Endocrinology and Metabolism

Original Articles

A Clinical study on the diagnesis and Treatment of Cushing's Disease - The significance of bilateral inferior petrosal sinus sampling -.: Seong Yeon Kim, Kyung Soo Park, Bo Youn Cho, Hong Kyu Lee, Jae Seok Jeon, Hyeong Kyu Park, Chang Soon Koh, Hun Ki Min, Heu Won Jeong, Dae Hee Han, Moon Hee Han, Kee Hyun Jang; J Korean Endocr Soc. 1994;9(2):115-120. Published online November 6, 2019

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Abstract PDF: Bilateral inferior petrosal sinus sampling(IPSS) is known to be useful for the differential diagnosis of ACTH-dependent Cushing's syndrome and for the preoperative localization of pituitary microadenomas.To evaluate the usefulness of IPSS, we performed the procedure in the 17 cases of ACTH-dependent Cushing's syndrome including 2 cases of macroadenomas, 6 of them with CRH stimulation test. A inferior petrosal sinus-to-peripheral ACTH ratio of 2:1 or greater(3:1 after CRH stimulation) indicates a pituitary source of ACTH hypersecretion, and a ratio of the ACTH level in one inferior petrosal sinus to the ACTH level in the other of 1:4 or greater lateralizes the microadenomas to that half of the pituitary gland.With these criteria, we diagnosed Cushing's disease in 15 of 17 cases of ACTH-dependent Cushing's syndrome, and localized the lesion in 8 of 13 cases of microadenoma.In conclusion, IPSS with CRH stimulation has high diagnostic accuracy in the differential diagnosis of ACTH-dependent Cushing's syndrome, but still has the limitations on the localization of microadenoma.

Clinical Study
Triiodothyronine Levels Are Independently Associated with Metabolic Syndrome in Euthyroid Middle-Aged Subjects: Hye Jeong Kim, Ji Cheol Bae, Hyeong Kyu Park, Dong Won Byun, Kyoil Suh, Myung Hi Yoo, Jae Hyeon Kim, Yong-Ki Min, Sun Wook Kim, Jae Hoon Chung; Endocrinol Metab. 2016;31(2):311-319. Published online May 13, 2016; DOI: https://doi.org/10.3803/EnM.2016.31.2.311

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Abstract PDF Supplementary Material PubReader

Background

Recent studies have shown an association between thyroid hormone levels and metabolic syndrome (MetS) among euthyroid individuals; however, there have been some inconsistencies between studies. Here, we evaluated the relationship between thyroid hormone levels and MetS in euthyroid middle-aged subjects in a large cohort.

Methods

A retrospective analysis of 13,496 euthyroid middle-aged subjects who participated in comprehensive health examinations was performed. Subjects were grouped according to thyroid stimulating hormone, total triiodothyronine (T3), total thyroxine (T4), and T3-to-T4 ratio quartile categories. We estimated the odds ratios (ORs) for MetS according to thyroid hormone quartiles using logistic regression models, adjusted for potential confounders.

Results

Of the study patients, 12% (n=1,664) had MetS. A higher T3 level and T3-to-T4 ratio were associated with unfavourable metabolic profiles, such as higher body mass index, systolic and diastolic blood pressure, triglycerides, fasting glucose and glycated hemoglobin, and lower high density lipoprotein cholesterol levels. The proportion of participants with MetS increased across the T3 quartile categories (P for trend <0.001) and the T3-to-T4 ratio quartile categories (P for trend <0.001). The multi-variate-adjusted OR (95% confidence interval) for MetS in the highest T3 quartile group was 1.249 (1.020 to 1.529) compared to the lowest T3 quartile group, and that in the highest T3-to-T4 ratio quartile group was 1.458 (1.141 to 1.863) compared to the lowest T3-to-T4 ratio quartile group, even after adjustment for potential confounders.

Conclusion

Serum T3 levels and T3-to-T4 ratio are independently associated with MetS in euthyroid middle-aged subjects. Longitudinal studies are needed to define this association and its potential health implications.

Citations

Citations to this article as recorded by

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Kyung A. Shin, Eun Jae Kim
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Clinical Parameters Are More Likely to Be Associated with Thyroid Hormone Levels than with Thyrotropin Levels: A Systematic Review and Meta-Analysis
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Thyroid disease and the metabolic syndrome
Ladan Mehran, Atieh Amouzegar, Fereidoun Azizi
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Şenay DURMAZ CEYLAN, Şuuri Ahsen CEYLAN, Fatih EKER, Aşkın GÜNGÜNEŞ
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Body Composition, Resting Energy Expenditure, and Metabolic Changes in Women Diagnosed with Differentiated Thyroid Carcinoma
Elena Izkhakov, Nachum Vaisman, Sophie Barnes, Micha Barchana, Naftali Stern, Lital Keinan-Boker
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High TSH Level within Normal Range Is Associated with Obesity, Dyslipidemia, Hypertension, Inflammation, Hypercoagulability, and the Metabolic Syndrome: A Novel Cardiometabolic Marker
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High free triiodothyronine and free-triiodothyronine-to-free-thyroxine ratio levels are associated with metabolic syndrome in a euthyroid population
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Case Reports

A Case of Improved Diabetes Mellitus After Removal of Nonfunctioning Adrenal Incidentaloma Diagnosed as Pheochromocytoma.: Se Kyung Park, Duk Su Kim, Mi Oh Roh, Min Soo Song, Chan Hee Jung, Jung Hwa Jung, Hyeong Kyu Park, Yeo Ju Kim, Ji Oh Mok, Sang Jin Kim, Chul Hee Kim, Dong Won Kim, Dong Won Byun, Kyo Il Suh, Myung Hi Yoo; J Korean Endocr Soc. 2009;24(3):189-194. Published online September 1, 2009; DOI: https://doi.org/10.3803/jkes.2009.24.3.189

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Abstract PDF: Pheochromocytoma not only decreases insulin secretion but also increases insulin resistance. One third of patients with pheochromocytoma have diabetes mellitus and their clinical prognosis showed improvement after surgery. Until now, those patients whose prognosis for diabetes mellitus improved after the operation of pheochromocytoma had typical characteristics such as hypertension, palpitation, headache and elevated hormones such as Vanillylmandelic acid, metanephrine, epinephrine and norepinephrine. We present the case of a 75-year-old woman with asymptomatic adrenal incidentaloma identified as pheochromocytoma which exhibited normal biochemical test results, and after removal of the abdominal mass, her severe hyperglycemia improved.

A Case of Primary Hypothyroidism with Anti-Triiodothyronine Autoantibody.: Jae Ho Park, Ji Hoon Ahn, Mi Hee Kang, Jong Chul Won, Kyung Wook Lee, Yeo Joo Kim, Ji Oh Mok, Hyeong Kyu Park, Chul Hee Kim, Sang Jin Kim, Dong Won Byun, Kyo Il Suh, Myung Hi Yoo; J Korean Endocr Soc. 2006;21(5):428-432. Published online October 1, 2006; DOI: https://doi.org/10.3803/jkes.2006.21.5.428

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Abstract PDF

Antithyroid hormone autoantibodies can be present in the sera of patients with thyroid and non-thyroid disorders. Antithyroid hormone autoantibodies in a patient's serum interfere with radioimmunoassay of thyroid hormones. Clinically, this interference can result in discordance between the serum thyroid hormone levels and the clinical features of the patient, which can lead to misdiagnosis or inappropriate treatment. We experienced a woman who had primary hypothyroidism with unexpectedly high concentrations of serum total triiodothyronine (T(3)) and free T(3), and she had been treated for Graves' disease in the past. Through the use of a polyethylene glycol precipitation method, we detected the anti-triiodothyronine autoantibodies in her serum. We report on this case along with a review of the related literature.

Citations

Citations to this article as recorded by

Thyroxine (T4) Autoantibody Interference of Free T4 Concentration Measurement in a Patient With Hashimoto’s Thyroiditis
Mi-Na Lee, Soo-Youn Lee, Kyu Yeon Hur, Hyung-Doo Park
Annals of Laboratory Medicine.2017; 37(2): 169. CrossRef

A Case of Panhypopituitarism with Rhabdomyolysis.: Sung Wook Hong, Eun Jung Lee, Ji Young Park, Ji Sung Yoon, Ji O Mok, Yeo Joo Kim, Hyeong Kyu Park, Jae Woo Kim, Chul Hee Kim, Sang Jin Kim, Dong Won Byun, Kyo Il Suh, Myung Hi Yoo; J Korean Endocr Soc. 2005;20(2):174-178. Published online April 1, 2005; DOI: https://doi.org/10.3803/jkes.2005.20.2.174

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Abstract PDF: Rhabdomyolysis is the consequence of extensive muscle injury with the release of muscle cell constituents into plasma. It can arise from trauma and also from a variety of nontraumatic causes. Trauma, drugs, toxins and infection are the major causes of rhabdomyolysis, but it is rarely associated with metabolic disorders such as severe electrolyte disturbance, diabetic ketoacidosis, hyperosmolar nonketotic coma, hypothyroidism and thyrotoxicosis. There have been several reported cases of metabolic rhabdomyolysis, but panhypopituitarism as a cause has never been identified. We experienced a case of acute rhabdomyolysis associated with panhypopituitarism. Thus, So we report this case with the review of related literature. Metabolic disorder is a rare cause of rhabdomyolysis, but it should always be considered in a patient having and unexplained increased of the creatine kinase concentration

A Case of Kallmann's Syndrome with Unilateral Renal Aplasia and Diabetes Mellitus.: En Jung Lee, Sung Wook Hong, Yun Ki Hong, Ji Sung Yoon, Ji O Mok, Yeo Joo Kim, Hyeong Kyu Park, Chul Hee Kim, Sang Jin Kim, Dong Won Byun, Won Kyung Bae, Kyo Il Suh, Myung Hi Yoo; J Korean Endocr Soc. 2005;20(1):96-102. Published online February 1, 2005; DOI: https://doi.org/10.3803/jkes.2005.20.1.96

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Abstract PDF

Kallmann's syndrome is defined as the combination of hypogonadotropic hypogonadism and anosmia/hyposmia. The syndrome is a result of defect in the embryonic migratory pathway of gonadotropin-releasing hormone, which synthesizes neurons and olfactory axons. The hypogonadotropic hypogonadism results due to absence of or incomplete pubertal development and may be associated with anosmia, hyposmia, midline defect(color blindness, cleft-lip, cleft-palate, unilateral renal agenesis, sensorineural deafness), cryptorchidism and skeletal anomaly. Till date in Korea, few cases of Kallmann's syndrome have been reported but there are no available reports on cases of Kallmann's syndrome with unilateral renal aplasia and diabetes mellitus. We handled a case of Kallmann's syndrome associated with unilateral renal agenesis and diabetes mellitus. In the current work, we present a peculiar case as afore mentioned with the review of related literature.

Citations

Citations to this article as recorded by

A Case of Kallmann's Syndrome with Frontal Lobe Atrophy and Mental Retardation
Soyoung Hyun, Seungguk Park, Dong Gu Kang, Seung Uk Jeong, Dea Ho Lee, Gwanpyo Koh
Endocrinology and Metabolism.2010; 25(2): 142. CrossRef
A Case of Kallmann's Syndrome Mildly Presenting as Secondary Amenorrhea
Na Rae Joo, Cheol Young Park, Hong Ju Moon, Jun Goo Kang, Sung Hee Ihm, Moon Gi Choi, Hyung Joon Yoo, Yul Lee, Ki Won Oh, Sung woo Park
Journal of Korean Endocrine Society.2007; 22(2): 130. CrossRef

A Case of Thyrotoxic Paraplegia.: Gun Wha Lee, Jin Woo Park, Ji Sung Yoon, Ji O Mok, Yeo Joo Kim, Hyeong Kyu Park, Chul Hee Kim, Sang Jin Kim, Dong Won Byun, Kyo Il Suh, Myung Hi Yoo, Du Shin Jeong; J Korean Endocr Soc. 2004;19(4):419-425. Published online August 1, 2004

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Abstract PDF: Hyperthyroidism may be associated or present with a variety of neuromuscular disorders, including thyrotoxic myopathy, exophthalmic ophthalmoplegia, periodic paralysis and myasthenia gravis. In contrast to muscle, peripheral nerve involvement in hyperthyroidism is exceedingly rare, and has received little attention. Paraplegia-like weakness during severe hyperthyroidism was first described by Charcot in 1889, and called Basedow's paraplegia' by Joffory in 1894. However, there has been no reported case in Korea. A 38-year-old woman was admitted for evaluation of progressive weakness and a gait disturbance. Her endocrinological results were compatible with hyperthyroidism. The polyneuropathy was also confirmed with sequential electrophysiological studies of the nerves and muscles. Drug therapy for hyperthyroidism resulted in resolution of the clinical neurological symptoms and progressive improvement of electrophysiological findings. Hyperthyroidisms are common medical disorders, which are often accompanied by diverse types of neurological and neuromuscular dysfunctions. All of these neurological manifestations are important, as they can serve as important clues to the diagnosis of a thyroid disorder. Furthermore, they are often related to the patient's presenting complaint. Therefore, the physician must be alert to the diverse manifestations of thyroid dysfunction, as they can lead to the diagnosis of potentially serious but treatable disorders. Herein is reported a case of myopathy and neuropathy associated with hyperthyroidism (Basedow's paraplegia), with a review of the literature

Original Articles

The Effects of Iodide on the Cellular Functions and Expression of Thyroid Autoantigens in Thyroid Cells.: Young Joo Park, Eun Shin Park, Tae Yong Kim, Hye Seung Jung, Hyeong Kyu Park, Do Joon Park, Won Bae Kim, Chan Soo Shin, Kyoung Soo Park, Seong Yeon Kim, Hong Kyu Lee, Bo Youn Cho; J Korean Endocr Soc. 2002;17(1):69-78. Published online February 1, 2002

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Abstract PDF: BACKGROUND
Iodide has been known to control the function and the growth of the thyroid gland, and to be used as a substrate of thyroid hormone. Moreover, it has been suggested that excessive iodide stimulates the thyroid autoimmune responses. To evaluate the effects of iodide on thyrocytes, we investigated cell function and proliferation, or thyroid autoantigen expression after administering iodide to rats or FRTL-5 cells. MEHTODS AND RESULTS: Ten-weeks-old Sprague-Dawley rats were sacrificed after 7 days of NaI treatment. The expressions of thyroid autoantigens were examined by northern blot analysis. Chronic administration of iodide resulted in no effect on TSH receptor (TSHR) and thyroperoxidase (TPO) mRNA expression, while it increased thyroglobulin (TG) and diminished sodium-iodide symporter (NIS) mRNA expression. FRTL-5 cells were also treated with various concentrations of NaI. The generation of cAMP or iodide uptake was decreased, and the cellular growth was also inhibited by iodide. However, the expressions of all thyroid autoantigens (TSHR, TG, TPO, MHC class I and class II) except NIS were unchanged for 72 hours after iodide administration. The expression of NIS was mildly increased after 24 hours. CONCLUSION: Iodide resulted in decreased cell proliferation and cellular function of cAMP generation and iodide uptake. Chronic administration of iodide increased TG and diminished NIS mRNA expression in vivo but not in vitro

The Changes of Expression of Thyroid Specific Antigens in Aging.: Young Joo Park, Eun Shin Park, Tae Yong Kim, Sang Wan Kim, Hyeong Kyu Park, Do Joon Park, Won Bae Kim, Chan Soo Shin, Kyoung Soo Park, Seong Yeon Kim, Sang Chul Park, Hong Kyu Lee, Bo Youn Cho; J Korean Endocr Soc. 2001;16(4-5):457-466. Published online October 1, 2001

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Abstract PDF: BACKGROUND
With the prevalence of serum antithyroglobulin(anti-TG) and antithyroperoxidase(anti-TPO) autoantibodies increasing with age, it has been suggested that changes of thyroid autoimmunity with aging are associated with endemic iodine intake. To understand the mechanism of aging-related increases of thyroid autoimmune response, we investigated the expression of thyroid specific autoantigens of aged phenotype, and compared them with those of young phenotype both in vivo and in vitro. METHODS: Sprague-Dawley rats were sacrificed at 5, 10 and 16 weeks(young), and at 23 months(aged). Their FRTL-5 thyroid cells were harvested at cell passages less than 10(fresh) or more than 30 (aged). The expression of thyroid autoantigens, sodium-iodide symporter(NIS), TSH receptor (TSHR), TG and TPO, were examined by northern blot analysis. To evaluate the effects of iodide, 1mM of NaI was added to the medium for 24 hours, and following incubation the expressions of MHC class I and class II were also examined. RESULTS: The expressions of TPO were markedly increased in the aged rats, and those of TG were moderately. However, NIS and TSHR showed no differences in their expression levels between aged rats and young rats. In vitro, there were no differences in the expressions of TG or TPO, nor of NIS or TSHR, between aged cells and fresh cells. Neither did Iodide exhibit any influence on the expression of MHC molecules in aged cells or fresh cells. CONCLUSION: The expression levels of TPO and TG were increased in aged rats, which may partially explain the mechanism of increasing thyroid autoimmunity with age.

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