Maria Kurowska

Thyroid diseases in patients with acromegaly

Acromegaly often involves the presence of different pathologies of the thyroid gland. Long-lasting stimulation of the follicular epithelium by growth hormone (GH) and insulin-like growth factor 1 (IGF-1) can cause disorders in thyroid function, an increase in its mass and the development of goitre. Acromegalic patients present most frequently with non-toxic multinodular goitre. Nodules are more prevalent in patients with active acromegaly. It has been suggested that then thyroid size increases and it can be reduced through treatment with somatostatin analogues. The relationship between thyroid volume and the level of IGF-1 and the duration of the disease is unclear. Each acromegalic patient requires a hormonal and imaging evaluation of the thyroid when the diagnosis is made, and an accurate evaluation during further observation and treatment. Although the data concerning the co-occurrence of acromegaly and thyroid cancer still remain controversial, it is particularly important to diagnose the patient early and to rule out thyroid cancer.

Temozolomide-Induced Shrinkage of Invasive Pituitary Adenoma in Patient with Nelson’s Syndrome: A Case Report and Review of the Literature

Introduction. Invasive tumours in Nelsons syndrome need aggressive therapy. Recent reports have documented the efficacy of temozolomide (TMZ) in the treatment of adenomas resistant to conventional management. Objective. The review of the literature concerning TMZ treatment of atypical corticotroph adenomas and a case study of 56-year-old woman who developed Nelsons syndrome. Treatment Proceeding. The patient with Cushings disease underwent transsphenoidal adenomectomy followed by a 27-month-long period of remission. Due to a regrowth of the tumor, she underwent two reoperations followed by stereotactic radiotherapy. Because of treatment failures, bilateral adrenalectomy was performed. Then she developed Nelsons syndrome. A fourth transsphenoidal adenomectomy was performed, but there was a rapid recurrence. Five months later, she underwent a right frontotemporal craniotomy. Due to a rapid regrowth of the tumour, the patient did not receive gamma-knife therapy and was treated with cabergoline and somatostatin analogue for some time. Only TMZ therapy resulted in marked clinical, biochemical, and radiological improvement. To date, this is the first case of invasive corticotroph adenoma in Nelsons syndrome treated with temozolomide in Poland. Conclusion. In our opinion, temozolomide can be an effective treatment option of invasive adenomas in Nelsons syndrome.

Long-term complete remission of Crooke’s corticotropinoma after temozolomide treatment

INTRODUCTION Crookes corticotropinomas are the unique cause of Cushings disease. The majority of them are aggressive macroadenomas, refractory to conventional therapy, with a high recurrence rate. The aim of the study was the presentation, in relation to data from the literature, of a case of a patient with ACTH-dependent Cushings syndrome caused by recurrent Crookes cells corticotropinoma, who achieved 33-month complete remission after treatment with temozolomide (TMZ). CASE REPORT A 54-year-old man was diagnosed with Cushings disease five years earlier on the basis of a typical clinical picture and hormonal tests. MRI revealed 32 × 29 × 24 mm macroadenoma. The patient underwent three subtotal selective transsphenoidal adenomectomies without retirement of hypercortisolaemia. A postoperative pathologic exploration revealed a densely granulated corticotroph Crookes cells adenoma with MIB-1 index < 1%. Because of the large size of the tumour with its expansion to both cavernous sinuses and suprasellar region together with a compression of the optic chiasm, the patient was disqualified for gamma-knife. Due to an exhaustion of all conventional therapeutic options the patient was qualified to TMZ therapy. The standard dose of TMZ (150 g/m²) for five days every 28 days was implemented. After three courses of TMZ pronounced regression of tumour size with a marked hormonal and clinical improvement was certified. After six courses, consecutive tumour regression was observed. Nine courses resulted in a total radiological tumour shrinkage and hormonal normalisation. Despite the cassation of TMZ treatment the complete remission of the disease maintained for 33 months. CONCLUSION Temozolomide can be an effective treatment option in invasive Crookes cell corticotropinoma. (Endokrynol Pol 2016; 67 (5): 526-533).

The efficacy of radioiodine therapy in patients with hyperfunctioning thyroid nodules

Achievement of euthyroidism or hypothyroidism is defined as a successful therapy. METHODS: The study was conducted in 666 patients – 484 with TA and 182 with TMG (85.58% of women), aged 56.19±13.88 years. We analyzed retrospectively hormonal and imaging findings (scintigraphy, ultrasonography), including isotopic results in subjects treated at Department of Nuclear Medicine and at Endocrinology Department during the eightyear period. The efficacy of RAI therapy has been assessed based on free thyroid hormones levels, measured 12 months after radioiodine administration. RESULTS: Mean concentrations of FT4 and FT3 and age did not differ significantly both groups. Patients with TA had lower thyroid mass and RAI 24-h uptake than subjects with TMG (p=0.0000). Administered therapeutic activities of RAI (MBq), calculated using Marinellis formula, were smaller in subjects with TA (537.03±181.39 vs 614.13±147.22; p=0.0000) and the thyroid-absorbed doses of RAI (Gy) in such patients were greater (p=0.0000).