An interesting case of kidney stones and it had something to do with thyroid cancer
Thread π§΅
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#OncoNephrology
Thread π§΅
1/
#OncoNephrology
54 yo female with no sig. PMH presents for evaluation of diarrhea
On examination she is found to have a palpable neck mass
Neck ultrasound shows a thyroid mass
FNA of the thyroid mass reveals presence of medullary thyroid cancer
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On examination she is found to have a palpable neck mass
Neck ultrasound shows a thyroid mass
FNA of the thyroid mass reveals presence of medullary thyroid cancer
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So why does she have diarrhea?
Medullary thyroid cancer is a neuroendocrine tumor of the parafollicular or c cells of the thyroid gland that produces calcitonin
Calcitonin can cause diarrhea
Patientβs serum calcitonin is
>13,000 pg/mlππ½
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Medullary thyroid cancer is a neuroendocrine tumor of the parafollicular or c cells of the thyroid gland that produces calcitonin
Calcitonin can cause diarrhea
Patientβs serum calcitonin is
>13,000 pg/mlππ½
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She is referred to nephrology for kidney stone evaluation
What is the link between medullary thyroid cancer and nephrolithiasis?
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What is the link between medullary thyroid cancer and nephrolithiasis?
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Two possible ways that medullary thyroid cancer and nephrolithiasis are linked
First:
Presence of MEN2A (multiple endocrine neoplasia 2A) which includes medullary thyroid cancer, primary hyperparathyroidism & pheochromocytoma
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First:
Presence of MEN2A (multiple endocrine neoplasia 2A) which includes medullary thyroid cancer, primary hyperparathyroidism & pheochromocytoma
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Primary hyperparathyroidism causes hypercalciuria and nephrolithiasis
PTH is checked and it is high in the presence of hypercalcemia ππ½
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PTH is checked and it is high in the presence of hypercalcemia ππ½
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What is the second potential link between medullary thyroid cancer and nephrolithiasis?
Remember high calcitonin can cause diarrhea and chronic diarrhea can lead to enteric hyperoxaluria
Urine oxalate is elevated
59 mg/24hππ½
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Remember high calcitonin can cause diarrhea and chronic diarrhea can lead to enteric hyperoxaluria
Urine oxalate is elevated
59 mg/24hππ½
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Another important thing to remember
In MEN2A, patients can have pheochromocytoma so biochemical screening is important even in asymptomatic patientsππ½
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In MEN2A, patients can have pheochromocytoma so biochemical screening is important even in asymptomatic patientsππ½
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Nephrolithiasis in a patient with medullary thyroid cancer caused by:
1. High calcitonin -> diarrhea -> enteric hyperoxaluria -> kidney stones
2. Primary hyperparathyroidism (MEN2A) -> hypercalciuria -> kidney stones
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1. High calcitonin -> diarrhea -> enteric hyperoxaluria -> kidney stones
2. Primary hyperparathyroidism (MEN2A) -> hypercalciuria -> kidney stones
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