RESUMO
Excessive amounts of vasoactive intestinal polypeptide (VIP) cause a special clinical syndrome characterized by secretory diarrhea, hypokalemia and dehydration. A careful clinical workup of a 62-year-old female admitted for refractory diarrhea revealed a neglected inflammatory right breast ductal carcinoma with VIP hypersecretion without any localized abdominal tumor. Immunohistochemistry of the breast biopsy showed neuroendocrine characteristics with positive staining for VIP, and Octreotide scan showed hyperfixation to the right breast and axilla. Primary therapy of breast cancer with hormones and chemotherapy achieved transitory regression of diarrhea, VIP level decrease, and tumor border reduction. Bilateral modified radical mastectomy and irradiation of the tumor failed to prevent liver and bone dissemination of the disease. Once more, partial response was obtained by octreotide and salvage chemotherapy; however, the patient died from progressive disease 23 months after initial diagnosis. To our best knowledge, this unusual presentation of a breast carcinoma with related VIPoma syndrome is the first reported case in the literature.
Assuntos
Carcinoma Ductal de Mama/metabolismo , Neoplasias Inflamatórias Mamárias/metabolismo , Peptídeo Intestinal Vasoativo/metabolismo , Vipoma/metabolismo , Feminino , Humanos , Imuno-Histoquímica , Pessoa de Meia-IdadeRESUMO
INTRODUCTION: Subacute thyroiditis (SAT) is a spontaneously remitting inflammatory disorder of the thyroid that is presumed to be virally induced in genetically predisposed individuals. A strong association has been suggested between human leukocyte antigen (HLA)-B35 and patients who developed SAT. However, familial occurrence of SAT associated with HLA-B35 is reported only rarely. CASE-REPORTS: We report three sibs, (two brothers and one sister) living in the same Lebanese town, who developed SAT during an 18-month-period. All tested positive for HLA-B35. DISCUSSION: The family described here represents the first Third World third familial report of SAT associated with HLA-B35. It highlights the probably underestimated importance of genetic predisposition to SAT in families.
Assuntos
Antígeno HLA-B35/genética , Tireoidite Subaguda/tratamento farmacológico , Tireoidite Subaguda/genética , Administração Oral , Antagonistas Adrenérgicos beta/administração & dosagem , Antagonistas Adrenérgicos beta/uso terapêutico , Adulto , Anti-Inflamatórios/administração & dosagem , Anti-Inflamatórios/uso terapêutico , Anti-Inflamatórios não Esteroides/administração & dosagem , Anti-Inflamatórios não Esteroides/uso terapêutico , Feminino , Seguimentos , Predisposição Genética para Doença , Humanos , Cetoprofeno/administração & dosagem , Cetoprofeno/uso terapêutico , Masculino , Prednisona/administração & dosagem , Prednisona/uso terapêutico , Propranolol/administração & dosagem , Propranolol/uso terapêutico , Tireoidite Subaguda/diagnóstico , Tireoidite Subaguda/imunologia , Fatores de Tempo , Resultado do TratamentoRESUMO
INTRODUCTION: Central pontine myelinolysis (CPM), demyelination of the brain stem, is a brain injury apparently due to osmotic forces. There is no consensus for its treatment. CASE: We describe here a case of CPM that occurred in a young patient after correction of hyponatremia, its treatment by intravenous thyrotropin-releasing hormone, and its outcome. DISCUSSION: Although very few instances of thyrotropin-releasing hormone treatment for CPM have been described, it appears to be effective and well tolerated. Studies are needed to assess its real efficacy.