Papillary carcinoma arising in a thyroglossal duct cyst; two case reports and review of the literature.

We present in this report two cases of papillary carcinoma arising in a thyroglossal duct cyst. The first case was a 32-year-old female patient who presented with a neck mass of 5 years' duration that had recently increased in size. The patient was otherwise asymptomatic. The second patient was a 41-year-old male patient who presented with a submental mass that had been growing over the previous several months. Associated symptoms included local symptoms such as dysphagia and hoarseness and general symptoms such as fatigue and weight loss. Pathological examination revealed the presence of papillary carcinoma in the mass with presence of focus of papillary carcinoma in the thyroid bed in both cases. Periosseous invasion of the hyoid bone and involvement of the submandibular lymph nodes were observed in the second patient. The patients underwent total thyroidectomy with lymph node dissection followed by radioactive iodine therapy and are currently on thyroxin replacement.

Silent pituitary infarction after coronary artery bypass grafting procedure: case report and review of literature.

OBJECTIVE: To report a case of silent pituitary infarction that occurred after a coronary artery bypass grafting procedure and review the relevant literature. METHODS: We describe a female patient with silent pituitary infarction several months after a coronary artery bypass operation and discuss her presentation, clinical findings, and laboratory evaluation. We also review similar cases in the literature. RESULTS: A 73-year-old woman presented with generalized fatigue, weakness, and an elevated creatine kinase level several months after she had undergone a coronary artery bypass procedure. The findings on laboratory evaluation were consistent with hypogonadism, growth hormone deficiency, central hypothyroidism, and adrenal insufficiency. Magnetic resonance imaging of the pituitary fossa showed an empty sella turcica and no sellar enlargement. The patient had no headaches, no neuro-ophthalmologic symptoms, and no focal neurologic deficits. The presentation was slow and insidious. The patient received glucocorticoid and thyroid hormone replacement therapy, after which her clinical status improved substantially. Silent pituitary infarction after coronary artery bypass grafting has been reported previously in 3 male patients, but our current case is the first such report in a female patient. CONCLUSION: Silent pituitary infarction can be a complication of a coronary artery bypass grafting procedure, with a delayed and insidious presentation.

Extreme elevation of intrasellar pressure in patients with pituitary tumor apoplexy: relation to pituitary function.

The dominant mechanism for hypopituitarism and hyperprolactinemia commonly observed in patients with pituitary macroadenomas was postulated to be increased intrasellar pressure (ISP) caused by the slow and gradual expansion of adenomas within the sella turcica. Hemorrhagic infarction of adenomas (pituitary tumor apoplexy) is associated with a rapid, rather than gradual, increase in intrasellar contents. The impacts of the sudden increase in intrasellar contents on ISP and pituitary function are unknown. ISP and pituitary function were determined in 13 patients with pituitary tumor apoplexy who had surgical decompression within 1 wk of symptoms' onset. ISP measurements were remarkably high (median, 47 mm Hg), whereas serum prolactin (PRL) concentrations were generally low (median, 3.5 microg/liter). There was an inverse correlation (r = -0.76; P < 0.01) between ISP measurements and serum PRL concentrations. Postoperatively, partial recovery or maintenance of pituitary function was noted in seven of 13 patients. These seven patients had higher (P = 0.013) serum PRL levels (9.3 +/- 7.4 microg/liter) and lower (P < 0.001) ISP measurements (35.9 +/- 7.3 mm Hg) than the respective values in the remaining six with persistent postoperative hypopituitarism (1.6 +/- 0.6 microg/liter and 55.9 +/- 2.4 mm Hg, respectively). The low serum PRL levels in patients with tumor apoplexy suggested that ischemic necrosis of the anterior pituitary resulting from sudden and extreme elevation of ISP was commonly observed in this setting. A normal or elevated serum PRL level in patients with non-PRL-secreting macroadenomas indicates the presence of viable pituitary cells and the high likelihood of postoperative recovery of pituitary function.

Endocrine changes in a rat model of chronic hypoxia mimicking cyanotic heart disease.

OBJECTIVE: The endocrine system plays an important role in the adaptation to hypoxia. The aim of this study is to assess the effect of chronic hypoxia on endocrine changes in a neonatal animal model mimicking cyanotic heart disease. METHODS: Sprague-Dawley rats were placed in a normobaric hypoxic environment at birth and oxygen levels were maintained at 10% in an airtight Plexiglas chamber. Controls remained in room air. Animals were sacrificed at 4 and 8 weeks of life. Hematocrit, Free T4 (FT4), Thyrotropin (TSH), corticosterone, and Growth hormone (GH) were measured. RESULTS: Significant polycythemia developed in the hypoxic rats. Free T4 levels were significantly lower in the hypoxic (H) group compared to the control (C) group at 4 and 8 weeks with FT4 of 2.44 +/- 1.11 ng/dL (H) and 4.35 +/- 1.62 (C) at 4 weeks with a p value < 0.005 and FT4 of 2.01 +/- 0.36 (H) and 3.25 +/- 0.54 (C) ng/dL at 8 weeks with p < 0.01. At 8 weeks TSH levels were significantly lower in the hypoxic group (1.84 +/- 0.9 ng/mL (H) vs. 3.11 +/- 1.1 (C)) with p < 0.05. Corticosterone levels were higher in the hypoxic group with values of 126 +/- 14.8 ng/mL (H) and 114.1 +/- 12.6 (H) at 4 and 8 weeks respectively, when compared to the control group with values of 82.9 +/- 18.1 (C) and 92.7 +/- 10.3 (C) and 4 and 8 weeks with p < 0.0005 and < 0.05 respectively. Growth hormone levels were lower in the hypoxic group at 4 and 8 weeks with p < 0.05 and p < 0.001, respectively. CONCLUSION: Chronic hypoxia in our neonatal rat model was associated with decrease in growth hormone levels and an increase in corticosterone levels. Furthermore, hypoxia resulted in thyroid hormone axis suppression. This effect seems to centrally mediated.