ABSTRACT
Factitious Cushing's syndrome is exceptionally rare. The diagnosis is challenging due to the interference of exogenous corticosteroids with cortisol immunoassays. We present a case of a 26 year old female that presented with clinical and biochemical features of Cushing's syndrome. She denied any exogenous corticosteroid use. She had a suppressed ACTH level with normal adrenal glands on CT scans. There was a paradoxical increase of cortisol with a 100% rise in 24 h urinary free cortisol (UFC) during the Liddle's test suggestive of primary pigmented nodular adrenocortical disease (PPNAD). However, basal UFC levels were within normal values, interpreted as an intermittent variation of cortisol secretion maybe due to cyclic Cushing's. At this point a synthetic glucocorticoid serum screening was ordered, which was denied by the administrators because the test was not available in our hospital. A positron emission tomography (PET)-CT using 18 F-Flurodeoxyglucose did not show any uptake in the adrenal glands. With the diagnosis of probable primary pigmented nodular adrenocortical disease a unilateral right adrenelectomy was performed. Histopathological examination revealed normal adrenal gland. A synthetic glucocorticoid serum screen by liquid chromatography-tandem mass spectrometry (LC-MS/MS) sent to Mayo Clinic lab revealed high levels of serum prednisone and prednisolone. In conclusion, factitious Cushing's syndrome is an important diagnosis to consider in patients being evaluated for hypercortisolism. Discordant hormonal test results as well as normal findings on adrenal glands on CT scan should raise suspicion of this entity, and prompt measurement of synthetic corticosteroids using LC-MS/MS.
Subject(s)
Humans , Male , Adult , Neoplasms, Germ Cell and Embryonal/radiotherapy , Neoplasms, Germ Cell and Embryonal/diagnostic imaging , Skull/diagnostic imaging , Magnetic Resonance Spectroscopy , Tomography, X-Ray Computed , Neoplasms, Germ Cell and Embryonal/complications , Neoplasms, Germ Cell and Embryonal/cerebrospinal fluid , Neoplasms, Germ Cell and Embryonal/pathology , Neoplasms, Germ Cell and Embryonal/blood , Image-Guided Biopsy , Hydrocephalus/complicationsABSTRACT
El quiste del ducto tirogloso intratiroideo (DTI) es una entidad extremadamente infrecuente, no encontrándose en la literatura estadísticas en incidencia. Objetivo: reportar un caso clínico de quiste de DTI, manifestado como nódulo solitario, de crecimiento progresivo, en un paciente adulto y revisión bibliográfica. Conclusión: el quiste del DTI es una entidad extremadamente infrecuente. Solo se encuentran descritos en la literatura reportes de casos. Debemos considerarlo dentro del diagnóstico diferencial de la patología estructural tiroidea.
Intra-thyroid thyroglossal duct cyst is an extremely rare entity, there being no incidence statistics in literature. Objective: to report the clinical case of intra-thyroid thyroglossal duct cyst, that presented as a solitary nodule of progressive growth in an adult patient, and to conduct a bibliographical review. Conclusion: intra-thyroid thyroglossal duct cyst is an extremely unusual entity. Only case reports were found in the literature. We need to consider this entity among the differential diagnostic of the thyroid structural pathology.
O cisto do ducto tireoglosso intratiroideo (DTI) é uma entidade extremamente infrequente, não se encontrando na literatura estatísticas sobre sua incidência. Objetivo: descrever um caso clínico de cisto DTI, manifestado como nódulo solitário, de crescimento progressivo em um paciente adulto, e revisão bibliográfica. Conclusão: o cisto de DTI é uma entidade extremamente infrequente. Na literatura somente estão disponíveis relatoss de casos. Deve ser considerado no diagnóstico diferencial da patologia estrutural tireoidea.
Subject(s)
Thyroglossal Cyst , Thyroid NoduleABSTRACT
El Carcinoma de mama masculina es el 0.5 al 1 por ciento de los tumores de mama y el 0.17 a 1.5 por ciento de los tumores malignos. En Uruguay la tasa de incidencia es de 0.80 (1991). Se analizan 16 casos de carcinoma de mama masculina. La edad media al diagnóstico fue 64 años. El 87.50 por ciento fueron retroareolares. El eje mayor promedio fue 23.6 mm. El tipo histológico ordinario (N.O.S) se observó en el 75 por ciento (12), CDI en alguna de sus variantes en el 12.5 por ciento (2), CD "in situ" en 12.5 por ciento (2). El grado histológico final III se observó en 6 de los casos , el II en 5 casos y el I en 3 casos. El carcinoma de mama en el hombre en nuestro país, muestra similares características epidemiológicas, clínicas y morfológicas a las comunicadas en la literatura mundial. Presenta un perfil clínico y patológico propio como enfermedad, con edad de presentación 5 a 10 años más tarde que en la mujer y topografía predominantemente retroareolar. El tamaño tumoral aparece como el factor pronóstico más importante, el tipo histológico mas frecuente es el CDI de tipo N.O.S. (70 por ciento), con grado histológico II o III en 80 por ciento de los casos (AU)
