary tumor, without cushing syndrome and not using steroids or oral estrogens. Twenty healthy volunteers with a mean age of 30 years (11 males) were studied as controls. In this last group, the lower limit of normal stimulated cortisol levels was defined as the mean value less two standard deviations and corresponded to 17 ug/dL. RESULTS: Based on stimulated cortisol levels, 15 percent of operated patients had a hypothalamic, pituitary adrenal axis dysfunction. Using cut-off levels of less than 5, 7.5 and 10 ug/dL, basal cortisol levels had a sensitivity for the diagnosis of hypothalamic, pituitaryadrenal axis dysfunction of 64, 81 and 100 percent, respectively. The figures were 100, 95 and 66 percent for specificity respectively, 100, 75 and 34 percent for positive predictive value and 94, 97 and 100 percent for negative predictive value. CONCLUSIONS: A basal morning cortisol value over 10 ug/dL discards the presence of hypothalamic, pituitary adrenal axis dysfunction and a value lower than 5 ug/dL confirmed alteration in all of the cases.