Karcinoid želuca tipa 1 u bolesnika s autoimunim poliglandularnim sindromom zahtijeva dodatne endokrinološke pretrage
| Autor: | Ana Marija Vrkljan, David Grašić, Ivan Kruljac, Marko Nikolić, Jakša Filipović-Čugura, Monika Ulamec, Ksenija Kovačić, Nenad Babić, Neven Ljubičić |
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| Jazyk: | angličtina |
| Rok vydání: | 2015 |
| Předmět: | |
| Zdroj: | Acta clinica Croatica Volume 54. Issue 4. |
| ISSN: | 1333-9451 0353-9466 |
| Popis: | Autoimmune polyglandular syndrome by definition consists of two or more endocrinological insufficiencies or two organ specific autoimmune diseases. There are no stringent criteria for endocrinological evaluation of patients with one endocrine insufficiency. However, detailed endocrinological evaluation should be undertaken in patients with two autoimmune diseases. Additionally, follow up thereafter should be a must in these patients in order to avoid the possibility of not diagnosing subsequent autoimmune diseases that can occur. The aim of this case report is to point to the necessity of endocrinological screening to be made in patients presenting with gastric carcinoid type 1. We report on a 62-year-old woman who was diagnosed with primary hypothyroidism in 1993. In 2011, she was re-admitted to the hospital due to increasing fatigue. Macrocytic anemia, low vitamin B12 levels and positive parietal antibodies confirmed pernicious anemia. Furthermore, she underwent gastroscopy, which revealed two polyps in the corpus of the stomach and one in the fornix. Endoscopic mucosal resection was performed and histopathologic analysis confirmed three G1 gastric carcinoids (Ki67 2%). Additional endocrinological evaluation disclosed positive glutamic acid decarboxylase antibodies, but normal fasting and postprandial glucose and HbA1c. In 2013, she was diagnosed with glucose intolerance and subsequently with latent autoimmune diabetes of adulthood. Plasma glucose and HbA1c normalized after dietary intervention. Due to the increase of serum chromogranin A, prophylactic antrectomy was performed in 2014. The patient is still followed-up and has normal chromogranin A, gastrin and HbA1c levels. Autoimuni poliglandularni sindrom čine dvije ili više endokrinih insuficijencija ili najmanje dvije za organ specifične autoimmune bolesti. Ne postoje jasne smjernice za endokrinološko testiranje i praćenje bolesnika s jednom endokrinom insuficijencijom. Bolesnici s dvije endokrine insuficijencije ili za organ specifične autoimmune bolesti trebaju detaljnu endokrinološku obradu kako bi se isključila mogućnost postojanja treće autoimmune bolesti. Cilj ovoga prikaza slučaja jest naglasiti nužnost dodatne endokrinološke obrade u bolesnika s karcinoidom želuca tipa 1. Prikazujemo slučaj bolesnice kojoj je godine 1993. otkrivena primarna hipotireoza. Godine 2011. bolesnica je hospitalizirana zbog izražene opće slabosti i malaksalosti. Makrocitna anemija, nizak vitamin B12 i pozitivna protutijela na parijetalne stanice potvrdili su dijagnozu perniciozne anemije. Gornjom endoskopijom probavnog trakta otkrivena su dva polipa u korpusu i jedan u forniksu želuca. Nakon endoskopskog ultrazvuka učinjena je endoskopska mukozektomija svih triju polipa. Patohistološka analiza potvrdila je karcinoide gradusa 2 (Ki67 2%). Dodatnim endokrinološkim testiranjem otkrivena su povišena protutijela na dekarboksilazu glutamata uz uredne vrijednosti glukoze u plazmi i HbA1c. Godine 2013. otkrivena je intolerancija glukoze te je postavljena dijagnoza latentnog autoimunog dijabetesa odrasle dobi. Glukoza u plazmi se normalizirala nakon higijensko-dijetetskih mjera. Zbog porasta kromogranina A u serumu učinjena je antrektomija godine 2014. Bolesnica sad ima uredan kromogranin A, gastrin i HbA1c. |
| Databáze: | OpenAIRE |
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