Vyas Neha, Neto Arino, Carakushansky Mauri, Gurnurkar Shilpa
Division of Pediatric Endocrinology, Nemours Children's Health, Orlando, FL 32827, USA.
Pediatrics Residency Program, Department of Pediatrics, Nemours Children's Health, Orlando, FL 32827, USA.
JCEM Case Rep. 2023 Jun 15;1(3):luad051. doi: 10.1210/jcemcr/luad051. eCollection 2023 May.
Graves' disease is the most common cause of pediatric hyperthyroidism and thyrotoxicosis. Thyroid storm is a rare initial manifestation of Graves' disease and represents an endocrine emergency. We report a case of transient hyperthyroidism, possibly a paraneoplastic syndrome presenting as impending thyroid storm in a patient with undiagnosed hepatoblastoma. To our knowledge, this is the first case of this association reported in children. A previously healthy 21-month-old male presented with abdominal pain and unremitting tachycardia. He was managed for thyrotoxicosis and impending thyroid storm. He subsequently was found to have hepatomegaly leading to a diagnosis of hepatoblastoma. Autoimmune markers for Graves' disease were negative, along with a negative human chorionic gonadotropin. After initiation of neoadjuvant chemotherapy, he had complete resolution of thyrotoxicosis. Paraneoplastic syndromes may occur with any tumor. We present a unique case of a patient developing human chorionic gonadotropin-negative hyperthyroidism, possibly as a paraneoplastic syndrome from hepatoblastoma.
格雷夫斯病是儿童甲状腺功能亢进和甲状腺毒症最常见的病因。甲状腺危象是格雷夫斯病罕见的初始表现，属于内分泌急症。我们报告一例短暂性甲状腺功能亢进病例，可能是一种副肿瘤综合征，表现为一名未确诊肝母细胞瘤患者即将发生甲状腺危象。据我们所知，这是儿童中首次报道的这种关联病例。一名此前健康的21个月大男性出现腹痛和持续性心动过速。他因甲状腺毒症和即将发生的甲状腺危象接受治疗。随后发现他肝肿大，最终诊断为肝母细胞瘤。格雷夫斯病的自身免疫标志物为阴性，人绒毛膜促性腺激素也为阴性。新辅助化疗开始后，他的甲状腺毒症完全缓解。任何肿瘤都可能发生副肿瘤综合征。我们报告了一例独特病例，患者发生人绒毛膜促性腺激素阴性的甲状腺功能亢进，可能是肝母细胞瘤引起的副肿瘤综合征。
