Clinical Overview > Condition/ Syndrome > Hashimoto’s disease

You are looking at 11 - 13 of 13 items

Wann Jia Loh Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore General Hospital, Academia, 20, College Road, Singapore, 169856, Singapore

Search for other papers by Wann Jia Loh in
Google Scholar
PubMed
Close
,
Kesavan Sittampalam Department of Pathology, Singapore General Hospital, Academia, 20, College Road, Singapore, 169856, Singapore

Search for other papers by Kesavan Sittampalam in
Google Scholar
PubMed
Close
,
Suan Cheng Tan Department of Radiology, Singapore General Hospital, Academia, 20, College Road, Singapore, 169856, Singapore

Search for other papers by Suan Cheng Tan in
Google Scholar
PubMed
Close
, and
Manju Chandran Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore General Hospital, Academia, 20, College Road, Singapore, 169856, Singapore

Search for other papers by Manju Chandran in
Google Scholar
PubMed
Close

Summary

Erdheim–Chester disease (ECD) is a potentially fatal condition characterized by infiltration of multiple organs by non-Langerhans histiocytes. Although endocrine dysfunction has been reported in association with ECD, to date, there have been no previous reports of empty sella syndrome (ESS) associated with it. We report the case of a patient with ECD who had symptomatic ESS. A 55-year-old man of Chinese ethnicity initially presented with symptoms of heart failure, fatigue and knee joint pain. Physical examination revealed xanthelasma, gynaecomastia, lung crepitations, hepatomegaly and diminished testicular volumes. He had laboratory evidence of hypogonadotrophic hypogonadism, secondary hypoadrenalism and GH deficiency. Imaging studies showed diffuse osteosclerosis of the long bones on X-ray, a mass in the right atrium and thickening of the pleura and of the thoracic aorta on fusion positron emission tomography–computed tomography. Magnetic resonance imaging (MRI) of the brain showed an empty sella. The diagnosis of ECD was confirmed by bone biopsy.

Learning points

  • ECD is a multisystemic disease that can affect the pituitary and other organs. The diagnosis of ECD is based on clinical and radiological features and histology, showing lipid-laden CD68+ CD1a S100 histiocytes surrounded by fibrosis.

  • The finding of xanthelasmas especially in the presence of normal lipid levels in the presence of a multisystem infiltrative disorder should raise the suspicion of ECD.

  • Systemic perturbation of autoimmunity may play a role in the pathogenesis of ECD and is an area that merits further research.

Open access
Shinya Makino Department of Internal Medicine, Osaka Gyomeikan Hospital, 5-4-8 Nishikujo, Konohana-ku, Osaka, 554-0012, Japan

Search for other papers by Shinya Makino in
Google Scholar
PubMed
Close
,
Takeshi Uchihashi Department of Internal Medicine, Osaka Gyomeikan Hospital, 5-4-8 Nishikujo, Konohana-ku, Osaka, 554-0012, Japan

Search for other papers by Takeshi Uchihashi in
Google Scholar
PubMed
Close
,
Yasuo Kataoka Department of Internal Medicine, Osaka Gyomeikan Hospital, 5-4-8 Nishikujo, Konohana-ku, Osaka, 554-0012, Japan

Search for other papers by Yasuo Kataoka in
Google Scholar
PubMed
Close
, and
Masayoshi Fujiwara Department of Internal Medicine, Osaka Gyomeikan Hospital, 5-4-8 Nishikujo, Konohana-ku, Osaka, 554-0012, Japan

Search for other papers by Masayoshi Fujiwara in
Google Scholar
PubMed
Close

Summary

Recovery from alopecia is rare in autoimmune polyglandular syndrome (APS). A 41-year-old male was admitted to our hospital with hyperglycemia. He developed alopecia areata (AA) 5 months before admission and developed thirst, polyuria, and anorexia in 2 weeks. His plasma glucose level upon admission was 912 mg/dl (50.63 mmol/l) and HbA1c was 13.7%. Although urinary and plasma C-peptide levels showed that insulin secretion was not depleted, anti-insulinoma-associated antigen 2 antibody was present. In addition, measurement of thyroid autoantibodies revealed the presence of Hashimoto's thyroiditis. These findings suggested a diagnosis of APS type 3. The patient has showed signs of improvement with the continuation of insulin therapy. During the successful control of diabetes, he had total hair regrowth within 2–3 months. Human leukocyte antigen typing showed that DRB1*1501-DQB1*0602 and DQB1*0301 were present. Similar cases should be accumulated to clarify the association of APS type 3 with recovery from AA.

Learning points

  • Alopecia in diabetic patients is a suspicious manifestation of autoimmune type 1 diabetes.

  • Patients with autoimmune type 1 diabetes specifically manifesting alopecia should be further examined for diagnosis of APS.

  • Insulin-mediated metabolic improvement may be a factor, but not the sole factor, determining a favorable outcome of alopecia in patients with autoimmune type 1 diabetes.

Open access
Mahmud Abo Salook Endocrine Institute

Search for other papers by Mahmud Abo Salook in
Google Scholar
PubMed
Close
,
Carlos Benbassat Endocrine Institute
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

Search for other papers by Carlos Benbassat in
Google Scholar
PubMed
Close
,
Yulia Strenov Pathology Laboratory, Rabin Medical Center, Beilinson Campus, Petah Tiqva 49100, Israel

Search for other papers by Yulia Strenov in
Google Scholar
PubMed
Close
, and
Amit Tirosh Endocrine Institute
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

Search for other papers by Amit Tirosh in
Google Scholar
PubMed
Close

Summary

A 55-year-old male, with a positive medical history for hypothyroidism, treated with stable doses for years was admitted with subacute thyroiditis and a feeling of pain and pressure in the neck. Laboratory tests showed decrease in TSH levels, elevated erythrocyte sedimentation rate, and very high antithyroid antibodies. Owing to enlarging goiter and exacerbation in the patient's complaints, he was operated with excision of a fibrotic and enlarged thyroid lobe. Elevated IgG4 plasma levels and high IgG4/IgG plasma cell ratio on immunohistochemistry led to the diagnosis of IgG4-mediated thyroiditis. We concluded that IgG4-thyroiditis and IgG4-related disease should be considered in all patients with an aggressive form of Hashimoto's thyroiditis.

Learning points

  • IgG4-related disease is a systemic disease that includes several syndromes; IgG4-related thyroiditis is one among them.

  • IgG4-thyroiditis should be considered in all patients with an aggressive form of Hashimoto's thyroiditis.

  • Patients with suspected IgG4-thyroiditis should have blood tested for IgG4/IgG ratio and appropriate immunohistochemical staining if possible.

Open access