Skip to main content
SpringerLink
Log in

Medullary Thyroid Carcinoma: Ectopic ACTH Production by Liver Metastases (Report of Two Cases)

  • Conference paper
Struma maligna

  • 16 Accesses

Summary

Two male patients with Cushing’s syndrome secondary to metastatic medullary thyroid carcinoma (MTC) were observed in our series of 49 patients with MTC admitted during years 1969–90. A 32-year old male (Case 1) and a 39-year old male (Case 2) had been initially treated elsewhere for neck tumours. Nearlytotal thyroidectomy was performed in Case 1, whereas the other patient was treated by irradiation. They were admitted to the Institute of Oncology Ljubljana (10) for the diagnosis and treatment. MTC was confirmed in both cases. Serum thyreocalcitonin (TC) and CEA assay were evaluated for diagnosis, treatment response and follow-up. In both cases the appropriate surgery and additional multimodal therapy failed to normalize tumour marker values. Bone and/or liver metastases were diagnosed in both cases 22 and eight months after admission, respectively. Clinical signs and symptoms indicating Cushing’s syndrome accompanied the onset of liver metastases. ACTH and Cortisol levels were elevated and ectopic ACTH production was confirmed by endocrinologic tests.

Medullary thyroid carcinoma (MTC) was recognized as a new clinicopatho-logical entity by Hazard et al. in 1959 [4]. Among numerous substances such as thyreocaltitonin (TC) and carcinoembrionic antigen (CEA) secreted by MTC cells, also ACTH is produced in rare instances. We present two patients with MTC in whom ACTH dependent Cushing’s syndrome [5,7,21] accompanied the onset of MTC liver metastases.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 49.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 59.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Aldabagh SM, Trujillo YP, Taxy JB (1986) Occult medullary thyroid carcinoma: unusual histological variant presenting with metastatic disease. Am J Clin Pathol 85:247–250

    PubMed  CAS  Google Scholar 

  2. Auersperg M, Us-Krasovec M, Petric G, Pogacnik A, Besic N (1990) Results of combined modality treatment in poorly differentiated and anaplastic thyroid carcinoma. Wien Klin Wochenschr 102:267–270

    PubMed  CAS  Google Scholar 

  3. Gautvik KM, Talle K, Hager B, Jorgensen OG, As M (1989) Early liver metastases in patient with medullary carcinoma of the thyroid gland. Cancer 63:175–180

    Article  PubMed  CAS  Google Scholar 

  4. Hazard JB, Hawk WA, Crile G Jr (1959) Medullary (solid) carcinoma of the thyroid — a clinicopathologic entity. J Clin Endocrinol Metab 19:152–161

    Article  PubMed  CAS  Google Scholar 

  5. Heitz PU, Kloppel G, Polak JM, Staub JJ (1981) Ectopic hormone production by endocrine toumors: localization of hormones at the cellular level by immunocytochemis-try. Cancer 48:2029–2037

    Article  PubMed  CAS  Google Scholar 

  6. Hoskin PJ, Harmer C (1987) Chemotherapy for thyroid cancer. Radiother Oncol 10:187–194

    Article  PubMed  CAS  Google Scholar 

  7. Jolivet J, Beauregard H, Sommamma M, Band PR (1980) ACTH-secreting medullary carcinoma of the thyroid: monitoring of clinical course with calcitonin and Cortisol assays and immunohistochemical studies. Cancer 46:2667–2670

    Article  PubMed  CAS  Google Scholar 

  8. Mendelsohn G, Wells SA, Baylin SB (1984) Relationship of tissue carcinoembryonic antigen and calcitonin to tumour virulence in medullary thyroid carcinoma: an immunohistochemical study in early, localized, and virulent disseminated stages of disease. Cancer 54:657–662

    Article  PubMed  CAS  Google Scholar 

  9. Ponder BA, Finer N, Coffey R, Harmer CL, Maisey M, Ormerod MG, Pembley ME, Ponder MA, Rosswick P, Shalet S (1988) Family screening in medullary thyroid carcinoma presenting without a family history. Q J Med 67:299–308

    PubMed  CAS  Google Scholar 

  10. Ruppert JM, Eggleston JC, DeBustros A, Baylin SB (1986) Disseminated calcitonin-poor medullary thyroid carcinoma in a patient with calcitonin-rich primary tomour. Am J Surg Pathol 10:513–518

    Article  PubMed  CAS  Google Scholar 

  11. Saad MF, Fritsche HA Jr, Samaan NA (1984) Diagnostic and prognostic values of carcinoembryonic antigen in medullary carcinoma of the thyroid. J Clin Endocrinol Metab 58:889–894

    Article  PubMed  CAS  Google Scholar 

  12. Saad MF, Ordonez NG, Rashid RK, Guido JJ, Hill CS, Hickey RC, Samaan NA (1984) Medullary carcinoma of the thyroid: a study of the clinical features and prognostic factors in 161 patients. Medicine 63:319–342

    Article  PubMed  CAS  Google Scholar 

  13. Schlumberger M, Gardet P, DeVathaire F, Sarrazin D, Travagli JP, Parmen (1991) External radiotherapy and chemotherapy in MTC patients. In: Calmettes C, Guliana JM (eds) Medullary thyroid carcinoma. John Libbey Eurotext, Paris London, pp 213–220

    Google Scholar 

  14. Sizemore GW (1987) Medullary carcinoma of the thyroid gland. Semin Oncol 14:306–314

    PubMed  CAS  Google Scholar 

  15. Stern N, Tuck ML (1989) The adrenal cortex and mineralocorticoid hypertension. In: Lavin N (ed) Manual of endocronology, 3rd edn. Little Brown and Co., Boston Toronto, pp 107–130

    Google Scholar 

  16. Takami H, Bessho T, Kameya T, Mimura T, Ito K, Abe O, Hosoda Y, Shikata J (1988) Immunohistochemical study of medullary thyroid carcinoma: relationship of clinical feature to prognostic factors in 36 patients. World J Surg 12:572–579

    Article  PubMed  CAS  Google Scholar 

  17. Tisell LE, Hansson G, Jansson S, Salander H (1986) Reoperation in the treatment of asymptomatic metastasizing medullary thyroid carcinoma. Surgery 99/1:60–66

    PubMed  CAS  Google Scholar 

  18. Tisell LE, Hanson G, Jansson S (1989) Surgical treatment of medullary carcinoma of the thyroid. Horm Metab Res [Suppl] 21:29–31

    CAS  Google Scholar 

  19. Tourniaire J, Rebattu B, Conte-Devolx B, Trouillas J, Grino M, Berger-Dutrieux N, Peix JL, Pugeant M (1988) Syndrome de Cushing secondaire a la production ectopique de CRF par un carcinome medullaire du corps thyroide. Ann Endocrinol 4:61–67

    Google Scholar 

  20. Trainer PJ, Grossman A (1991) The diagnosis and differential diagnosis of Cushing’s syndrome. Clin Endocrinol 34:317–330

    Article  CAS  Google Scholar 

  21. Uribe M, Grimes M, Fenoglio-Preiser C, Feind C (1985) Medullary carcinoma of the thyroid gland. Am J Surg Pathol 9:577–594

    Article  PubMed  CAS  Google Scholar 

  22. White IL, Vimadalal S, Catz B, Van de Velde R, Laganga T (1981) Occult medullary carcinoma of thyroid: an unusual clinical and pathologic presentation. Cancer 47:1364–1368

    Article  PubMed  CAS  Google Scholar 

Download references

Authors
  1. D. Bergant
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Auersperg
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Us-Krašovec
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. G. Petrič
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. Hočevar
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. EMCO-Privatklinik, Chirurgie, Martin-Hell-Str. 7-9, A-5422, Bad Dürrnberg, Austria

    Wolfgang Pimpl

  2. Nuklearmedizin, LKA, Müllnerhauptstr. 48, A-5020, Salzburg, Austria

    Günther Galvan

  3. Radiotherapie und Radioonkologie, LKA, Müllnerhauptstr. 48, A-5020, Salzburg, Austria

    H. Dieter Kogelnik

  4. Heeressanitätsanstalt, Khevenhüller-Kaserne, A-9020, Klagenfurt-Lendorf, Austria

    Dieter Manfreda

  5. I. Chir. Univ.-Klinik, Alserstr. 4, A-1090, Wien, Austria

    Bruno Niederle

  6. Robert-Rössle-Klinik, Am Max-Delbrück-Zentrum, Lindenberger Weg 80, O-1115, Berlin-Buch, Germany

    Peter Schlag

  7. I. Chir. Abtlg., LKA, Müllnerhauptstr. 48, A-5020, Salzburg, Austria

    Hans-Werner Waclawiczek

Rights and permissions

Reprints and permissions

Copyright information

© 1993 Springer-Verlag Berlin Heidelberg

About this paper

Cite this paper

Bergant, D., Auersperg, M., Us-Krašovec, M., Petrič, G., Hočevar, M. (1993). Medullary Thyroid Carcinoma: Ectopic ACTH Production by Liver Metastases (Report of Two Cases). In: Pimpl, W., et al. Struma maligna. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-78192-6_19

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-78192-6_19

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-56637-3

  • Online ISBN: 978-3-642-78192-6

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation