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Gastric carcinoid type 1 in a patient with autoimmune polyglandular sydrome: additional endocrinological evaluation requiered

Ana Marija Vrkljan ; Mladen Sekso Clinical Department of Endocrinology, Diabetology and Metabolic Diseases, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
David Grašić ; Mladen Sekso Clinical Department of Endocrinology, Diabetology and Metabolic Diseases, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
Ivan Kruljac ; Mladen Sekso Clinical Department of Endocrinology, Diabetology and Metabolic Diseases, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
Marko Nikolić ; Clinical Department of Gastroenterology and Hepatology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
Jakša Filipović-Čugura ; Clinical Department of Surgery, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
Monika Ulamec ; Ljudevit Jurak Clinical Department of Pathology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
Ksenija Kovačić ; Clinical Department of Oncology and Nuclear Medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
Nenad Babić ; Clinical Department of Diagnostic and Interventional Radiology, Sestre milosrdnice University Hospital Center, School of Medicine, University of Zagreb, Zagreb, Croatia
Neven Ljubičić ; Clinical Department of Gastroenterology and Hepatology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia

Abstract

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.

Keywords

Stomach neoplasms; Carcinoid tumor; Polyendocrinopathies, autoimmune; Anemia, pernicious; Glucose intolerance; Case reports

Hrčak ID:

156230

URI

https://hrcak.srce.hr/156230

Publication date:

1.12.2015.

Article data in other languages: croatian

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