The cardinal treatment modality for any glomerular disease is glucocorticoids. The glucocorticoids cause an imbalance in the hypothalamus–pituitary–adrenal axis by altering the endogenous cortisol levels. The low levels of cortisol result in a clinical syndrome called adrenal insufficiency (AI). The occurrence of iatrogenic AI by the glucocorticoids among glomerular disease is evaluated in this study by both biochemical cortisol assay and clinical evaluation, and also, the value of salivary cortisol over serum cortisol is correlated. Materials and methods: This cross-sectional study was done on 30 biopsy-proven glomerular disease patients on glucocorticoid treatment. Clinical implications were noted using a detailed questionnaire, and serum and salivary cortisol assays were analyzed by enzyme-linked immunosorbent assay (ELISA) technique. Results: On clinical evaluation, 78% of the study population did not show signs of AI. However, 15% of the patients exhibited cushingoid symptoms. Biochemical assay with serum cortisol showed 45% with low serum cortisol levels, suggesting AI and only 3% of the study population had low salivary cortisol levels. There was no linear correlation between serum and salivary cortisol levels. Conclusion: The evidence of AI among glucocorticoid-treated glomerular disease patients is established with serum cortisol assay. The value of salivary cortisol is not marked as the other confounding factors, such as drugs and cross-reactivity with antibodies, could alter the assay values. Overall, the suppression of the hypothalamic–pituitary–adrenal (HPA) axis is evident in our study, and a monitored glucocorticoid therapy is vital so as to prevent the tendency of AI and its complications.

Aim: To discuss a case of papillary thyroid cancer with desmoid-type fibromatosis (PTC-DTF) highlighting the clinical presentation and management of PTC with DTF nodal metastasis. Background: Papillary thyroid cancer with desmoid-type fibromatosis (PTC-DTF) is a rare biphasic variant of PTC with an incidence of up to 0.5%. It is made up of two distinct components—the PTC component (classical epithelial carcinoma) and the DTF component (mesenchymal proliferation of spindled cells resembling fibromatosis). We report the youngest case of PTC-DTF and one of only five cases with nodal metastasis of the DTF component. Case description: A 17-year-old female presented with a 4 cm left-sided neck lump without cervical lymphadenopathy. Ultrasonography (US) and fine needle aspiration (FNA) showed thyroid imaging reporting and data system 4 and Bethesda 5 nodules. She underwent a total thyroidectomy with bilateral central lymph node dissection. Histopathology demonstrated a 45 × 40 × 35 mm tumor with extrathyroidal extension into strap muscle and lymphovascular invasion. There were three metastases out of four excised lymph nodes, with both PTC and DTF components. The epithelial component was positive for BRAF and the mesenchymal component was positive for smooth muscle actin (SMA) and catenin beta 1 (CTNNB1). The patient underwent adjuvant radioactive iodine (RAI) treatment. Conclusion: Diagnosis of PTC-DTF is challenging, as preoperative workup including examination and US does not differentiate for this rare subtype. Further, FNA can sometimes misdiagnose an aspirated DTF component as benign fibroma or schwannoma, so caution is advised in the context of clinically enlarging lesions. Management of PTC-DTF is difficult as it is a more aggressive form of PTC, with nodal metastasis of the DTF component adding to the complexity of management. Complete surgical resection is important, as the DTF component is not sensitive to RAI. These cases should be discussed at a multidisciplinary meeting. Clinical significance: Patients with PTC-DTF are at a higher risk of invasion and nodal metastasis. Surgical clearance is of utmost importance in the management of PTC-DTF. Multidisciplinary meeting (MDM) discussion and ongoing surveillance are prudent in the management of this rare condition.

Introduction: Ectopic mediastinal thyroid is uncommon, accounting for <1% of cases, and is often found incidentally on diagnostic imaging. Case description: A 56-year-old female diagnosed with toxic multinodular goiter with incidental finding of a mediastinal mass during preoperative workup for total thyroidectomy. Differentials include enlarged metastatic lymph node, thymoma, ectopic parathyroid adenoma, ectopic thyroid tissue, dermoid cyst and lymphoma. A functional thyroid scan with technetium-99m (99mTc) pertechnetate was able to characterize the mediastinal mass as an ectopic thyroid tissue, obviating the need for an invasive presurgical biopsy. Subsequent total thyroidectomy and excision of the mediastinal mass later confirmed the presence of ectopic thyroid tissue in the mediastinum. Conclusion: Although rare, mediastinal ectopic thyroid should be considered as one of the differentials in a mediastinal mass. ^99mTc-pertechenetate SPECT/CT is a useful noninvasive tool to differentiate ectopic thyroid tissue from other mediastinal tumors and also assess its functional and anatomic characteristic. Surgical removal is advocated for treatment of mediastinal thyroid ectopia especially in symptomatic patients.

Aim: This case report aims to highlight the behavior of pheochromocytoma (PCC) based on its size and its malignant potential. Background: Pheochromocytomas (PCCs) are rare catecholamine-secreting tumors of the chromaffin cells of the adrenal medulla or paraganglia at other places. They usually present with a symptom triad of headache, palpitations and sweating with paroxysmal hypertension. There are also those which are asymptomatic, termed as silent/nonsecretory/nonfunctional/unsuspected. Roughly 10% are malignant in nature. Case description: We report the case of a 33-year-old male who presented with complaints of mass over the left side of the abdomen for 2 weeks which was not noticed before and is nonprogressive. Abdominal examination revealed a large retroperitoneal lump measuring 10 × 10 cm in the left hypochondrium. Contrast computerized tomography (CT) abdomen revealed a suprarenal heterogeneous mass likely arising from the adrenal glands with normal biochemical workup. He was operated on, and the mass was removed with the postoperative report suggestive of PCC with malignant potential with a PCC of the Adrenal gland Scaled Score (PASS) score of 8/10. Conclusion: This was a case of a large PCC that was nonsecretory, and usually, PCC secretory behavior correlates well with size.² Clinical significance: Our case highlights one of the rarer cases of a borderline PCC which was nonsecretory despite its large size.

Aim: To report the surgical approach of a giant thyroid tumor despite the histological type. Background: Although salt for human consumption contains iodine; in some populations far from civilization stone salt (noniodized salt) is still used, the latter plus a lack of medical attention, leads to the development of goiter with excessive growth and possible malignant transformation. Case description: We report the case of surgical treatment of a giant tumor of the thyroid gland in a 55-year-old female patient who was admitted to the emergency department with respiratory distress and difficulty swallowing food. She underwent an emergency total thyroidectomy due to airway obstruction. During the surgical treatment, adhesions of the tumor to the cervical esophagus and to the aorta artery in its projection towards the mediastinal region were found. Conclusion: Anaplastic thyroid carcinoma is the rarest and most dangerous of all types of thyroid cancers, so extreme caution should be exercised in the treatment choice according to the patient's case. Clinical significance: Although the literature establishes the management of sarcomatoid anaplastic thyroid tumors, surgery remains the first option in severe cases with obstructive symptoms.

The thyroid gland is one of the uncommon locations for a head and neck schwannoma with an incidence of 25%, head and neck schwannomas arise from the cervical sympathetic chain, and peripheral nerves. They usually mimic a benign thyroid lesion or sometimes malignancy. This is a report of a suspicious thyroid nodule which turned out to be a schwannoma. We summarize previously reported cases with an emphasis on establishing preoperative diagnosis.

A 79-year-old presented with pain and swelling over the abdomen for 1 month. On evaluation, the patient was found to have a large lipid density-enhancing lesion with a solid component within it in the right upper quadrant suggestive of adrenal myelolipoma. The patient underwent open adrenalectomy with the removal of the mass measuring 28 × 24 cm and weighing 3.5 kg. In view of our case, perhaps it would be wise to operate all myelolipomas before they attain monstrous size, making surgery difficult.