Medicine and Health Sciences Commons^™

Case Report: Lady With Bone Pains For 5 Years-Parathyroid Carcinoma, Azra Rizwan, Abid Jamal, Maseeh Uz Zaman, Saira Fatima

Section of Diabetes, Endocrinology and Metabolism

Background: Parathyroid cancer is a rare cause of primary hyperparathyroidism. It presents a diagnostic and therapeutic challenge that may not be recognized preoperatively, and is often not conclusively identified during the operation. We present the case of a lady with backache and hypercalcemia, but with inadequate work-up for her condition for several years.

Case Presentation: A middle aged lady of Asian descent presented with backache. Initial work up revealed mild hypercalcemia, negative work up for multiple myeloma, negative sestamibi scan for parathyroid pathology. A phenomenally elevated parathormone (PTH) level-2105 pg/mL (16-87 pg/mL), and rising serum calcium, 15.1 mg/dL, (8.6-10.5 …

Primary Adrenal Non-Hodgkin Lymphoma: A Case Report And Review Of The Literature, Nanik Ram, Owais Rashid, Saad Farooq, Imran Ulhaq, Najmul Islam

Section of Diabetes, Endocrinology and Metabolism

Background: Lymphomas are cancers that arise from the white blood cells and have been traditionally divided into two large subtypes: Hodgkin and non-Hodgkin lymphoma. B-cell lymphoma is the most common subtype of non-Hodgkin lymphoma; almost 85% of patients with lymphoma have this variant. Lymphomas can potentially arise from any lymphoid tissue located in the body; however, primary adrenal non-Hodgkin lymphoma is extremely rare. We report the history, examination findings, and laboratory results of a 50-year-old man diagnosed with a primary left adrenal diffuse large B-cell lymphoma.

CASE PRESENTATION: A 50-year-old Pakistani man presented to our hospital with progressively increasing pain …

Resistant Thyrotoxicosis In A Patient With Graves Disease: A Case Report, Taimur Saleem, Aisha Sheikh, Qamar Masood

Section of Diabetes, Endocrinology and Metabolism

Background: Conventional management of thyrotoxicosis includes antithyroid drugs, radioactive iodine, and surgery while adjunctive treatment includes beta-blockers, corticosteroids, inorganic iodide and iopanoic acid. Very rarely, patients may be resistant to these modalities and require additional management.

Case Presentation: A 50-year-old lady presented with weight loss and palpitations diagnosed as atrial fibrillation. Her past history was significant for right thyroid lobectomy for thyrotoxicosis. Thyroid functions tests at this presentation showed free T4 of 6.63 ng/dl (normal range: 0.93-1.7) and TSH of <0.005 μIU/mL (normal range: 0.4-4.0). She was given aspirin, propranolol, heparin and carbimazole; however free T4 failed to normalize. Switching to propylthiouracil (PTU) did not prove successful. She was then given high doses of prednisolone (1 mg/kg/day) and lithium (400 mg twice daily) which prepared the patient for radioactive iodine treatment by reducing free T4 levels (2.82 ng/dl). Two doses of radioactive iodine were then administered 6 months apart. Subsequently she became hypothyroid and was started on thyroid replacement therapy.

Conclusion: This case highlights management options in patients with resistant thyrotoxicosis. Radioactive iodine and surgery are definitive modes …