J. Rendl

The use of recombinant human TSH in a patient with metastatic follicular carcinoma and insufficient endogenous TSH production

We present a case of a patient suffering from metastatic differentiated thyroid carcinoma (DTC) and insufficient endogenous TSH production suspicious of secondary hypothyroidism. The use of recombinant human TSH (rhTSH) enabled us to administer a therapeutic activity of radioactive iodine (RAI) under maximal TSH-stimulation, achieving a marked decrease in thyroglobulin accompanied by a clinical improvement.

Serum Inorganic Iodide Determined by Paired-Ion Reversed-Phase Hplc with Electrochemical Detection

Abstract We propose an automated method for the analysis of serum inorganic iodide (SII), using paired-ion reversed phase HPLC with electrochemical detection and a silver working electrode. Assay conditions include a flow rate of 1.0 mL/min and an operating potential of 0.10 V. The retention time for iodide is 5.3 min. Sample preparation consists in protein removal by ultrafiltration and concentration of the ultrafiltrate, because of the very low levels of SII, especially in iodine deficient areas. Ultrafiltration separation is achieved by pouring 2mL of a serum sample into a filter cup (membrane cutoff: 5kD) and then using a centrifugal force of 14000G over 90 min. A 1200μL aliquot of the ultrafiltrate is concentrated by a factor of 10 to a volume of 120μL in a centrifugal vacuum concentrator (Speed-Vac). A 100μL aliquot of the concentrate is injected into the HPLC. Due to concentration the detection threshold (signal-to-noise ratio of 3) could be lowered to 0.004μmol/L. The recovery of iodide during con...

Darstellung einer Orbitametastase eines Dünndarmkarzinoids mittels Oktreotidszintigraphie Eine kritische Betrachtung der Methodik

ZusammenfassungHintergrund: Orbitametastasen von Karzinoidtumoren sind selten. Die Überlebensdauer von Patienten mit Orbitametastasen eines Dünndarmkarzinoids beträgt nach Literaturangaben zwei Jahre. Eine kausale Therapie ist nicht möglich. Ziel der Arbeit: Anhand eines Falles soll die Bedeutung von Oktreotid bei diesem Krankheitsbild dargestellt werden. Kasuistik: Es wird die Krankengeschichte einer 59-jährigen Patientin mit Doppelbildern 6 Jahre nach Resektion eines Dünndarmkarzinoids beschrieben. Im Staging konnten mittels MRT und CT eine Orbitametastase rechts und Lebermetastasen nachgewiesen werden. In der Oktreotidszintigraphie fanden sich darüber hinaus paraaortal Lymphknotenmetastasen und die Orbitametastase rechts wurde bestätigt. Die Behandlung mit Oktreotid führte zu einer Besserung der Symptome Flush und Diarrhoe. Schlußfolgerung: In der Diagnostik von Karzinoidtumoren ist die Szintigraphie mit dem Somatostatin-Analogon Oktreotid für die Lokalisation von extrahepatischen und extraabdominellen Metastasen CT und Ultraschall überlegen. Die Oktreotidszintigraphie kann helfen, die Verdachtsdiagnose Orbitametastase eines Karzinoids zu erhörten. Oktreotid stellt ein wirksames Mittel zur Behandlung der Flush-Symptome und der Diarrhoe dar. Die Prognose quoad vitam wird davon nicht beeinflußt.SummaryBackground: An orbital carcinoid metastasis can be specifically imaged by octreotide scintigraphy. Orbital metastases of carcinoid tumors are rare. In the current literature only 27 cases have been published. Case report: We report on a 59 year-old woman who presented with diplopia 6 years after resection of a carcinoid tumor of the ileum. She also complained about flush and diarrhea. The diplopia was caused by limited extensibility of the right inferior muscle. Computed tomography with contrast revealed an enhancing tumor in the area of the right inferior rectus muscle, which appeared in the MRT as an isointense structure in the T1-weighted image. On staging, we found a contrast-enhancing nodular hepatic lesion. In octreotide scintigraphy, enhancement of the liver, thoracic and abdominal para-aortic lymph nodes and of the right inferior orbit was found. Conclusion: The survival times of patients with orbital metastasis of carcinoid tumors range between 7 months and 11 years. No specific treatment is available. Surgical excision is indicated for a symptomatic solitary metastasis. Octreotide is helpful in two ways: (1) as a radiolabeled tracer to detect extra-abdominal and extrahepatic secondary tumors; (2) as a treatment modality for flush and diarrhea, which is successful in over 60% of patients (life expectancy uninfluenced). Our patient is presently being treated with 200 μ of octreotide three times a day subcutaneously. Flush episodes and diarrhea have been reduced, but her ophthalmologic symptoms remain unchanged, and she has recently developed cardiac insufficiency.