title: [Endocrine abnormalities in a young patient with metastatic cancer - case 3/2013].
abstract: METHODS
  We report on a 24-year-old male patient who presented with worsening of the general condition and abdominal pain.
  
  
  METHODS
  On physical examination, gynecomastia was noted. Laboratory tests showed manifest hyperthyroidism. The beta-hCG levels were markedly increased. By ultrasound, the thyroid gland was hyperperfused without thyroid nodules. Several large echo mixed lesions were found in the liver. The testes appeared normal.
  
  
  METHODS
  In light of the typical laboratory findings, a non-seminomatous extragonadal germ cell tumor was diagnosed. Hyperthyroidism was most probably HCG induced.
  
  
  METHODS
  Initially the patient was treated with thyreostatic drugs. After initiation of chemotherapy and a marked decrease in beta-hCG, thyreostatic therapy could be terminated.
  
  
  CONCLUSIONS
  Germ cell tumors may cause an increase in beta-hCG concentration. By cross-reacting with the TSH-receptor this could induce hyperthyroidism. Germ cell tumors are therefore a rare differential diagnosis of hyperthyreoidism.
authors.affiliation: Medizinische Klinik IV, Endokrinologie und Diabetologie, Angiologie, Nephrologie und Klinische Chemie, Universitätsklinikum Tübingen.
authors.forename: M
authors.initials: M
authors.lastname: Heni
authors.forename: B
authors.initials: B
authors.lastname: Besemer
authors.forename: M
authors.initials: M
authors.lastname: Guthoff
authors.forename: M
authors.initials: M
authors.lastname: Häntschel
authors.forename: S
authors.initials: S
authors.lastname: Wirths
authors.forename: F
authors.initials: F
authors.lastname: Mayer
authors.forename: L
authors.initials: L
authors.lastname: Kanz
authors.forename: H- U
authors.initials: H
authors.lastname: Häring
authors.forename: G
authors.initials: G
authors.lastname: Schnauder
authors.forename: W
authors.initials: W
authors.lastname: Vogel
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D013956:Antithyroid Agents / Q000627:therapeutic use; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood*; D006177:Gynecomastia / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D006980:Hyperthyroidism / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy; D008113:Liver Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy / Q000556:secondary*; D008297:Male; D009373:Neoplasms, Germ Cell and Embryonal / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy / Q000556:secondary*; D013972:Thyrotropin / Q000097:blood
chemical_list: D000970:Antineoplastic Agents; D013956:Antithyroid Agents; D018997:Chorionic Gonadotropin, beta Subunit, Human; D013972:Thyrotropin