Patient: Male, 58Final Diagnosis: Pituitary metastais from thyroid carcinomaSymptoms: Visual acuity worseningMedication: —Clinical Procedure: NeurosurgerySpecialty: Endocrinology and MetabolicObjective:Rare diseaseBackground:Pituitary metastasis of thyroid carcinoma is a rare entity. Differential diagnosis with other lesions in the sellar/parasellar region, through clinical, histopathological, immunohistochemical, and imaging is challenging but essential for adequate treatment.Case Report:This case report describes a 58-year-old patient with the previous diagnosis of follicular thyroid carcinoma, with metastasis to cervical lymph nodes, bone, and lung, initially evolving to left palpebral ptosis. In the investigation, laboratory tests showed hypopituitarism, and magnetic resonance imaging of the skull showed a suprasellar formation measuring 2.2×3.5×2.5 cm, which increased in size in a few months. The patient underwent transcranial neurosurgery and subsequent immunohistochemical analysis, which confirmed pituitary metastasis of follicular thyroid carcinoma. The patient underwent chemotherapy and radiotherapy but died 26 months after the onset of symptoms.Conclusions:The differential diagnosis of pituitary metastasis from a benign lesion is difficult. Therefore, a careful analysis of the history and clinical evolution, use of complementary imaging tests, and, where possible, the histopathological and immunohistochemical analysis of the lesion for diagnostic elucidation are necessary.

Objective: To analyze the importance of preoperative cytology of thyroid nodules and its relationship with mortality risk, recurrence risk, dynamic stratification, and aggressive characteristics (vascular invasion, aggressive histology, incomplete tumor resection, extrathyroidal extension of the tumor, and presence of lymph node and distant metastases). Subjects and methods: Retrospective evaluation of 153 patients diagnosed with differentiated thyroid carcinoma (DTC) and following up at the Hospital Universitário Presidente Dutra between January 1999 and December 2016. Results: In all, 96% of the patients were female, 79.7% had papillary carcinoma and the most common fineneedle aspiration (FNA) result was Bethesda II (29.4%). The mean age was 43.11 ± 12.8 years. Overall, 85% of the patients progressed without any evidence of disease. There was a statistically significant relationship between the presurgical FNA and the presence of extrathyroidal extension, vascular invasion, and lymph node metastasis. Conclusions: The preoperative cytology of the nodule may have an impact on the follow-up of patients with DTC. Future studies in a larger population are required to confirm this finding.

Acromegaly results from oversecretion of growth hormone and subsequent insulin growth factor-I. Some studies have described an association between acromegaly and increased risk of some cancers, including thyroid cancer, the most common endocrine malignancy. It is well known that follicular thyroid cells express IGF-I receptor and that GH and IGF-I have both proliferative and anti-apoptotic effects and their hypersecretion may theoretically induce tumor development and stimulate its growth, despite the fact that research data is conflicting and population-based data on thyroid cancer and acromegaly is rare. Some molecular alterations, including point mutations in BRAF and RAS genes and RET/PTC gene rearrangements, have been associated with oncogenesis of PTC. However, the implications of these genetic markers in the development of PTC in patients with acromegaly are not yet well known. In this chapter, we discuss epidemiology, pathogenesis, molecular biology aspects, and how to screen and to manage acromegalic patients with nodular thyroid disease and thyroid cancer.Keywords: acromegaly and thyroid cancer, IGF-I and cancer, thyroid and acromegaly, GH and cancer, molecular markers and thyroid cancer Knowledges on Thyroid Cancer 2 2. Epidemiology

Depois de anos dedicados à especialidade de sua escolha, os médicos atentos aos avanços da Medicina e às possibilidades de aquisição de novos conhecimentos deparam com mais um desafio: a obtenção do título de especialista. Porém, mais do que o reconhecimento de sua trajetória rumo à excelência profissional, o interesse por tal conquista confirma a preocupação desses indivíduos com o seu papel social de oferecer à população um serviço com a profundidade, a confiança e a eficiência de que ela venha a necessitar. E é em nome desses profissionais que a Sociedade Brasileira de Endocrinologia e Metabologia (SBEM) concebeu o TEEM – Preparação para Título de Especialista em Endocrinologia e Metabologia, nesse segundo volume, com novidades a fim de facilitar ainda mais a absorção do conteúdo presente nas 300 questões e nos 30 casos clínicos comentados dos anos de 2017, 2018 e 2019. Tudo isso reforçando a certeza de que esta obra representa um objeto de estudo fundamental!

Obter uma especialidade é o sonho de muitos médicos que buscam aprofundar os conhecimentos em uma área do vasto universo da Medicina, e alcançar esse sonho não é uma tarefa fácil. Os Títulos de Especialistas conferidos pelas Sociedades Médicas, dentre os quais destacamos o Título de Especialista em Endocrinologia e Metabologia (TEEM), pela Sociedade Brasileira de Endocrinologia e Metabologia (SBEM), têm um importante papel social. Representam não somente o reconhecimento da excelência do especialista pelos seus pares, mas também um auxílio à população na identificação dos profissionais nos quais ela pode confiar.