Metastatic Pancreatic Neuroendocrine Tumor that Progressed to Ectopic Adrenocorticotropic Hormone (ACTH) Syndrome with Growth Hormone-releasing Hormone (GHRH) Production.

The patient was a 61-year-old woman who had a well-differentiated pancreatic neuroendocrine tumor (PNET) with lymph node metastasis. After 15 months of octreotide treatment, glucose control deteriorated and pigmentation of the tongue and moon face developed, leading to the diagnosis of ectopic adrenocorticotropic hormone (ACTH) syndrome. An abnormal secretion of growth hormone (GH) was identified, and the plasma growth hormone-releasing hormone (GHRH) level was elevated. A tumor biopsy specimen positively immunostained for ACTH and GHRH. Ectopic hormone secretion seems to have evolved along with the progression of the PNET.

Prevalence of malignant tumors and adenomatous lesions detected by ultrasonographic screening in patients with autoimmune thyroid diseases.

BACKGROUND: Thyroid ultrasonography (US) is the most sensitive method for detecting thyroid nodules, and US-guided aspiration biopsy is the most accurate diagnostic procedure for thyroid nodules. We performed this retrospective study to establish the prevalence of thyroid nodules in Graves' disease and patients with Hashimoto's thyroiditis at the time of their initial visit. METHODS: We performed thyroid US as routine screening in 1652 patients with Graves' disease and 2036 Hashimoto's thyroiditis and performed US-guided fine-needle aspiration biopsy when the diameter of a nodule >1 cm or a nodule was suspected of being malignant. RESULTS: The prevalence of papillary carcinoma in the patients with Hashimoto's thyroiditis was higher than in the patients with Graves' disease (1.77% vs. 0.97%), and two patients with Hashimoto's thyroiditis (0.098%) were found to have malignant lymphoma. Adenomatous lesions were observed more frequently in the patients with Hashimoto's thyroiditis than in the patients with Graves' disease. The prevalence of adenomatous lesions increased in an age-dependent manner in both the patients with Graves' disease and those with Hashimoto disease; and adenomatous lesions were more frequent in younger patients with Hashimoto' s thyroiditis than in those with Graves' disease. CONCLUSIONS: The prevalence of both thyroid papillary cancer and adenomatous lesions was greater in the patients with Hashimoto's thyroiditis than in those with Graves' disease; and adenomatous lesions were more frequent in younger patients with Hashimoto's thyroiditis. We recommend performing US at the time of the initial visit in patients with autoimmune thyroid disease, who have a high prevalence of thyroid papillary carcinoma, to detect malignant thyroid tumors and adenomatous lesions.

A LIM protein, Hic-5, functions as a potential coactivator for Sp1.

Hic-5 is a LIM protein with striking similarity to paxillin, and shuttles between focal adhesions and the nucleus. Our previous study suggested that Hic-5 participates in the transcriptional control of several genes such as the c-fos and p21 genes. In the present study, we examined the function of Hic-5 in the nucleus using the transcriptional promoter region of the p21 gene. When localized to the nucleus, Hic-5 was found to transactivate the p21 promoter through two of five Sp1 sites in the region proximal to the TATA box. The Hic-5 effect was mediated by a transactivation domain of Sp1 and functional interaction with p300 through the LIM4 domain. Hic-5 was also shown to interact functionally and physically with Smad3 through the LIM domains and to potentiate p21 promoter activity together with Smad3 and Sp1. These properties were confirmed in an artificial system using GAL4-fusion protein. Thus, Hic-5 was suggested to have a potential function as a cofactor in the transcriptional complex that contains Sp1, playing a role in gene transcription in the nucleus as well as in integrin signaling at focal adhesion sites.