Yesterday in morning report we had a really interesting case of medullary thyroid cancer presenting with chronic diarrhea and complicated by heart failure, likely secondary to amyloidosis.
A little more about medullary thyroid cancer (MTC):
- MTC can be either sporadic or inherited. Inherited forms involve mutations to the RET proto-oncogene and can be either be alone or as part of one of the Multiple Endocrine Neoplasia syndromes- MEN 2A or MEN 2B.
- MEN 2A is characterized by MTC with hyperparathyroidism and/or pheochromocytoma
- MEN 2B is characterized by MTC with typical phenotyic features such as marfanoid body habitus or mucosal neuromas with or without pheochromocytoma.
- Most patients present with a thyroid mass, but some present with symptoms of local spread such as dysphagia, dyspnea, or hoarseness. Roughly 10% will present with systemic symptoms related to the production of neuroendocrine mediators such as calcitonin, resulting in bone pain, flushing, and/or diarrhea.
- Those that present with systemic symptoms usually have metastatic disease.
- More in a review from Cancer here
We also found out through our group searching excercise that MTC is associated with secondary amyloidosis casued by calcitonin.
-A good related article sent out by Dr. Abrams here.
- More on amyloidosis from a prior post here.