Clinical and Surgical Attitude in a Men2 Syndrome Case With Medullary Thyroid Carcinoma Recurrence During Pregnancy

Abstract

Multiple endocrine neoplasia type 2 is a group of medical disorders associated with tumours of the endocrine system. The tumours may be benign or malignant. They generally occur in the endocrine organs (e.g. thyroid, parathyroid, and adrenals), but may also occur in the endocrine tissues of organs not classically thought of as endocrine. We present the case of a 28-year-old female, with history of MEN2A syndrome confirmed by genetic screening and manifested by bilateral pheochromocytoma, for which she underwent right adrenalectomy in 2009 and left adrenalectomy in 2011, as well as by medullary carcinoma of the thyroid, for which total thyroidectomy was performed in 2009. At present, the patient is under replacement treatment of the thyroid function with LT4 and glucocorticoid and mineralocorticoid replacement therapy with Prednisone and Astonin. Currently, the patient has been periodically presenting herself for clinical and therapeutic endocrinological re-evaluation, in the context of an ongoing pregnancy. During a presentation, in September 2015, the pregnancy being in its 24th week, at ultrasonography, a possible remnant of thyroid tissue was detected, a superior and mediolateral adenopathy, well defined, with some interior calcifications, discretely vascularized, therefore of a suspicious nature and a left supraclavicular small cluster of microcalcifications was also detected. Calcitonin blood level was measured in order to dynamically correlate its evolution with the new ultrasound findings with a significant increase at the current dosing reaching 587.20 pg / ml.