RESUMEN
RATIONALE: Multiple endocrine neoplasia 2A (MEN2A) is a rare autosomal-dominant genetic syndrome, frequently misdiagnosed or neglected clinically, resulting in delayed therapy to patients. PATIENT CONCERNS: A 47-year-old Chinese male patient underwent laparoscopic right adrenal tumorectomy, and postoperative pathology confirmed the tumor as pheochromocytoma (PHEO). He was readmitted to the department of endocrinology and metabolism due to constant increase in carcinoembryonic antigen (CEA) at 5âmonths after the operation. DIAGNOSIS: The patient was confirmed with medullary thyroid carcinoma (MTC), multiple neck lymph node metastasis, and pituitary microadenoma. The p.Cys611Tyr (c.1832G>A, C611Y) mutation was detected. Therefore, he was diagnosed with MEN2A. INTERVENTIONS: He underwent total thyroidectomy. The gene-sequencing analysis of his family was conducted, and the C611Y mutation was detected in his daughter. OUTCOMES: The level of carcinoembryonic antigen decreased significantly after thyroidectomy in this patient. Long-term follow-up management was conducted. Elevated serum calcitonin and bilateral thyroid nodules were found in his 13-year-old daughter. Thus, MEN2A was highly suspected and she was suggested to undergo total thyroidectomy. CONCLUSION: Patients with MEN2A should be screened regularly and managed by a multidisciplinary team.
Asunto(s)
Neoplasias de las Glándulas Suprarrenales/patología , Antígeno Carcinoembrionario/metabolismo , Neoplasia Endocrina Múltiple Tipo 2a/genética , Feocromocitoma/cirugía , Proteínas Proto-Oncogénicas c-ret/genética , Adolescente , Cuidados Posteriores , Pueblo Asiatico/etnología , Carcinoma Neuroendocrino/complicaciones , Carcinoma Neuroendocrino/diagnóstico , Carcinoma Neuroendocrino/cirugía , Exones , Femenino , Reordenamiento Génico/genética , Humanos , Comunicación Interdisciplinaria , Metástasis Linfática/patología , Masculino , Persona de Mediana Edad , Neoplasia Endocrina Múltiple Tipo 2a/diagnóstico , Neoplasia Endocrina Múltiple Tipo 2a/patología , Mutación , Núcleo Familiar/etnología , Linaje , Neoplasias Hipofisarias/complicaciones , Neoplasias Hipofisarias/diagnóstico , Neoplasias de la Tiroides/complicaciones , Neoplasias de la Tiroides/diagnóstico , Neoplasias de la Tiroides/cirugía , Tiroidectomía/métodos , Resultado del TratamientoRESUMEN
OBJECTIVES: Several studies have reported that the secretory immunoglobulin A (S-IgA) concentration in saliva is an indicator of psychological stress. The aim of this study was to clarify the relationship between S-IgA and the stress from academic examinations. METHODS: S-IgA levels in 10 medical student volunteers from the second year course between May 4 and July 13, 2000 were examined using the ELISA method. RESULTS: There was a tendency for S-IgA in saliva to be higher on the day before academic examinations and during them, and lower on the days between these examinations. CONCLUSIONS: It may be possible to use this measurement to monitor psychological stress in students and workers.