Ectopic ACTH syndrome caused by thymic neuroendocrine tumor: a case report and literature review.

A 36-year-old woman presented with onset of reduced menstrual flow, gradually progressed to typical Cushingoid features with 24-hour urine free cortisol (UFC) increased, low-dose dexamethasone suppression test and high-dose dexamethasone suppression test both not suppressed, adrenocorticotropic hormone (ACTH) increased, and computed tomography (CT) scan of the chest revealed a large mass in the anterior mediastinum. The local hospital administered mediastinal mass resection which afterwards showed type B1 thymoma. The above symptoms were relieved post-operation, and the levels of ACTH and cortisol decreased. Symptoms recurred 5 months after the surgery, with laboratory and imaging suggested possible multiple tumor metastases. The patient was referred to our hospital and was diagnosed with ectopic ACTH syndrome and thymic neuroendocrine tumor with multiple metastases post-operation. After administered mifepristone to antagonize the glucocorticoid receptor, the patient's symptoms improved. The patient also received "etoposide" single-agent chemotherapy, and the symptoms were relieved after 4 months of follow-up. The case showed that complete surgical resection of the primary tumor is the best treatment for ectopic ACTH syndrome, if the primary tumor which cause ectopic ACTH syndrome cannot be completely cured, it is particularly important to control hypercortisolemia and prevent its complications. This article purports to report this case and review the relevant literature.

Association between lifestyle and thyroid dysfunction: a cross-sectional epidemiologic study in the She ethnic minority group of Fujian Province in China.

BACKGROUND: Thyroid dysfunction is one of the prevalent endocrine disorders. The relationship between lifestyle factors and thyroid dysfunction was not clear and some of the factors seemed paradoxical. METHODS: We conducted this population-based study using data from 5154 She ethnic minority people who had entered into the epidemic survey of diabetes between July 2007 to September 2009. Life style information was collected using a standard questionnaire. Body mass index (BMI), Blood pressure and serum TSH, TPOAb, triglycerides (TG), total cholesterol (TC) and high-density lipoprotein cholesterol (HDL) were collected. RESULTS: The study showed that people who drank, had higher education or suffered from insomnia have lower incidence of hyperthyroidism. On the other hand, smoking, alcohol consumption, exercise, undergoing weight watch and chronic headache were associated with decreased incidence of hypothyroidism. Using multivariable logistic regression analysis, we found that alcohol consumption was associated with decreased probability of hyperthyroidism, hypothyroidism, as well as positive TPOAb. The amounts of cigarettes smoked daily displayed a positive correlation with hyperthyroidism among smokers. Accordingly, smoking seemed to be associated with decreased risk for hypothyroidism and positive TPOAb. Exercise and maintaining a healthy weight might have a beneficial effect on thyroid health. Interestingly, daily staple amount showed an inverse correlation with incidence of positive TPOAb. CONCLUSIONS: Within the Chinese She ethnic minority, we found associations between different lifestyle factors and the incidence of different thyroid diseases. Understanding the nature of these associations requires further investigations.