RESUMO
BACKGROUND: Macroprolactinemia is a common presentation especially in gynecology and fertility clinics. However, with this clinical condition, there is a potential for misdiagnosis and unnecessary investigations/treatments due to lack of awareness of its prevalence and diagnostic approaches amongst trainees and physicians. METHODS: In this paper, we discuss the causes of hyperprolactinemia, its pathobiology, and an approach to macro-prolactinemia including relevant clinical chemistry methods and their limitations through the case of a 45-year-old female with a history of irregular menstrual cycles, who was seen in the endocrine clinic. RESULTS: Patient did not have a history of infertility, galactorrhea, visual-disturbance, or headaches. Her physical examination and routine clinical chemistry investigations were unremarkable. Her initial prolactin level was 4,836 mIU/L (109 - 557) with subsequent results demonstrating diminishing levels of prolactin a month apart (1,023 mIU/L). Polyethylene glycol (PEG) precipitation test demonstrated the presence of macroprolactin with a 3% post-PEG recovery of prolactin and 111 mIU/L post-PEG prolactin concentration. CONCLUSIONS: Patient's post-PRL results and clinical course confirmed the presence of macroprolactin to be the cause of factitious hyperprolactinemia. A sound approach to macroprolactinemia is critical in clinical and laboratory practices.
Assuntos
Galactorreia , Hiperprolactinemia , Amenorreia , Feminino , Humanos , Hiperprolactinemia/diagnóstico , Pessoa de Meia-Idade , Gravidez , ProlactinaAssuntos
Citodiagnóstico/métodos , Nódulo da Glândula Tireoide/diagnóstico , Nódulo da Glândula Tireoide/patologia , Tireoidectomia/métodos , Adulto , Biópsia por Agulha Fina/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Nódulo da Glândula Tireoide/classificação , Nódulo da Glândula Tireoide/cirurgiaRESUMO
The cribriform morular variant of papillary thyroid carcinoma (CMV-PTC) is a rare morphologic entity that is associated with familial adenomatous polyposis (FAP). We report a case of a young lady with an incidentally discovered right-sided neck nodule on ultrasonography with a diagnosis of CMV-PTC confirmed on thyroidectomy and review the literature associated with the clinical presentation, imaging characteristics, pathological findings and the association with FAP.
Assuntos
Carcinoma Papilar/patologia , Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/patologia , Carcinoma Papilar/diagnóstico por imagem , Feminino , Humanos , Achados Incidentais , Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Ultrassonografia , Adulto JovemRESUMO
INTRODUCTION: We present a rare variety of adrenocorticotrophic hormone (ACTH)-independent Cushing's syndrome known as primary pigmented nodular adrenocortical disease (PPNAD). CLINICAL PICTURE: The patient initially underwent unilateral adrenalectomy for what was thought to be a left adrenal adenoma. OUTCOME: Partial resolution of symptoms and demonstrable persistent hypercortisolism after surgery prompted further evaluation with findings leading to the diagnosis of Carney complex. A review of the adrenal histology was consistent with PPNAD. CONCLUSION: This entity of PPNAD, which has rarely been reported in Asians, forms part of the Carney complex. The diagnosis may not be simple and straightforward, as illustrated in this patient.