ACTA ENDOCRINOLOGICA (BUC)

Antithyroidperoxidase antibodies (ATPO), antithyroid antibodies directed to thyroid follicular microsomes, are recognized as the test for diagnosis of Hashimoto?s thyroiditis. The study tries to establish relationships between the ATPO and echographic picture in thyroiditis. In 383 patients (15-85 years, 354 women and 29 men) the antithyroperoxidase assay was performed using ELISA technique, (N= 0 - 34 ?U/ml). Therefore, 185 patients had Hashimoto thyroiditis and 198 patients were excluded. The images obtained from all the patients and controls, classified in 7 patterns, showed that pattern #1 (?hypoechogenic and pseudonodular?) could be considered as pathognomonic for the diagnosis of Hashimoto thyroiditis: the predictive positive value was 95.61%. Five hundred and six evaluation moments echo-ATPO were correlated in both Hashimoto thyroiditis and control group. In patients with Hashimoto thyroiditis, 301 evaluations were performed, both immune (ATPO) and echographic. For all cases and patterns (36 degrees of freedom), &#967;2 test was 77.35. P value was < 0.0001. When ATPO are high, pattern #1 was the most frequent, while for pattern #7 (normal), ATPO should be the lowest. The ATPO evolution can be considered mostly as unchanged during over one year observation. There is no correlation between the ATPO level, echographic pattern and thyroid function: the patients were in the same percent euthyroid and hypothyroid associated with similar echographic patterns. In conclusion, this study shows a highly correlative relationship between the echographic pattern and ATPO levels in Hashimoto patients.

The study comments unusual associations between thyroid and cutaneous autoimmunity: Graves-Basedow disease (GBD), vitiligo and alopecia areata (AA) starting from two cases. In the first case, a woman with systemic lupus erythematosus (SLE), data were recorded from 38 to 49 years as follows: vitiligo (at 38 ys), alopecia areata (4-6 months afterwards), SLE (after 2 ys) and then GBD (after 8 ys). After 3 years, hyperthyroidism has spontaneously vanished, but vitiligo, AA, leucothrichia, SLE, goiter and ophthalmopathy persisted. In the second case, a man, data were recorded from 26 to 70 years and the disease was associated with psoriasis. The sequence of diseases was: vitiligo (at 26 ys), AA and GBD (after 8 ys), followed by iatrogenic 131I hypothyroidism, and psoriasis (after 33 ys). Vitiligo and AA have spontaneously vanished before GBD began. These multiple immune syndrome associations bring up the question: ?Are these diseases multiple associations or a unique immune disease?? A possible point of view, related to immune network, suggests that these multiple associations represent in fact only one process, therefore they represent not many diseases, but different expressions in time (sequence) and space (organ-lesion) of the disease of the immune network.

A 75 years old woman was referred to abdominal echography for pain related to biliaryduodenal motriceal dysfunction. The ultrasound discovered a dense (hyperechogenic) image under (posterior of) the 8th segment of the liver. The dense process was supposed to be a calcification situated medial from the right kidney in the cranial 1/3 length of it. Specific clinical and biological data related to possible adrenal destruction were analyzed: the patient was in good condition, body mass index was 29. She had no tuberculosis during her life. The current arterial pressure was 145/80 mm Hg. All laboratory data, including basal cortisol were normal. Cortisolemia at 8 a.m. was 523 nmol/l. The diagnosis was made by CT scan: clear and only organ-disseminated calcification in adrenals appeared as a rim. The management of this case was related to follow-up of adrenal lesions by abdominal ultrasound.\r\nThe calcification of one adrenal raised several issues for discussion: the role of ultrasound vs CT in adrenal lesions, the prevalence of calcifications in adrenal glands, the importance of the calcification process. Calcifications of adrenals are seldom found in primary autoimmune cortical atrophy associated with Addison's disease, but they are supposed to be more frequent in adrenal tuberculosis; calcification suggests a former local tuberculosis process, associated with pulmonary tuberculosis and with borderline adrenal insufficiency. Various etiologies and mechanisms for adrenal calcifications (infectious, tumor, hemorrhage, parasitic) are discussed. To our knowledge, the rim-like appearance of the adrenal calcification was described only in one patient. In conclusion, incidental diagnostic of adrenal gland calcifications was reported in patients without adrenal insufficiency, signaled by ultrasound and detailed by CT, associated with normal adrenal function. Therefore, we consider that calcifications in the right adrenal in our patient could mean a process of cicatrisation or healing after an autoimmune aggression, only on the right adrenal gland.