INTERNAL MEDICINE GRAND ROUNDS

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INTERNAL MEDICINE GRAND ROUNDS

• Neel Chokshi MD
• October 17, 2007

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INITIAL PRESENTATION

• Chief Complaint
• 37 year old woman presents with new neck mass
• History of Present Illness
• Patient was diagnosed with hypertension 4 years
  prior to this presentation and was started on
  medication at that time. In addition, she notes
  multiple family members, including her mother,
  have had thyroid problems as well as
  hypertension. She is unclear on which members as
  well as the exact nature of these problems.
• She now presents to her primary care physician
  after noticing a mass on her neck approximately 3
  weeks prior while getting dressed. She has no
  associated symptoms.
• On review of systems, she notes occasional
  headaches.

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ADDITIONAL HISTORY

• Past Medical History None
• Past Surgical History Caesarean Section birth 5
  years prior
  
• Family History
• Multiple family members, including mother, with
  unknown thyroid problems
  
• Multiple family members, including mother, with
  hypertension
  
• Social History
• She drinks alcohol socially, and notes no history
  of tobacco or drug use
  
• She is married, lives at home with husband and
  child, works part-time at local retail store
  
• Medications
• Hydrochlorothiazide
• Multivitamin
• No known allergies

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PHYSICAL EXAM

• General Well appearing, mildly obese White
  woman
  
• Vitals BP 145/85, Pulse 67, Temp 98.9
• Head and Neck 2 cm firm mass in left inferior
  aspect of thyroid
  
• No other pertinent findings on physical exam

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LABORATORY VALUES
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LABORATORY VALUES
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DIAGNOSTIC COURSE

• Fine Needle Aspiration of Neck Mass Changes
  consistent with medullary thyroid cancer
  
• Neck and Chest CT No lymphadenopathy or
  metastases
  
• 24 Hour Urine Studies
• Abdominal CT Scan Left adrenal gland 2 cm mass
• Genetic Testing Analysis revealed a mutation in
  the RET domain
  

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TREATMENT PLAN

• Pheochromocytoma Referral to surgery for
  resection with pre-operative medical management
  
• Medullary Thyroid Cancer Resection and neck
  dissection post management of pheochromocytoma
  
• Referral to genetic counseling

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FINAL DIAGNOSIS

• Multiple Endocrine Neoplasia Type 2A With
  Medullary Thyroid Cancer and Pheochromocytoma