imaging studies (3) . The Japanese revised ‘Clinical Diagnostic Criteria of Autoimmune Pancreatitis’ (2006) contained three items: radiological imaging showing diffuse or segmental narrowing of the main pancreatic duct, and diffuse or segmental
Milena S Pandrc, Stanko Petrović, Vanja Kostovski, Marijana Petrović and Miloš Zarić
Noor Rafhati Adyani Abdullah, Wong Lok Chin Jason and Azraai Bahari Nasruddin
change) was noted. The findings were supportive of pachydermoperiostosis. Based on the clinical, radiological and the histopathological features in the absence of GH hypersecretion, a diagnosis of pachydermoperiostosis was made. Figure 7 Radiograph
Aishah Ekhzaimy, Afshan Masood, Seham Alzahrani, Waleed Al-Ghamdi, Daad Alotaibi and Muhammad Mujammami
, and radiological features in a large cohort of patients with central diabetes insipidus of known and unknown etiology . Journal of Clinical Endocrinology and Metabolism 2003 1629 – 1636 . ( https://doi.org/10.1210/jc.2002-020791 ) 4 Scherbaum
Roghieh Molaei Langroudi, Fatemeh Ghazanfari Amlashi and Mohammad Hassan Hedayati Emami
Background: Spontaneous ovarian hyperstimulation syndrome (sOHSS) can occur following hypothyroidism. Ultrasonography facilitates diagnosis and monitoring of this syndrome. We describe ovarian sonographic changes in a hypothyroid patient with sOHSS after treatment with levothyroxine (l-T4).
Case presentation: A 15-year-old girl presented with abdominal pain and distension for a few months. On examination, she had classical features of hypothyroidism. Abdominal and pelvic ultrasound revealed enlarged ovaries with multiple thin-walled cysts and mild ascitic fluid. On follow-up, abdominal ultrasound showed significant reduction of ovary size after 6 weeks of initiation of l-T4. Normal ovary size with complete regression of ovarian cysts was seen after 4 months.
Conclusion: Serial ultrasound in sOHSS associated with hypothyroidism showed regression of ovarian cysts and ovarian volume after 4 months whereas in other studies, it is reported to happen in various durations, presumably according to its etiology.
- OHSS can rarely occur due to hypothyroidism.
- This type of OHSS can be simply treated by l-T4 replacement, rather than conservative management or surgery in severe cases.
- Ultrasound follow-up shows significant regression of ovarian size and cysts within 6 weeks of initiation of l-T4.
- Ultrasound follow-up shows normal ovarian size with complete resolution of ovarian cysts 4 months after treatment.
R Bou Khalil, M Abou Salbi, S Sissi, N El Kara, E Azar, M Khoury, G Abdallah, J Hreiki and S Farhat
Methimazole is an anti-thyroid drug commonly used to treat hyperthyroidism and is a relatively safe medication. Several side effects have been reported and usually develop within 3 months of therapy. Well-known adverse reactions include agranulocytosis, hepatitis, skin eruptions, and musculoskeletal complaints such as myalgia, arthralgia, and arthritis. So far, myositis secondary to carbimazole was described in the context of a lupus-like syndrome or other rare cases of anti-neutrophil cytoplasmic antibodies-associated vasculitis. Methimazole-induced myositis occurring independently of such reactions was rarely stated. We report a patient with hyperthyroidism who, early after therapy with methimazole, developed hepatitis, eosinophilia, and fever that resolved completely after stopping the medication as well as a delayed onset of biopsy-proven eosinophilic myositis and fasciitis of gluteal muscles that resolved eventually without any additional therapy. Therefore, we raise the awareness regarding a rare side effect of methimazole: myositis.
- Several differential diagnoses arise when managing a hyperthyroid patient with muscle complaints.
- Both hyperthyroidism and methimazole are associated with myositis.
- Methimazole-induced myositis is a rare clinical entity.
- Resolution of symptoms may occur after stopping methimazole.
Geetanjali Kale, Elaine M Pelley and Dawn Belt Davis
: CT and ultrasound findings . Urologic Radiology 6 7 – 13 . ( doi:10.1007/BF02923691 ) 10.1007/BF02923691 6702033 Nermoen I Rorvik J Holmedal SH Hykkerud DL Fougner KJ Svartberg J Husebye
Soledad Bell, Gabriela Alejandra Sosa, Ana del Valle Jaen and María Fabiana Russo Picasso
Thyroid lipomatosis is a rare disease, as a total of 20 cases have been described in the literature. It is characterized by diffuse infiltration of the stroma by mature adipose tissue and by progressive growth that produces different degrees of compressive symptoms. Our aim is to present the case of a 36-year-old woman who consulted because of dyspnea caused by a multinodular goiter. She underwent surgery with the presumptive diagnosis of a malignant neoplasia, but the pathological examination of the surgical specimen established the diagnosis of thyroid lipomatosis.
- Thyroid lipomatosis is a rare, benign disease characterized by diffuse infiltration of the stroma by mature adipose tissue.
- The pathophysiology of diffuse proliferation of adipose tissue in the thyroid gland is unclear.
- Thyroid lipomatosis is clinically manifested by a progressive enlargement of the thyroid that can involve the airway and/or upper gastrointestinal tract, producing dyspnea, dysphagia, and changes in the voice.
- Given the rapid growth of the lesion, the two main differential diagnoses are anaplastic carcinoma and thyroid lymphoma.
- Imaging studies may suggest a differential diagnosis, but a definitive diagnosis generally requires histopathological confirmation after a thyroidectomy.
Lara Ulrich, Graham Knee and Colin Todd
Knee provided the histopathological images and C Todd provided the radiological images. References Capps R 1934 Multiple parathyroid tumors with massive mediastinal and subcutaneous haemorrhage . American Journal of the
Elda Kara, Elisa Della Valle, Sara De Vincentis, Vincenzo Rochira and Bruno Madeo
Spontaneous or fine-needle aspiration (FNAB)-induced remission of primary hyperparathyroidism (PHPT) may occur, especially for cystic lesions. However, the disease generally relapses over a short time period. We present a case of PHPT due to an enlarged hyperfunctioning parathyroid that underwent long-term (almost 9 years) clinical and ultrasonographic remission after the disappearance of the lesion following ultrasound (US)-assisted FNAB. A 67-year-old woman with PHPT underwent biochemical and US examinations that confirmed the diagnosis and showed a lesion suggestive for parathyroid adenoma or hyperplasia. US-FNAB of the lesion confirmed its parathyroid nature by means of elevated levels of parathyroid hormone within the needle washing fluid. At the second visit, the patient referred slight neck swelling that resolved spontaneously in the days after the US-FNAB. At subsequent follow-up, the enlarged parathyroid was not found; it was visible neither with US nor with magnetic resonance imaging. Biochemical remission persists after 9 years. This is the first reported case of cure of PHPT after US-FNAB performed on a hyperfunctioning parathyroid resulting in its complete disappearance over a period of 9 years of negative biochemical and ultrasonographic follow-up.
- Spontaneous or fine-needle aspiration-induced remission of primary hyperparathyroidism can occur.
- Both circumstances may present disease relapse over a variable time period, but definite remission is also possible even though long-term periodic follow-up should be performed.
- Parathyroid damage should be ruled out in case of neck symptomatology after parathyroid fine-needle aspiration or spontaneous symptomatology in patients with history of primary hyperparathyroidism.
Adrienne Dow, Run Yu and John Carmichael
To report the puzzling, rare occurrence of coexisting adrenal insufficiency and Cushing's syndrome from chronic, intermittent use of intranasal betamethasone spray. A 62-year-old male was referred to our endocrinology clinic for management of adrenal insufficiency. This previously healthy individual began to experience chronic sinus symptoms in 2007, was treated with multiple ensuing sinus surgeries, and received oral glucocorticoid for 6 months. In the following 5 years, he suffered severe fatigue and was diagnosed with secondary adrenal insufficiency. He could not be weaned from corticosteroid and developed clear cushingoid features. In our clinic, careful inquiry on medications revealed chronic, intermittent use of high-dose intranasal betamethasone since 2008, which was not apparent to his other treating physicians. His cushingoid features significantly improved after holding intranasal betamethasone.
- Chronic, intermittent intranasal betamethasone can cause secondary adrenal insufficiency and iatrogenic Cushing's syndrome when used in excess.
- Topical corticosteroid use should be considered in the differential diagnosis of adrenal insufficiency or Cushing's syndrome.