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Article: A Case Report of Sheehan Syndrome: A Rare Cause of Hypopituitarism.

Vasconcelos, Ana Luís / Pinto Ribeiro, Rita / Claúdio Ferreira, Patrícia / Maciel, Joana / Araújo, Rosário

2024 Volume 16, Issue 2, Page(s) e53544

Abstract: Sheehan syndrome is a rare cause of hypopituitarism characterized by pituitary gland necrosis after postpartum hemorrhage. It is a pertinent cause of maternal morbidity and mortality in developing countries with deficient obstetrical care but is ... ...

Abstract	Sheehan syndrome is a rare cause of hypopituitarism characterized by pituitary gland necrosis after postpartum hemorrhage. It is a pertinent cause of maternal morbidity and mortality in developing countries with deficient obstetrical care but is frequently overlooked in developed countries where its occurrence is uncommon. We present the case of a 66-year-old female diagnosed with Sheehan syndrome more than 30 years after her last delivery complicated by postpartum hemorrhage. Although the patient presented several symptoms and signs of pituitary hormonal deficiencies, a diagnosis had never been established before. The complete laboratory analysis revealed a deficiency in the pituitary axis, and the cranial imaging showed an empty sella turcica. Hormonal replacement therapy resolved several impairments in terms of general energy, physical capacity, temperature regulation, skin characteristics, and sexual function. It also improved her cardiovascular and osteoporosis risk, and, most importantly, prevented a potential life-threatening adrenal crisis. This report highlights the subtle manifestations of Sheehan syndrome to help clinicians establish a prompt diagnosis. Even in developed countries such as Portugal, this condition should be regarded as a potential cause of hypopituitarism.
Language	English
Publishing date	2024-02-04
Publishing country	United States
Document type	Case Reports
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.53544
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Article ; Online: Acute suppurative thyroiditis with Graves disease - A very rare association.

Damásio, Inês / Maciel, Joana / Costa, Maria Manuel / Raimundo, Luisa

Archives of endocrinology and metabolism

2023 Volume 67, Issue 5, Page(s) e000610

Abstract: Acute suppurative thyroiditis is an uncommon disorder caused by a bacterial infection, usually presenting with normal thyroid function. It is a serious condition that requires a prompt diagnosis and treatment with antibiotics and supportive measures. A ... ...

Abstract	Acute suppurative thyroiditis is an uncommon disorder caused by a bacterial infection, usually presenting with normal thyroid function. It is a serious condition that requires a prompt diagnosis and treatment with antibiotics and supportive measures. A 62 years-old female presented with a painful cervical induration and odynophagia a week after a fish bone had been removed from her pharynx. She was febrile, and tachycardic and, on physical examination, a painful thyroid mass was detected. High inflammatory parameters and thyrotoxicosis were confirmed: thyroid stimulating hormone (TSH) < 0.01 mIU/L (normal range [NR] 0.27-4.2); free thyroxine (FT4) 3.86 ng/dL (NR 0.9-1.7) and anti-TSH receptor antibodies (TRABs) 5.3 U/L (NR < 1.5). Thyroid scintigraphy showed a diffuse uptake of the thyroid parenchyma suggesting Graves disease. Cervical ultrasonography revealed an abscess of the left thyroid lobe of 36 × 36 mm and fine needle aspiration biopsy (FNAB) with partial drainage was performed.
MeSH term(s)	Female ; Humans ; Thyroiditis, Suppurative/complications ; Methimazole/therapeutic use ; Abscess/complications ; Graves Disease/complications ; Thyrotoxicosis/complications ; Acute Disease
Chemical Substances	Methimazole (554Z48XN5E)
Language	English
Publishing date	2023-05-29
Publishing country	Brazil
Document type	Case Reports
ISSN	2359-4292
ISSN (online)	2359-4292
DOI	10.20945/2359-3997000000610
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Article ; Online: Effectiveness and safety of lenvatinib in a series of advanced well-differentiated thyroid carcinomas from a single tertiary cancer center and literature review.

Damásio, Inês L / Figueiredo, Ana / Maciel, Joana / Horta, Mariana / Silva, Tiago N / Simões-Pereira, Joana / Donato, Sara / Leite, Valeriano

Minerva endocrinology

2024

Abstract: Background: Treatment of advanced differentiated thyroid carcinoma (DTC) remains a challenge as 25-50% of patients with locally invasive or distant metastatic disease become refractory to radioiodine (RAI) therapy. Tyrosine kinase inhibitors (TKI) are ... ...

Abstract	Background: Treatment of advanced differentiated thyroid carcinoma (DTC) remains a challenge as 25-50% of patients with locally invasive or distant metastatic disease become refractory to radioiodine (RAI) therapy. Tyrosine kinase inhibitors (TKI) are increasingly used in this setting. The SELECT trial demonstrated that lenvatinib, a multikinase inhibitor, significantly improved progression free survival (PFS) compared to placebo. Our aim was to report the effectiveness and safety of lenvatinib in our series of patients with advanced DTC. Methods: A total of 25 patients with advanced DTC followed at a single tertiary center from January of 2016 to January of 2022 were retrospectively reviewed. Results: Patients were treated with a mean daily dose of lenvatinib of 16.9 mg for a mean of 9.1 months. Median estimated PFS was 31.3 months. One patient achieved complete response. The objective response rate (ORR) was 40% and the disease control rate was 84%. The mean change in summed longest diameter of target lesions from baseline to nadir was -36.9%. Lenvatinib prolonged the tumor volume doubling time in 86.7% patients. Interestingly, we found that patients treated with a lower dose of lenvatinib (<16.9 mg daily) had a significantly higher PFS and ORR than patients treated with higher dosages (>16.9 mg). Adverse events were frequently reported. Conclusions: Our results confirm the effectiveness of lenvatinib in the management of patients with advanced DTC and support the need to adjust the dosage of lenvatinib to patient´s performance status and comorbidities.
Language	English
Publishing date	2024-03-21
Publishing country	Italy
Document type	Journal Article
ZDB-ID	3062786-2
ISSN	2724-6116
ISSN (online)	2724-6116
DOI	10.23736/S2724-6507.23.03982-9
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Article ; Online: Isolated adrenal metastases of papillary thyroid carcinoma.

Maciel, Joana / Vilar, Helena / Ferreira, Teresa C / Leite, Valeriano

Endokrynologia Polska

2022 Volume 73, Issue 1, Page(s) 167–168

Abstract: Not required for Clinical Vignette. ...

Abstract	Not required for Clinical Vignette.
MeSH term(s)	Adrenal Gland Neoplasms/pathology ; Carcinoma, Papillary/pathology ; Humans ; Thyroid Cancer, Papillary/pathology ; Thyroid Neoplasms/pathology
Language	English
Publishing date	2022-02-04
Publishing country	Poland
Document type	Journal Article
ZDB-ID	419270-9
ISSN	2299-8306 ; 0423-104X
ISSN (online)	2299-8306
ISSN	0423-104X
DOI	10.5603/EP.a2021.0104
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Article ; Online: Clinical outcomes of a conservative approach in cervical lymph node metastases of thyroid cancer.

Maciel, Joana / Donato, Sara / Simões, Helder / Leite, Valeriano

Clinical endocrinology

2020 Volume 94, Issue 3, Page(s) 460–465

Abstract: Context: Lymph node metastases (LNM) can be present in 35% of patients with differentiated thyroid cancer (DTC), and the management of persistent/recurrent nodal disease has been controversial. Watchful waiting may be a reasonable approach in selected ... ...

Abstract	Context: Lymph node metastases (LNM) can be present in 35% of patients with differentiated thyroid cancer (DTC), and the management of persistent/recurrent nodal disease has been controversial. Watchful waiting may be a reasonable approach in selected patients, but uncertainty about clinical outcomes remains a concern. Objective: To investigate the outcomes of patients with DTC with recurrent/persistent confirmed LNM under surveillance. Methods: Patients with LNM from DTC were selected from databases of needle washout thyroglobulin measurements and fine-needle aspiration biopsies performed in our institution. Patients with confirmed metastases, in whom active surveillance was initially proposed, were selected. Main clinical outcomes were analysed. Results: We found 89 patients with LNM under surveillance. Classic papillary was the most frequent variant (44%). During a median follow-up of 3 (0.5-17.2) years, different treatments were needed in 35 (39.3%) patients: radioactive iodine (RAI) in 23 (25.8%), surgery in 9 (10.1%) and radiotherapy (RT) in 3 (3.4%). From those submitted initially to RAI, progression of disease was observed in 8 patients, 4 requiring other treatment modalities: surgery (n = 2), RT (n = 1) and RAI (n = 1). The remaining 54 (60.7%) patients maintained surveillance. In this group, progression of disease was observed in 26 (48.1%), due to increase in the number and/or volume of metastases, but further treatments were not required. Conclusion: In a group of patients with cervical LNM under active surveillance, only 16.9% (n = 15) required invasive intervention (surgery or RT).
MeSH term(s)	Humans ; Iodine Radioisotopes/therapeutic use ; Lymph Nodes/pathology ; Lymphatic Metastasis ; Thyroglobulin ; Thyroid Neoplasms/pathology ; Thyroid Neoplasms/radiotherapy ; Thyroid Neoplasms/surgery ; Thyroidectomy
Chemical Substances	Iodine Radioisotopes ; Thyroglobulin (9010-34-8)
Language	English
Publishing date	2020-08-26
Publishing country	England
Document type	Journal Article
ZDB-ID	121745-8
ISSN	1365-2265 ; 0300-0664
ISSN (online)	1365-2265
ISSN	0300-0664
DOI	10.1111/cen.14306
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Article ; Online: Clinical outcomes of a cohort of 271 patients with lung metastases from differentiated thyroid carcinoma.

Maciel, Joana / Cavaco, Daniela / Silvestre, Catarina / Simões Pereira, Joana / Vilar, Helena / Leite, Valeriano

Clinical endocrinology

2022 Volume 97, Issue 6, Page(s) 814–821

Abstract: Context: Lung is the most common site of distant metastases from differentiated thyroid carcinoma (DTC).: Objective: To investigate the outcomes of a cohort of patients with DTC and lung metastases (LM).: Methods: A retrospective analysis of a ... ...

Abstract	Context: Lung is the most common site of distant metastases from differentiated thyroid carcinoma (DTC). Objective: To investigate the outcomes of a cohort of patients with DTC and lung metastases (LM). Methods: A retrospective analysis of a cohort of 271 patients with LM was performed. Results: The female-to-male ratio was 1:1 and the median follow-up time was 5.9 (1.1-38.4) years. Papillary thyroid carcinoma (PTC) was the most frequent type (83.4%), mainly the classic variant, followed by follicular thyroid carcinoma (FTC, 10.3%) and Hürthle cell carcinoma (HTC, 6.3%). The prevalence of PTC, FTC and HCC was different between the micronodular and macronodular LM groups [87.4%, 6.3% and 6.3% vs. 74.6%, 19.0% and 6.3%, respectively (p = .013)]. Only 5.0% of the patients had LM diagnosed after a period of remission. LM were submitted to radioactive iodine treatment (RAIT) in 84.5% (52.8% showed <sup>131</sup> iodine avid metastases). Complete remission was only achieved in 12.2%. Micronodular disease and age <55 years at LM diagnosis were associated with a better prognosis (p < .05). We found no difference in survival between patients with LM treated or not with RAIT. However, in patients submitted to RAIT, there was a tendency for longer survival in the group of patients with <sup>131</sup> I avid lesions. Conclusion: The classic variant of PTC was the most frequent histology found in LM of DTC. LM are rarely diagnosed in the follow-up when complete remission is achieved after surgery and <sup>131</sup> I. Younger age at LM diagnosis and a micronodular pattern are associated with a better prognosis.
MeSH term(s)	Humans ; Male ; Female ; Middle Aged ; Thyroid Neoplasms/pathology ; Iodine Radioisotopes/therapeutic use ; Retrospective Studies ; Carcinoma, Hepatocellular/drug therapy ; Carcinoma, Hepatocellular/surgery ; Liver Neoplasms/drug therapy ; Liver Neoplasms/surgery ; Adenocarcinoma, Follicular/pathology ; Thyroid Cancer, Papillary/surgery ; Prognosis ; Lung Neoplasms ; Iodine ; Thyroidectomy
Chemical Substances	Iodine Radioisotopes ; Iodine (9679TC07X4)
Language	English
Publishing date	2022-03-02
Publishing country	England
Document type	Journal Article
ZDB-ID	121745-8
ISSN	1365-2265 ; 0300-0664
ISSN (online)	1365-2265
ISSN	0300-0664
DOI	10.1111/cen.14700
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Article ; Online: Adrenal findings in FDG-PET: analysis of a cohort of 1021 patients from a cancer center.

Maciel, Joana / Cavaco, Daniela / Fraga, Davide / Donato, Sara / Simões, Helder / Sousa, Rita / Simões-Pereira, Joana

Hormones (Athens, Greece)

2022 Volume 22, Issue 1, Page(s) 131–138

Abstract: Purpose: The use of FDG-PET for cancer staging has led to the increasing incidence of adrenal lesions, which are usually a clinical challenge. We aimed to characterize the adrenal lesions found in FDG-PET of patients followed in a cancer center.: ... ...

Abstract	Purpose: The use of FDG-PET for cancer staging has led to the increasing incidence of adrenal lesions, which are usually a clinical challenge. We aimed to characterize the adrenal lesions found in FDG-PET of patients followed in a cancer center. Methods: Retrospective analysis was conducted of all FDG-PET studies performed in our center in the last 10 years. Exams reporting adrenal lesions in the CT component and/or anomalous adrenal FDG uptake were selected. Cases were characterized by the clinical, laboratory, imaging, and pathological findings. Results: We identified 27,427 FDG-PET studies. Of those, 7.6% reported adrenal findings. We included 1364 exams corresponding to 1021 patients. Only 15.6% of the patients were referred to the Endocrinology Department and 38% of the lesions were not studied. In 38.9% of the studied patients, malignant lesions were present, including metastases in 37.5%, carcinoma in 1.2%, and other malignant tumors in 0.4%. The median SUVmax of malignant lesions was significantly higher than the SUVmax of the benign findings (p < 0.05). We also observed a higher median SUVmax in adrenal metastases than in adenomas (p < 0.05). There was a tendency for higher SUVmax of adrenal carcinomas when compared with other malignant lesions (p = 0.066). The median SUVmax was not different between pheochromocytomas and other tumors (p > 0.05). Conclusion: Occult adrenal lesions discovered during FDG-PET/CT are common in the cancer context and are frequently benign. SUVmax may be a useful tool in the workup of adrenal lesions but with several important caveats.
MeSH term(s)	Humans ; Fluorodeoxyglucose F18 ; Positron Emission Tomography Computed Tomography/methods ; Radiopharmaceuticals ; Retrospective Studies ; Tomography, X-Ray Computed/methods ; Positron-Emission Tomography ; Adrenal Gland Neoplasms/diagnostic imaging ; Adrenal Gland Neoplasms/pathology ; Adrenocortical Carcinoma ; Adrenal Cortex Neoplasms
Chemical Substances	Fluorodeoxyglucose F18 (0Z5B2CJX4D) ; Radiopharmaceuticals
Language	English
Publishing date	2022-12-07
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2075912-5
ISSN	2520-8721 ; 1109-3099
ISSN (online)	2520-8721
ISSN	1109-3099
DOI	10.1007/s42000-022-00423-5
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Article ; Online: Precocious and accelerated puberty in children with neurofibromatosis type 1: results from a close follow-up of a cohort of 45 patients.

Pinheiro, Sara Lomelino / Maciel, Joana / Cavaco, Daniela / Figueiredo, Ana Abrantes / Damásio, Inês Lemos / Donato, Sara / Passos, João / Simões-Pereira, Joana

Hormones (Athens, Greece)

2022 Volume 22, Issue 1, Page(s) 79–85

Abstract: Purpose: Central precocious puberty (CPP) in neurofibromatosis type 1 (NF1) occurs mainly in association with optic pathway glioma (OPG), but it can also develop in the absence of OPG. The aim of this study was to analyze the prevalence of puberty ... ...

Abstract	Purpose: Central precocious puberty (CPP) in neurofibromatosis type 1 (NF1) occurs mainly in association with optic pathway glioma (OPG), but it can also develop in the absence of OPG. The aim of this study was to analyze the prevalence of puberty disorders in children with NF1 and its association with OPG and its location. Methods: A retrospective study of 45 children with NF1 (68.9% boys) followed at our center between 2008 and 2020 was conducted. A cerebral MRI scan was performed in all children. We analyzed auxological, laboratory, and imaging data of children with CPP or accelerated puberty (AP). Treatments used for CPP/AP and their effect on height were also evaluated. Results: The prevalence of puberty disorders in our cohort was 17.8% (male to female ratio of 7:1). CPP and AP were diagnosed in 8/45 (17.8%) NF1 children. Among children with puberty disorders, 5/8 (62.5%) had an OPG with chiasm involvement, 1/8 (12.5%) had an isolated optic nerve tumor, and 2/8 (25%) did not have any evidence of OPG on MRI. Fisher's exact test showed an association between CPP/AP and chiasm OPG (p = 0.025). Treatment with triptorrelin was initiated in 5/8 children, of whom four attained final predicted height. Conclusion: Our study confirms the higher prevalence of CPP/AP in NF1 patients, as well as an association between chiasm OPG and puberty disorders. However, CPP/AP also occurred in the absence of OPG with an incidence of 9.1%. Comprehensive evaluation of every child with NF1 regardless of the presence of OPG is therefore essential.
MeSH term(s)	Humans ; Child ; Male ; Female ; Neurofibromatosis 1/complications ; Neurofibromatosis 1/diagnostic imaging ; Follow-Up Studies ; Retrospective Studies ; Optic Nerve Glioma/complications ; Optic Nerve Glioma/diagnosis ; Optic Nerve Glioma/therapy ; Optic Nerve Neoplasms/complications ; Puberty, Precocious/etiology ; Puberty, Precocious/complications ; Gonadotropin-Releasing Hormone
Chemical Substances	Gonadotropin-Releasing Hormone (33515-09-2)
Language	English
Publishing date	2022-10-21
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2075912-5
ISSN	2520-8721 ; 1109-3099
ISSN (online)	2520-8721
ISSN	1109-3099
DOI	10.1007/s42000-022-00411-9
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Article ; Online: Endocrine complications after hematopoietic stem cell transplantation during childhood-Results from a close follow-up in a cohort of 152 patients.

Figueiredo, Ana Abrantes / Cavaco, Daniela / Damásio, Inês / Maciel, Joana / Pinheiro, Sara / Donato, Sara / Simões-Pereira, Joana

Clinical endocrinology

2022 Volume 98, Issue 2, Page(s) 202–211

Abstract: Context: Haematopoietic stem cell transplantation (HSCT) is a therapeutic option for numerous haematologic diseases and solid tumours. Increasing indications for HSCT and reduction in associated mortality have been raising the number of paediatric HSCT ... ...

Abstract	Context: Haematopoietic stem cell transplantation (HSCT) is a therapeutic option for numerous haematologic diseases and solid tumours. Increasing indications for HSCT and reduction in associated mortality have been raising the number of paediatric HSCT survivors and their long-term toxicities. Objective: To characterize the endocrine disorders developed after HSCT. Design and patients: Retrospective analysis of 152 patients submitted to HSCT in paediatric age with at least 24 months of follow-up at our endocrine late-effects clinics. Results: Patients were followed up for 9.9 (interquartile range [IQR]: 12.2) years. The median age at HSCT was 7.5 (IQR: 9) years. At least one endocrine complication was observed in 65.1% of the patients. Primary hypogonadism was detected in 34.2%. Female gender (p < .001), HSCT > 10 years old (p = .01) and chemotherapy before HSCT (p < .001) were identified as risk factors for developing gonadal dysfunction. Growth hormone deficiency (GHD) occurred in 23.0% with a mean stature Z-score at diagnosis of -1.8 ± 1.4. GHD was associated with cranial (p < .001) and HSCT < 10 years old (p ≤ 0.001). Patients who were exposed to total body irradiation (TBI) were at higher risk for primary hypothyroidism (22.3%) (p = .01), thyroid nodules (17.1%) (p < .001), thyroid carcinoma (5.3%) (p < .001), dyslipidaemia (19.1%) (p < .001) and disturbance of carbohydrate metabolism (19.1%) (p < .001). Conclusion: At least one endocrine complication was diagnosed in 65.1% of patients, with gonadal dysfunction being the most prevalent. The conditioning regimen with TBI was a risk factor for the development of several endocrine disorders. This study is one of the largest series evaluating the endocrine disorders among survivors of paediatric HSCT and intends to reinforce the importance of routine follow-up of these patients.
MeSH term(s)	Child ; Humans ; Female ; Child, Preschool ; Follow-Up Studies ; Retrospective Studies ; Endocrine System Diseases/etiology ; Thyroid Nodule/complications ; Hematopoietic Stem Cell Transplantation/adverse effects ; Hematopoietic Stem Cell Transplantation/methods
Language	English
Publishing date	2022-10-10
Publishing country	England
Document type	Journal Article
ZDB-ID	121745-8
ISSN	1365-2265 ; 0300-0664
ISSN (online)	1365-2265
ISSN	0300-0664
DOI	10.1111/cen.14826
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Article ; Online: Predictive factors for thyroid complications after radiation therapy-data from a cohort of cancer patients closely followed since they were irradiated.

Duarte, Vitoria / Maciel, Joana / Cavaco, Daniela / Donato, Sara / Damásio, Inês / Pinheiro, Sara / Figueiredo, Ana / Ferreira, Ana / Pereira, Joana S

Clinical endocrinology

2022 Volume 96, Issue 5, Page(s) 728–733

Abstract: Introduction: Cancer survivors are at an increased risk of adverse outcomes, including thyroid neoplasms, given the high radiosensitivity of this gland. The aim of this study is to assess the incidence and timeframe of thyroid complications in cancer ... ...

Abstract	Introduction: Cancer survivors are at an increased risk of adverse outcomes, including thyroid neoplasms, given the high radiosensitivity of this gland. The aim of this study is to assess the incidence and timeframe of thyroid complications in cancer patients, followed systematically since their radiation therapy, and to identify risk factors for the development of hypothyroidism and thyroid cancer. Methods: We performed a retrospective study, including 282 subjects, who received neck, craniospinal, or total body irradiation (TBI). Patients were grouped into four primary diagnostic clusters: leukaemia, Hodgkin's disease, central nervous system, and head and neck tumours. Results: Hypothyroidism was observed in 56.7% of patients, on average 6.8 ± 5.9 years after the treatment. Neck and craniospinal irradiation presented a 3.5-fold increased risk for the development of hypothyroidism compared to TBI. Papillary thyroid cancer was diagnosed in 8.5% of the patients, on average, 18.5 ± 4.9 years after radiotherapy (RT). Female gender, younger age, and lower irradiation doses were independently associated with thyroid cancer development. Conclusion: Our study provides useful information about the risk of hypothyroidism and thyroid cancer after RT, as it was performed in a cohort of patients closely followed since the oncological therapies, and, thus, may give new insights into the follow-up management of these patients.
MeSH term(s)	Female ; Head and Neck Neoplasms ; Humans ; Hypothyroidism/diagnosis ; Hypothyroidism/epidemiology ; Hypothyroidism/etiology ; Retrospective Studies ; Thyroid Neoplasms/complications
Language	English
Publishing date	2022-01-03
Publishing country	England
Document type	Journal Article
ZDB-ID	121745-8
ISSN	1365-2265 ; 0300-0664
ISSN (online)	1365-2265
ISSN	0300-0664
DOI	10.1111/cen.14665
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