Subject(s)
Cholesterol/blood , Hypercholesterolemia/diagnosis , Tendons/pathology , Xanthomatosis/diagnosis , Anticholesteremic Agents/administration & dosage , Atorvastatin , Coronary Angiography , Coronary Stenosis/diagnostic imaging , Coronary Stenosis/therapy , Echocardiography , Female , Heptanoic Acids/administration & dosage , Humans , Hypercholesterolemia/drug therapy , Hypercholesterolemia/genetics , Middle Aged , Pyrroles/administration & dosage , Stents , Treatment Outcome , Xanthomatosis/therapyABSTRACT
Pseudoacromegaly is a condition characterized by cutaneous manifestations of growth hormone excess but with normal growth hormone levels. This is described in patients with severe insulin resistance, pachydermoperiostitis, burnt out acromegaly and with intake of drugs like Minoxidil. Severe thyroid hormone deficiency rarely present with similar picture and the issue is further complicated in presence of pituitary hyperplasia. We report an unusual presentation of primary hypothyroidism with pseudoacromegaly and thyrotroph hyperplasia mimicking a pituitary macroadenoma. The thyrotroph hyperplasia resolved completely with levothyroxine therapy.
Subject(s)
Acromegaly/diagnosis , Hypothyroidism/diagnosis , Acromegaly/metabolism , Adult , Humans , Hypothyroidism/metabolism , Insulin Resistance , Male , Pituitary Gland/pathology , Young AdultABSTRACT
Von Hippel-Lindau (VHL) disease includes a wide spectrum of highly vascular tumors like pheochromocytoma, cysts and adenomas of the pancreas and kidney, endolymphatic sac and renal cell carcinoma. Molecular analysis of the VHL gene is vital in these patients and their kindred. Neuroendocrine pancreatic tumors are rare and are known for their malignant and metastatic potential. We discuss an interesting case of a young lady who had a strong family history of central nervous system and spinal tumors. Our patient presented with recently detected severe hypertension. She was found to have elevated urinary normetanephrine levels; radiological imaging revealed bilateral pheochromocytomas with a pancreatic lesion. On genetic analysis, a variation, c.IVS 2 + 3 A > G, was found in the intronic region following exon 2 of the VHL gene. This variant appears novel. This patient underwent bilateral adrenalectomy (right total and left cortical sparing), distal pancreatectomy and splenectomy. Histology was diagnostic for pheochromocytoma with a neuroendocrine tumor of the pancreas. The postoperative period was uneventful. She was advised genetic screening of all her first-degree relatives.
Subject(s)
Exophthalmos/diagnosis , Myxedema/diagnosis , Osteoarthropathy, Primary Hypertrophic/diagnosis , Adult , Humans , Male , SyndromeABSTRACT
Detection of bilateral adrenal masses in any patient often presents a management dilemma. Despite extensive imaging, positron emission tomography (PET) scanning, and fine needle aspiration biopsy (FNAB), a definite diagnosis may not be reached. We report an unusual case of bilateral adrenal mass diagnosed as histoplasmosis postoperatively and managed successfully by laparoscopy. Focus is placed on the role of laparoscopic adrenalectomy (LA) as a diagnostic and therapeutic tool in such patients.
