Coexistence of Pituitary Adenoma Causing Acromegaly and Medullary Thyroid Cancer
Bibliographic record
Abstract
Abstract Background: We present a case of coexisting acromegaly and medullary thyroid cancer. As both conditions are rare, the association raises the possibility of causality (non-genomic) as opposed to pure coincidence. Clinical Lesson: A 73 year-old man presented to our clinic with an incidental finding of a left thyroid nodule. The patient underwent an ultrasound-guided fine needle aspiration biopsy which revealed medullary thyroid carcinoma. Shortly afterward, the patient underwent a total thyroidectomy with bilateral cervical lymph node dissection. The patient tested negative for mutations involving RET exons 8, 10, 11, 13, 14, 15, and 16. On initial presentation, the patient was also noticed to have an appearance typical of acromegaly, with spade-like hands and characteristic acromegalic facial features, including prognathism and macroglossia. These findings were long-standing. He was found to have elevated IGF-1 (121.4 nmol/L, reference range 6.1 - 26.9 nmol/L) and hyperprolactinemia (78.2 mcg/L, reference range 2.7 - 16.9 mcg/L). His growth hormone (GH) levels did not suppress following a 75 g oral glucose tolerance test. Magnetic resonance imaging of the sella turcica revealed a prominent pituitary gland and stalk with a rightward deviated infundibulum, with a suspected 1.1 cm left-sided pituitary macroadenoma. The patient declined surgical management, and he was instead managed medically with octreotide. Conclusion: Coexistance of GH-producing pituitary adenoma and medullary thyroid cancer is a rare occurrence. We identified ten cases previously described in the literature. Specifically, this is the second reported case of a patient presenting with both medullary thyroid cancer and pituitary adenoma causing acromegaly. The advanced acromegalic phenotype suggested long standing disease and therefore prolonged tissue exposure to elevated levels of IGF-I. Although acromegaly is more commonly associated with nodular goiter of follicular-cell origin, the possibility of a thyroidal C-cell neoplasm must be entertained especially if GLP-1 agonist therapy is being considered for the treatment of hyperglycemia.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".