Jha Vivek, Bhadada Sanjay, Das Liza, Madhad Siddhartha
Endocrinology, PGIMER, Chandigarh, India.
Endocrinology, PGIMER, Chandigarh, India
BMJ Case Rep. 2024 Dec 4;17(12):e262801. doi: 10.1136/bcr-2024-262801.
An adult man in his 30s with newly diagnosed diabetes mellitus and hypertension presented with a 33 lb weight gain, generalised swelling and classic Cushingoid features, including proximal muscle weakness, easy bruisability, wide violaceous striae and a painless, progressively enlarging right-sided neck swelling over the past month. Physical examination revealed a 4×4 cm thyroid mass, facial plethora and dorsocervical fat pads. Laboratory investigations confirmed hypercortisolism with elevated cortisol and Adrenocorticotropic Hormone(ACTH), with non-suppression on dexamethasone suppression tests. Imaging studies identified a malignant thyroid mass and bulky adrenal glands. Fine-needle aspiration cytology confirmed medullary thyroid carcinoma (MTC) with significantly elevated calcitonin and carcinoembryonic antigen. The patient was diagnosed with ectopic Cushing's syndrome secondary to MTC and underwent bilateral adrenalectomy followed by total thyroidectomy. Postoperatively, ACTH levels normalised; however, residual tumour was detected, necessitating external beam radiotherapy.
一名30多岁新诊断为糖尿病和高血压的成年男性，体重增加33磅，全身肿胀，并具有典型的库欣样特征，包括近端肌无力、易瘀斑、宽紫纹，以及在过去一个月中右侧颈部无痛性、进行性增大的肿胀。体格检查发现一个4×4厘米的甲状腺肿块、面部潮红和颈背部脂肪垫。实验室检查证实存在皮质醇增多症，皮质醇和促肾上腺皮质激素（ACTH）升高，地塞米松抑制试验无抑制作用。影像学研究发现一个恶性甲状腺肿块和肿大的肾上腺。细针穿刺细胞学检查证实为甲状腺髓样癌（MTC），降钙素和癌胚抗原显著升高。该患者被诊断为继发于MTC的异位库欣综合征，并接受了双侧肾上腺切除术，随后进行了全甲状腺切除术。术后，ACTH水平恢复正常；然而，检测到残留肿瘤，需要进行外照射放疗。
