Normocalcemic hyperparathyroidism is associated with complications similar to those of hypercalcemic hyperparathyroidism.

Normocalcemic primary hyperparathyroidism (NC-PHPT) is a variant of hyperparathyroidism, characterized by normal serum calcium levels, high parathyroid hormone (PTH) and normal 25-OH vitamin D status. The present study aimed to compare complications related to hyperparathyroidism in patients with NC-PHPT and hypercalcemic PHPT (HC-PHPT). We retrospectively evaluated the records of 307 PHPT patients between January 2010 and March 2013. We excluded patients with impaired renal function and liver failure. All patients underwent a biochemical and hormonal examination including serum glucose, albumin, total calcium, phosphorus, creatinine, lipoproteins, PTH and 25-OH vitamin D. Nephrolithiasis and bone mineral density were documented based on a review of the medical records. The study population consisted of 36 (12 %) males and 271 (88 %) females with a mean age of 53.3 ± 9.5 years (29-70 years). Twenty-three of the patients were diagnosed with NC-PHPT (group 1) and 284 were diagnosed with HC-PHPT (group 2). There were no significant differences in terms of age, gender, prevalence of hypertension, low bone mineral density and kidney stones between the groups. The mean thyroid-stimulating hormone (TSH) and low-density lipoprotein (LDL) levels were significantly higher in group 1 than in group 2. Our study found that patients with NC-PHPT have similar several complications as patients with HC-PHPT. NC-PHPT patients have higher TSH levels despite being within the normal range, and higher LDL-C levels than patients with HC-PHPT. However, this relationship needs to be clarified in future studies with larger cohorts.

A rare presentation of subclinical Cushing's syndrome as a pubic fracture.

Osteoporosis and bone fractures are commonly seen in patients with Cushing's syndrome (CS). Fractures usually occur in the vertebrae and ribs whereas pubic fractures are less common. Similar to obvious hypercortisolemia, subclinical hypercortisolemia can increase the risk of fractures. However, in subclinical cases, bone fractures are very rarely seen as the presenting symptom. We herein report the case of a 62-year-old postmenopausal woman who was presented with a pubic fracture. During the evaluation of the fracture, thoracoabdominal magnetic resonance imaging of the patient demonstrated an adrenal mass. Although the patient did not show any signs of overt hypercortisolism, an endocrinologic evaluation revealed hypercortisolism due to an adrenal tumor. Adrenalectomy was performed, which resulted in a cure of the disease. During the orthopedic follow-up, the patient's pubic area pain gradually improved, and the pubic fracture healed without any accompanying new bone fractures. One year after the surgery, a remarkable improvement was detected in the patient's bone density in spite of the lack of administration of any medications for osteoporosis. Subclinical CS can present as a pubic fracture, and awareness of this relationship can help physicians to diagnose the disease.

Is autoimmune thyroiditis a risk factor for early atherosclerosis in premenopausal women even if in euthyroid status?

Autoimmune thyroiditis (AIT) is a systemic disease. It is well-known that overt thyroid dysfunction is a cardiovascular risk factor. However, the influence of euthyroid status is unclear. The aim of this study was to evaluate the metabolic parameters and carotid intima-media thickness (CIMT) in euthyroid premenopausal women with AIT. Fourty-eight premenopausal women and 18 age-matched healthy controls attending the Endocrinology and Metabolism Clinic from 2008 to 2009 were enrolled to this cross-sectional study. Patients were divided into 2 groups according to TSH levels; patients in group 1 (n = 23) had TSH levels ≤ 2.5 µIU/mL and patients in group 2 had TSH levels > 2.5 µIU/mL (n = 25). All participants were evaluated by ultrasound for CIMT (mean of three segments in both carotid arteries) by the same experienced investigator. Fasting venous blood samples were collected to evaluate insulin resistance (HOMA-IR), TSH, FT4, plasma lipids, high-sensitive CRP (Hs-CRP), homocysteine, and fibrinogen. Carotid intima-media thickness was found to be significantly higher in patients than the controls (p < 0.001). However, there was no significant difference in average CIMT between group 1 and 2 (0.66 ± 0.08 vs 0.63 ± 0.09 mm). Anti-Tg levels were independently associated with CIMT in the patient group (p = 0.014). There were no significant correlations between serum TSH levels and BMI; waist circumference, serum lipids, and glucose levels. However, there was a positive significant correlation between TSH levels and blood pressure in the patients (for systolic blood pressure r = 0.466, p = 0.001, for diastolic blood pressure r = 0.372, p = 0.009). In the present study, it was shown that CIMT is increased in euthyroid premenopausal women with autoimmune thyroiditis compared to age-matched healthy controls.

Prevalence of incidental thyroid cancer and its ultrasonographic features in subcentimeter thyroid nodules of patients with hyperthyroidism.

In patients, who undergo surgery for hyperthyroidism, many cases of incidental thyroid cancer (ITC) have been detected. In the literature, there is no study about ITC in subcentimeter nodules in these patients. We performed this study to determine the frequency of ITC in subcentimeter nodules and ultrasonographic features that can predict malignancy in the patients with hyperthyroidism. We retrospectively reviewed our database about 3114 patients, who underwent thyroidectomy in our hospital. Among 869 patients (27.9%), who were operated because of hyperthyroidism, we enrolled 337 patients, who underwent total thyroidectomy and had subcentimeter nodule [59 Graves' disease (GD) 98 subcentimeter nodule; 278 toxic multinodular goitre (TMNG), 359 subcentimeter nodule], in this study. Twenty-five nodules with ITC and 432 benign nodules have been detected and compared for ultrasonographic (US) features. Incidental thyroid cancer detection ratio was 5.4% [10.2% (10/98) in subcentimeter thyroid nodules in individuals with GD, and 4.1% (15/359) in individuals with TMNG, P = 0.018)]. Significant differences have been observed between the groups in terms of microcalcification in US examination of malign and benign subcentimeter thyroid nodules and the ratio of anterioposterior diameter to transverse diameter (A/T) ≥1 [(OR = 5.172; 95% CI: 1.495­17.886, P = 0.015), and (OR = 5.930; 95% CI: 1.531­22.971, P = 0.007), respectively]. We detected a higher incidence of ITC in subcentimeter thyroid nodules in GD compared to TMNG. US examination of subcentimeter nodules in hyperthyroid individuals has indicated that microcalcification and ratio of A/T ≥1 are the parameters that predict malignancy.

A rare cause of acute abdomen: ruptured adrenal pheochromocytoma.

Pheochromocytoma is a tumor of the chromaffin cells which secretes catecholamines and 90% of it originates from adrenal medulla. The main symptoms and signs are hypertension, tachycardia, sweating and headache. Rarely, acute abdomen may occur as a result of the rupture of tumoral mass or bleeding inside the mass. Here we present a 43 year old male patient who applied with acute abdominal syndrome and severe hypertension. Abdominal MRI showed a large mass hemorrhagic in nature above the right kidney. At laparotomy, ruptured adrenal mass was seen and excised successfully. The histological evaluation confirmed the diagnosis as pheochromocytoma. Ruptured adrenal pheochromocytoma is a mortal situation potentially and it should be considered in patients who present with an acute abdominal syndrome and hypertension or shock. It should be known that early diagnosis and surgery with proper preoperative treatment is a life saver.