Pancytopenia Associated with Hypopituitarism in an Acromegaly Patient: A Case Report and a Review of the Literature

We present the case of a patient with acromegaly who had pancytopenia with hypopituitarism secondary to the excision of a pituitary macroadenoma and radiation therapy. A 28-year-old man presented with pancytopenia and serum electrolyte abnormalities. He was diagnosed with acromegaly and underwent surgery and gamma-knife radiotherapy for a pituitary macroadenoma at the age of 22 years. A recent brain magnetic resonance imaging showed an empty sella, and the basal hormonal profile demonstrated deficiencies of pituitary hormones except thyrotropin. As presenting pancytopenia, his bone marrow biopsy showed hypocellular marrow. The total number of hemocytes increased after hydrocortisone replacement. Hypopituitarism was a possible cause of pancytopenia, and glucocorticoids had crucial effects on converting pancytopenia to normal in this case.

A Case of Bilateral Struma Ovarii Combined with Subclinical Hyperthyroidism

Struma ovarii is a rare monodermal variant of ovarian teratoma accounting for only 2% of all mature teratomas. To be classified as a struma ovarii, teratoma must be composed predominantly of mature thyroid tissue (> 50%). This tumor is generally benign, although malignant transformation has been reported. Struma ovarii occur mostly as unilateral cases, so bilateral cases are quite rare (less than 6% of cases). Struma ovarii occur largely without symptoms or are accompanied by non-specific symptoms, such as abdominal pain, a palpable abdominal mass, and abdominal distension. The preoperative diagnosis is generally difficult. The incidence of hyperthyroidism has been reported to be 5-10% of patients with struma ovarii. Thus, cases of functional bilateral struma ovarii are very rare. We report a case of bilateral struma ovarii with subclinical thyrotoxicosis and a diffuse goiter, mimicking a malignant ovarian tumor, and include a brief review of related literature.

A Case of Actinomycotic Thyroiditis in an Adult with Piriform Sinus Fistula

Acute suppurative thyroiditis is an uncommon infectious thyroid disease affecting mainly children and young adults. The route of infection is frequently a pyriform sinus fistula. The major pathogens responsible for acute bacterial suppurative thyroiditis are the Streptococcus and Staphylococcus species. In contrast, Actinomyces species are a very rare cause of acute suppurative thyroiditis. We experienced a case of a 23-year-old man who has presented general weakness and neck pain. Thyroid ultrasonography showed an ill-defined area of heterogeneous hypoechogenicity in the left lobe of the thyroid gland. Histologic examination by fine needle aspiration demonstrated gram-positive, filamentous-like organisms with branching hyphae and characteristic sulfur granules. Barium esophagogram showed a linear barium-filled track at the left pyriform sinus. We report a case of actinomycotic thyroiditis in a young adult with pyriform sinus fistula along with a brief review of related literature.