Diagnosis and Treatment > Signs and Symptoms > Soft tissue swelling
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Search for other papers by Laura Hamilton Adams in
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Summary
Co-secreting TSH and growth hormone pituitary adenomas are rare. We present a case of a 55-year-old woman who presented with symptoms of neck fullness. Ultrasound revealed multiple thyroid nodules and examination revealed several clinical features of acromegaly. She was found to have a co-secreting TSH and growth hormone pituitary macroadenoma. She underwent surgical resection followed by gamma knife radiation, which resulted in complete remission of her TSH and GH-secreting adenoma.
Learning points:
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TSH-secreting pituitary adenomas are rare and about one-third co-secrete other hormones.
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Thyroid nodules are common in acromegaly and can be the presenting sign of a growth hormone-secreting pituitary adenoma.
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In the workup of acromegaly, assessment of other pituitary hormones is essential, even in the absence of symptoms of other pituitary hormone dysfunction.
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Complete remission of co-secreting GH and TSH pituitary macroadenomas is possible with surgery and radiation alone.
Search for other papers by Taiba Zornitzki in
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Sackler School of Medicine, Tel-Aviv University, Tel Aviv, 69978, Israel
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Search for other papers by Lyudmila Lysyy in
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Search for other papers by Tal Schiller in
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Search for other papers by Véronique Raverot in
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Sackler School of Medicine, Tel-Aviv University, Tel Aviv, 69978, Israel
Search for other papers by Ilan Shimon in
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Search for other papers by Hilla Knobler in
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Summary
Acromegaly due to ectopic GHRH secretion from a neuroendocrine tumor (NET) is rare and comprises <1% of all acromegaly cases. Herein we present a 57-year-old woman with clinical and biochemical features of acromegaly and a 6 cm pancreatic NET (pNET), secreting GHRH and calcitonin. Following surgical resection of the pancreatic tumor, IGF1, GH and calcitonin normalized, and the clinical features of acromegaly improved. In vitro studies confirmed that the tumor secreted large amounts of both GHRH and calcitonin, and incubation of pNET culture-derived conditioned media stimulated GH release from a cultured human pituitary adenoma. This is a unique case of pNET secreting both GHRH and calcitonin. The ability of the pNET-derived medium to stimulate in vitro GH release from a human pituitary-cell culture, combined with the clinical and hormonal remission following tumor resection, confirmed the ectopic source of acromegaly in this patient.
Learning points
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Signs, symptoms and initial work-up of acromegaly due to ectopic GHRH secretion are similar to pituitary-dependent acromegaly. However, if no identifiable pituitary lesion is found, somatostatin receptor scan and further imaging (CT, MRI) should be performed.
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Detection of GHRH in the blood and in the tumor-derived medium supports the diagnosis of ectopic GHRH secretion.
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Functional bioactivity of pNET-secreted GHRH can be proved in vitro by releasing GH from human pituitary cells.
Search for other papers by Soham Mukherjee in
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Search for other papers by Anuradha Aggarwal in
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Search for other papers by Ashu Rastogi in
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Search for other papers by Anil Bhansali in
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Search for other papers by Mahesh Prakash in
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Search for other papers by Kim Vaiphei in
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Search for other papers by Pinaki Dutta in
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Summary
Spontaneous diabetic muscle infarction (DMI) is a rare and under diagnosed complication of diabetes mellitus. Clinically it presents with acute to subacute onset swelling, pain and tenderness of muscle(s) without systemic manifestations. MRI is helpful in diagnosis, exclusion of other causes and for localization of affected muscle for biopsy in atypical cases. Muscles of the thighs are commonly affected in diabetic myonecrosis (DMN). Here we present the summary of four cases seen in the last 3 years in a tertiary care centre with simultaneous or sequential involvement of multiple groups of muscles or involvement of uncommon sites. All these patients had advanced duration of diabetes with microvascular complications and poor glycemic control. Conservative management including rest and analgesics is the treatment of choice. Short-term prognosis is good but there may be recurrence.
Learning points
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A high index of suspicion is required for the diagnosis of DMN which can avoid inadvertent use of antibiotics.
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Acute–subacute onset severe focal muscle pain in the absence of systemic symptoms in a female patient with long-standing diabetes with microvascular complications suggests DMI.
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MRI is the most sensitive test for diagnosis.
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Muscle biopsy should be reserved for atypical cases.
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Conservative management including rest and analgesics has good outcome.
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Improvement usually occurs within 6–8 weeks, but there may be recurrence.
