RESUMO
Background: Acromegaly is an acquired disorder related to excessive production of growth hormone (GH) and insulin-like growth factor-1 (IGF-1). Empty sella (ES) is an anatomical condition of sella turcica that is partially or completely filled with cerebrospinal fluid mainly due to intrasellar herniation of subarachnoid space. Here, we describe a patient who presented with clinical and biochemical features of acromegaly and who had an ES on pituitary magnetic resonance imaging (MRI). Case report: A 73-year-old male patient was consulted in our clinic because of the acromegalic phenotype while planning for colorectal adenocarcinoma surgery. The patient noticed gradual enlarging of his hands, feet and nose for 30 years, but never consulted to any clinician for this reason. Serum GH was 20.6 ng/mL (normal <3 ng/mL) and IGF-1 was 531 ng/mL (normal, 69-200 ng/ml). An oral glucose tolerance test showed no suppression of GH values. T1-weighted MRI revealed an ES. 18F-FDG PET/CT and Ga-DOTATADE PET/CT did not show any finding consistent with ectopic GH secretion. Growth hormone releasing hormone (GHRH) was within the normal range (<100mg/dL). He was treated with long-acting octreotide 20 mg per 28 days. At the 6th month of treatment, serum GH and IGF-1 levels were decreased to 5.45 ng/mL and 274 ng/mL, respectively. Conclusion: The mechanism underlying the association of acromegaly and ES remains unclear. Apoplexy on existing pituitary adenoma and then formation of necrosis can proceed to ES. Since our patient did not have a history of pituitary apoplexy and we could not find any reason for secondary ES, we considered primary ES.
RESUMO
OBJECTIVE: The Bethesda classification was introduced in 2008 to provide standardisation in the evaluation of thyroid fine needle aspiration cytology (FNAC). We compared the diagnostic value of pre-Bethesda and Bethesda classification systems in the differentiation of benign and malignant thyroid nodules. METHODS: Medical records of patients who underwent a thyroidectomy between June 2007 and June 2014 were reviewed retrospectively. Nodules evaluated with FNAC before March 2010 were classified as pre-Bethesda (non-diagnostic, benign, indeterminate, suspicious for malignancy and malignant), and those evaluated after March 2010 were considered Bethesda (non-diagnostic, benign, atypia of undetermined significance/follicular lesion of undetermined significance, follicular neoplasia/suspicious for follicular neoplasia, suspicious for malignancy and malignant). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of the two classification systems were calculated. RESULTS: There were 1810 nodules in the pre-Bethesda and 5115 nodules in the Bethesda group. The non-diagnostic rate was significantly higher, and benign and suspicious for malignancy rates were lower in Bethesda compared with the pre-Bethesda group (P<.001 for each). When benign cytology was considered negative, and indeterminate, follicular neoplasia/suspicious for follicular neoplasia, suspicious for malignancy and malignant cytologies were considered positive, results for pre-Bethesda and Bethesda were as follows: sensitivity, 78.9% and 78.5%; specificity, 86.6% and 97.0%; PPV, 42.8% and 72.6%; NPV, 97% and 97.8%; and accuracy, 85.7% and 95.3%, respectively. CONCLUSIONS: Among operated nodules, percentages of benign and suspicious for malignancy cytologies decreased, and percentages of non-diagnostic and uncertain cytologies increased with the implementation of Bethesda. The diagnostic value of FNAC seems to have increased with the use of Bethesda classification.
