University of Texas Medical Branch at Galveston Missouri City, TX, United States
Gabrielle Manno, BS1, Akhil Sood, MD1, Rohit Venkatesan, MD1, Ligia Belalcazar, MD1, Qiu Suimin, MD, PhD1, Kelly Olino, MD2, Sreeram Parupudi, MD1 1University of Texas Medical Branch at Galveston, Galveston, TX; 2Yale University School of Medicine, New Haven, CT
Introduction: Gastric malignancy in the setting of endocrine disorders is uncommon. Here we present a unique case of a patient with hyperthyroidism found to have gastric adenocarcinoma.
Case Description/Methods: A 27-year-old male with no past medical history presented to the emergency department with a 6-month history of nausea, vomiting and abdominal pain. Associated symptoms included palpitations, tremors, and unintentional weight loss (100 lbs). He denied any inciting factors or recent medication use. No history of illicit drug use. Of note, patient reported strong family history of malignancy including mother and father.
Vital signs showed T 36.9 C, Pulse 120 beats/min, BP 126/65 RR 19 breaths/min. Patient was diaphoretic and in moderate distress. Cardiac exam revealed sinus tachycardia, peripheral pulses intact. Lungs were clear to auscultation bilaterally. Abdominal exam showed right and left upper quadrant tenderness to palpation. Labs were notable for calcium 11.6 mg/dL (11.9 mg/dL corrected). Parathyroid hormone (1.9 pg/mL) (PTH) and PTH-related protein (2.0 pmol/L) were undetectable. Thyroid function test showed suppressed TSH 0.02 mIU/L and elevated Free T4 (2.60 ng/dL) and Free T3 (19.90 pg/mL). TSH receptor antibody was elevated 7.04 IU/L. The patient was treated for suspected Graves’ disease.
The patient’s abdominal pain worsened. CT abdomen and pelvis revealed nodularity present in lesser sac along with enhancement of gastroesophageal and gastrohepatic lymph nodes. Given the high suspicion for malignancy, patient underwent EGD which showed mass in the antrum. Biopsy revealed poorly differentiated adenocarcinoma. Patient received neoadjuvant chemotherapy followed by subtotal gastrectomy with lymph node resection with Roux-en-y bypass. The patient’s hyperthyroidism was refractory to medications. He later underwent total thyroidectomy. Thyroid biopsy revealed multinodular hyperplasia. He tolerated the procedures well and received additional cycles of chemotherapy. Patient is currently in remission.
Discussion: Endocrinopathies in association with gastric malignancy is extremely rare. It is hypothesized that untreated hyperthyroidism increased the risk for gastric malignancy. This relationship has been noted in preclinical studies. This case highlights the importance of considering gastric malignancy in a patient with poorly controlled hyperthyroidism intolerant to medications.
Disclosures: Gabrielle Manno indicated no relevant financial relationships. Akhil Sood indicated no relevant financial relationships. Rohit Venkatesan indicated no relevant financial relationships. Ligia Belalcazar indicated no relevant financial relationships. Qiu Suimin indicated no relevant financial relationships. Kelly Olino indicated no relevant financial relationships. Sreeram Parupudi indicated no relevant financial relationships.
Gabrielle Manno, BS1, Akhil Sood, MD1, Rohit Venkatesan, MD1, Ligia Belalcazar, MD1, Qiu Suimin, MD, PhD1, Kelly Olino, MD2, Sreeram Parupudi, MD1. P1035 - A Rare Case of Gastric Adenocarcinoma in a Patient With Graves’ Disease, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.