TY - JOUR

T1 - Редкий случай АКТГ-продуцирующей медуллярной карциномы щитовидной железы

AU - Тимофеева, Наталья Игоревна

AU - Слепцов, Илья Валерьевич

AU - Семенов, Арсений Андреевич

AU - Реброва, Дина Владимировна

AU - Черников, Роман Анатольевич

AU - Алексеев, Михаил Александрович

AU - Куликов, Алексей Юрьевич

AU - Придвижкина, Татьяна Сергеевна

AU - Воробьев, Сергей Леонидович

AU - Русаков, Владимир Федорович

PY - 2025/7/22

Y1 - 2025/7/22

N2 - Medullary thyroid carcinoma is a rare aggressive tumor of thyroid gland. Due to its neuroendocrine origine medullary thyroid carcinoma can be the source of ectopic production of different peptides and hormones. We describe a unique case of severe ACTH-dependent Cushing's syndrome due to ectopic corticotropin production by medullary thyroid carcinoma in a male patient of 39 years old with calcitonin level more than 4000 pg/ml (<11,8), thyroid nodule, multiple neck jugular and central lymphnodes. The potassium level was 1,34 mmol/l (3,5-5,1), hypercortisolemia up to 1613,2 nmol/l (185-624) with elevated level of ACTH up to 24,7 pmol/l (1,03-10,74). After the correction of water and electrolytes disorders an operation was performed - thyroidectomy, central and lateral neck dissection. Postoperative calcitonin decreased to 126 pg/ml (<11,8), calcium and parathormone blood levels remained normal. The potassium level didn't decrease without any pharmacological treatment. There was a sharp fall in postoperative blood levels of cortisol and ACTH. The hormonal replacement treatment with hydrocortisone was induced. Morphological examination showed medullary carcinoma with ACTH production in tumor nodule, with metastatic neck lymph nodes. Thus this is a rare case and successful treatment of patient with severe hypercortisolism by thyroidectomy and neck lymphnodes dissection.

AB - Medullary thyroid carcinoma is a rare aggressive tumor of thyroid gland. Due to its neuroendocrine origine medullary thyroid carcinoma can be the source of ectopic production of different peptides and hormones. We describe a unique case of severe ACTH-dependent Cushing's syndrome due to ectopic corticotropin production by medullary thyroid carcinoma in a male patient of 39 years old with calcitonin level more than 4000 pg/ml (<11,8), thyroid nodule, multiple neck jugular and central lymphnodes. The potassium level was 1,34 mmol/l (3,5-5,1), hypercortisolemia up to 1613,2 nmol/l (185-624) with elevated level of ACTH up to 24,7 pmol/l (1,03-10,74). After the correction of water and electrolytes disorders an operation was performed - thyroidectomy, central and lateral neck dissection. Postoperative calcitonin decreased to 126 pg/ml (<11,8), calcium and parathormone blood levels remained normal. The potassium level didn't decrease without any pharmacological treatment. There was a sharp fall in postoperative blood levels of cortisol and ACTH. The hormonal replacement treatment with hydrocortisone was induced. Morphological examination showed medullary carcinoma with ACTH production in tumor nodule, with metastatic neck lymph nodes. Thus this is a rare case and successful treatment of patient with severe hypercortisolism by thyroidectomy and neck lymphnodes dissection.

KW - ACTH Syndrome, Ectopic/etiology

KW - Adrenocorticotropic Hormone/blood

KW - Adult

KW - Carcinoma, Neuroendocrine/complications

KW - Cushing Syndrome/etiology

KW - Humans

KW - Male

KW - Thyroid Neoplasms/complications

KW - Thyroidectomy

UR - https://www.mendeley.com/catalogue/b16d1fc9-c52b-3779-a77b-0a567a913e58/

U2 - 10.14341/probl13512

DO - 10.14341/probl13512

M3 - статья

C2 - 40734296

VL - 71

SP - 25

EP - 33

JO - ЭНДОКРИННАЯ ХИРУРГИЯ

JF - ЭНДОКРИННАЯ ХИРУРГИЯ

SN - 2306-3513

IS - 3

ER -