Endocrinology and Metabolism

Original Article

Clinical Study
Recovery of Adrenal Function in Patients with Glucocorticoids Induced Secondary Adrenal Insufficiency: Jong Ha Baek, Soo Kyoung Kim, Jung Hwa Jung, Jong Ryeal Hahm, Jaehoon Jung; Endocrinol Metab. 2016;31(1):153-160. Published online March 16, 2016; DOI: https://doi.org/10.3803/EnM.2016.31.1.153

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Background

The chronic use of glucocorticoids (GC) suppresses function of the hypothalamic-pituitary-adrenal axis and often results in secondary adrenal insufficiency (AI). The present study aimed to determine the recovery rate of adrenal function in patients with secondary AI within 1 to 2 years and to assess the factors predictive of adrenal function recovery.

Methods

This was a retrospective observational study that enrolled patients diagnosed with GC-induced secondary AI between 2007 and 2013. AI was defined by peak serum cortisol levels <18 µg/dL during a standard-dose short synacthen test (SST). A follow-up SST was performed after 1 to 2 years, and responders were defined as those with adrenocorticotropic hormone (ACTH)-stimulated peak serum cortisol levels ≥18 µg/dL.

Results

Of the total 34 patients diagnosed with GC-induced secondary AI at first, 20 patients (58.8%) recovered normal adrenal function by the time of the follow-up SST (median follow-up period, 16.5 months). Although the baseline serum ACTH and cortisol levels at the first SST did not differ between responders and non-responders, the incremental cortisol response during the first SST was higher in responders than that of non-responders (7.88 vs. 3.56, P<0.01). Additionally, higher cortisol increments during the first SST were an independent predictive factor of the adrenal function recovery (odds ratio, 1.58; 95% confidence interval, 1.02 to 2.46; P<0.05).

Conclusion

In the present study, adrenal function recovery was achieved frequently in patients with GC-induced secondary AI within 1 to 2 years. Additionally, an incremental cortisol response at the first SST may be an important predictive factor of adrenal function recovery.

Citations

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Secondary Adrenal Insufficiency: Recent Updates and New Directions for Diagnosis and Management
Lucinda M. Gruber, Irina Bancos
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Andrew Menzies-Gow, Mark Gurnell, Liam G Heaney, Jonathan Corren, Elisabeth H Bel, Jorge Maspero, Timothy Harrison, David J Jackson, David Price, Njira Lugogo, James Kreindler, Annie Burden, Alex de Giorgio-Miller, Kelly Padilla, Ubaldo J Martin, Esther G
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Development and Resolution of Secondary Adrenal Insufficiency after an Intra-Articular Steroid Injection
Jia Wei Tan, Sachin K. Majumdar, Osamu Isozaki
Case Reports in Endocrinology.2022; 2022: 1. CrossRef
Long‐term corticosteroid use, adrenal insufficiency and the need for steroid‐sparing treatment in adult severe asthma
M. Gurnell, L. G. Heaney, D. Price, A. Menzies‐Gow
Journal of Internal Medicine.2021; 290(2): 240. CrossRef
Glucocorticoid Withdrawal—An Overview on When and How to Diagnose Adrenal Insufficiency in Clinical Practice
Katarzyna Pelewicz, Piotr Miśkiewicz
Diagnostics.2021; 11(4): 728. CrossRef
Morning Serum Cortisol as a Predictor for the HPA Axis Recovery in Cushing’s Disease
Q. Cui, D. Liu, B. Xiang, Q. Sun, L. Fan, M. He, Y. Wang, X. Zhu, H. Ye, Giorgio Borretta
International Journal of Endocrinology.2021; 2021: 1. CrossRef
Dexamethasone-related adrenal insufficiency in patients with brain and skull base tumours
H. Benghiat, P. Sanghera, D. Stange, P. Nightingale, A. Hartley, M.W O’Reilly, N. Nundall, H. Currie, M. Ali, G. Cruickshank, D. Spooner, A. Toogood
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Articles inEndocrinology and Metabolismin 2016
Won-Young Lee
Endocrinology and Metabolism.2017; 32(1): 62. CrossRef
The unresolved riddle of glucocorticoid withdrawal
F. Guerrero Pérez, A. P. Marengo, C. Villabona Artero
Journal of Endocrinological Investigation.2017; 40(11): 1175. CrossRef
Lessons from iatrogenic Cushing syndrome in children
Betty P Messazos, Margaret R Zacharin
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Case Report

Thyroid
Delayed Surgery for Parathyroid Adenoma Misdiagnosed as a Thyroid Nodule and Treated with Radiofrequency Ablation: Ho-Su Kim, Bong Hoi Choi, Jung Rang Park, Jong Ryeal Hahm, Jung Hwa Jung, Soo Kyoung Kim, Sungsu Kim, Kyong-Young Kim, Soon Il Chung, Tae Sik Jung; Endocrinol Metab. 2013;28(3):231-235. Published online September 13, 2013; DOI: https://doi.org/10.3803/EnM.2013.28.3.231

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Abstract PDF PubReader

Primary hyperparathyroidism occurs as a result of isolated parathyroid adenoma in 80% to 85% of all cases. A ^99mtechnetium (^99mTc) sestamibi scan or neck ultrasonography is used to localize the neoplasm prior to surgical intervention. A 53-year-old female was referred for the exclusion of metabolic bone disease. She presented with low back pain that had persisted for the past 6 months and elevated serum alkaline phosphatase (1,253 IU/L). Four years previously, she had been diagnosed at a local hospital with a 2.3-cm thyroid nodule, which was determined to be pathologically benign. Radiofrequency ablation was performed at the same hospital because the nodule was still growing during the follow-up period 2 years before the visit to our hospital, and the procedure was unsuccessful in reducing the size of the nodule. The results of the laboratory tests in our hospital were as follows: serum calcium, 14.6 mg/dL; phosphorus, 3.5 mg/dL; and intact parathyroid hormone (iPTH), 1,911 pg/mL. Neck ultrasonography and ^99mTc sestamibi scan detected a 5-cm parathyroid neoplasm in the left lower lobe of the patient's thyroid; left parathyroidectomy was performed. This case indicated that thyroid ultrasonographers and pathologists need to be experienced enough to differentiate a parathyroid neoplasm from a thyroid nodule; ^99mTc sestamibi scan, serum calcium, and iPTH levels can help to establish the diagnosis of parathyroid neoplasm.

Citations

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Complications after radiofrequency ablation of hyperparathyroidism secondary to chronic kidney disease
Li-Ping Lin, Miao Lin, Song-Song Wu, Wei-hua Liu, Li Zhang, Yi-ping Ruan, Mei-zhu Gao, Fu-Yuan Hong
Renal Failure.2023;[Epub] CrossRef
Risk factors influencing cure of ultrasound-guided microwave ablation for primary hyperparathyroidism
Fangyi Liu, Li Zang, Yang Liu, Xiaoling Yu, Zhigang Cheng, Zhiyu Han, Jie Yu, Ping Liang
International Journal of Hyperthermia.2022; 39(1): 258. CrossRef
Efficacy and safety of radiofrequency ablation versus parathyroidectomy for secondary hyperparathyroidism in dialysis patients: a single-center retrospective study
Mian Ren, Danna Zheng, Juan Wu, Yueming Liu, Chengzhong Peng, Wei Shen, Bo Lin
Scientific Reports.2022;[Epub] CrossRef
Radiofrequency Ablation of Parathyroid Adenoma: A Novel Treatment Option for Primary Hyperparathyroidism
Iram Hussain, Shahzad Ahmad, Jules Aljammal
AACE Clinical Case Reports.2021; 7(3): 195. CrossRef
Efficacy of Ultrasound-guided Radiofrequency Ablation of Parathyroid Hyperplasia: Single Session vs. Two-Session for Effect on Hypocalcemia
Zeng Zeng, Cheng-Zhong Peng, Ji-Bin Liu, Yi-Wen Li, Hong-Feng He, Qiao-Hong Hu, Bo Lin, Xiao-Gang Shen
Scientific Reports.2020;[Epub] CrossRef
Efficacy and safety of microwave ablation for ectopic secondary hyperparathyroidism: a feasibility study
Xin Li, Ying Wei, Hongzeng Shao, Lili Peng, Chao An, Ming-An Yu
International Journal of Hyperthermia.2019; 36(1): 646. CrossRef
US-guided Microwave Ablation of Hyperplastic Parathyroid Glands: Safety and Efficacy in Patients with End-Stage Renal Disease—A Pilot Study
Li Zhuo, Li-li Peng, Yu-mei Zhang, Zhi-hong Xu, Gu-ming Zou, Xin Wang, Wen-ge Li, Ming-de Lu, Ming-an Yu
Radiology.2017; 282(2): 576. CrossRef
Safety and efficiency of microwave ablation for recurrent and persistent secondary hyperparathyroidism after parathyroidectomy: A retrospective pilot study
Ming-An Yu, Li Yao, Ling Zhang, Lili Peng, Li Zhuo, Yumei Zhang, Wenge Li, Ming-De Lv
International Journal of Hyperthermia.2016; 32(2): 180. CrossRef
A nonfunctioning parathyroid carcinoma misdiagnosed as a follicular thyroid nodule
Filomena Cetani, Gianluca Frustaci, Liborio Torregrossa, Silvia Magno, Fulvio Basolo, Alberto Campomori, Paolo Miccoli, Claudio Marcocci
World Journal of Surgical Oncology.2015;[Epub] CrossRef
Brief Review of Articles in 'Endocrinology and Metabolism' in 2013
Won-Young Lee
Endocrinology and Metabolism.2014; 29(3): 251. CrossRef

Original Articles

Differential Diagnostic Value of Total T3/Free T4 Ratio in Graves' Disease and Painless Thyroiditis Presenting Thyrotoxicosis.: Sang Min Lee, Soo Kyoung Kim, Jong Ryeal Hahm, Jung Hwa Jung, Ho Su Kim, Sungsu Kim, Soon Il Chung, Bong Hoi Choi, Tae Sik Jung; Endocrinol Metab. 2012;27(2):121-125. Published online June 20, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.2.121

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Abstract PDF

BACKGROUND
It is important to differentiate Graves' disease from that of painless thyroiditis in patients with thyrotoxicosis. In this study, we evaluated the usefulness of total T3 to free T4 ratio in making a differential diagnosis between Graves' disease and painless thyroiditis. METHODS: We reviewed medical records of thyrotoxic patients, who had been diagnosed with Graves' disease or painless thyroiditis, from October 2009 to July 2011. We assessed clinical characteristics, serum levels of total T3, free T4, thyroid stimulating hormone, thyrotropin-binding inhibitory immunoglobulin, and findings of 99mTechnetium thyroid scan. We analyzed the total T3/free T4 ratios between Graves' disease and painless thyroiditis patients. RESULTS: A total of 76 untreated thyrotoxic patients "49 Graves' disease and 27 painless thyroiditis" were examined. The total T3, free T4 levels and the total T3/free T4 ratios were significantly higher in patients with Graves' disease than in those with painless thyroiditis (P < 0.001). In the total T3/free T4 ratio > 73, the possibility of Graves' disease was significantly higher than in painless thyroiditis (sensitivity, 75.5%; specificity, 70.3%). The sensitivity and specificity of the total T3/free T4 ratio in patients with free T4 < 3.6 ng/dL have been increased (sensitivity, 100%; specificity, 71.4%). CONCLUSION: The total T3/free T4 ratios was useful for making a differential diagnosis between Graves' disease and painless thyroiditis.

Citations

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Comparison of 99mTc Pertechnetate Thyroid Uptake Rates by Gamma Probe and Gamma Camera Methods for Differentiating Graves’ Disease and Thyroiditis
Meihua Jin, Jonghwa Ahn, Seong-gil Jo, Jangwon Park, Min Ji Jeon, Won Gu Kim, Tae Yong Kim, Won Bae Kim, Young Kee Shong, Jin-Sook Ryu
Nuclear Medicine and Molecular Imaging.2022; 56(1): 42. CrossRef
Interpretation of puzzling thyroid function tests
Jee Hee Yoon, Ho-Cheol Kang
Journal of the Korean Medical Association.2018; 61(4): 241. CrossRef
The High Proportion of Painless Thyroiditis as a Cause of Thyrotoxicosis in Korea
Sang Il Mo, A Jeong Ryu, Yeo Joo Kim, Sang Jin Kim
Journal of Korean Thyroid Association.2015; 8(1): 61. CrossRef

Clinical Characteristics of Patients with Hyperglycemic Emergency State Accompanying Rhabdomyolysis.: Soo Kyoung Kim, Jong Ha Baek, Kyeong Ju Lee, Jong Ryeal Hahm, Jung Hwa Jung, Hee Jin Kim, Ho Su Kim, Sungsu Kim, Soon Il Chung, Tae Sik Jung; Endocrinol Metab. 2011;26(4):317-323. Published online December 1, 2011; DOI: https://doi.org/10.3803/EnM.2011.26.4.317

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Abstract PDF

BACKGROUND
The purpose of this study was to investigate the prevalence of rhabdomyolysis and its association with both clinical course and prognosis and to evaluate the factors associated with rhabdomyolysis in patients with hyperglycemic emergencies. METHODS: We reviewed the medical records of patients with hyperglycemic emergencies who visited our hospital from May 2003 to April 2010. We assessed the clinical characteristics, biochemical profiles and clinical course of patients and analyzed these data according to the presence of rhabdomyolysis. RESULTS: The prevalence of rhabdomyolysis was 29 patients (28.4%) among 102 patients. Mean serum osmolarity, glucose and serum creatinine levels were higher in patients with rhabdomyolysis than those without rhabdomyolysis. Patients with rhabdomyolysis had higher rates of hemodialysis and mortality than those without the condition. The factors associated with rhabdomyolysis in the hyperglycemic emergency state were increased serum osmolarity and APACHE II score on admission (P < 0.05). CONCLUSION: Rhabdomyolysis commonly occurred in patients with hyperglycemic emergencies and this could aggravate their clinical course and increase mortality.

Citations

Citations to this article as recorded by

Acute diabetes complications
Salvatore Piro, Francesco Purrello
Journal of Gerontology and Geriatrics.2021; 69(4): 269. CrossRef
The Authors Reply: Clinical and Biochemical Characteristics of Elderly Patients With Hyperglycemic Emergency State at a Single Institution
Yong Jung Cho
Annals of Geriatric Medicine and Research.2017; 21(1): 38. CrossRef
Clinical and Biochemical Characteristics of Elderly Patients With Hyperglycemic Emergency State at a Single Institution
Yun Jae Shin, Dae In Kim, Dong Won Lee, Beung Kwan Jeon, Jung Geun Ji, Jung Ah Lim, Young Jung Cho, Hong Woo Nam
Annals of Geriatric Medicine and Research.2016; 20(4): 185. CrossRef

Case Reports

Sustained Maintenance of Normal Insulin-like Growth Factor-I during Pregnancy and Successful Delivery in an Acromegalic Patient with Octreotide-LAR(R) Treatment.: Soo Kyoung Kim, Jung Hwa Jung, Jae Hyeon Kim, Kyu Yeon Hur, Alice Hyun Tan, Hee Kyung Kim, Ji In Lee, Hye Soo Chung, Kwang Won Kim; Endocrinol Metab. 2010;25(3):213-216. Published online September 1, 2010; DOI: https://doi.org/10.3803/EnM.2010.25.3.213

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Abstract PDF: We report here on a 34-year-old Korean woman with active acromegaly and who received Octreotide-LAR(R) for 12 months following transsphenoidal pituitary surgery. During Octreotide-LAR(R) treatment, the clinical improvement was paralleled with the decrease of the growth hormone levels to 1.1 ng/mL and the insulin-like growth factor-I (IGF-I) levels to 345.5 ng/mL. Octreotide-LAR(R) was discontinued when the patient was found to be at the 12th week of pregnancy. During pregnancy, the patient experienced clinical well-being and she maintained her IGF-I levels within the normal range for her age-matched despite discontinuation of Octreotide-LAR(R) treatment at early gestation. She delivered a full-term healthy male infant. The serum IGF-I levels of the patient increased progressively increased after delivery. This report describes a successful pregnancy in an acromegalic woman who was exposed to Octreotide-LAR(R) during the early gestational period. She and who showed an unexpected pattern of persistently normal IGF-I levels through the pregnancy despite discontinuation of Octreotide-LAR(R) therapy.

The Case of Accelerated Linear Growth Despite Growth Hormone and Insulin-like Growth Factor-I Deficiency.: Kyeong Ju Lee, Jong Ryeal Hahm, Tae Sik Jung, Jung Hwa Jung, Soo Kyoung Kim, Jong Ha Baek, Won Hyun Lee, Han wook Yoo, Soon Il Chung; J Korean Endocr Soc. 2009;24(3):206-211. Published online September 1, 2009; DOI: https://doi.org/10.3803/jkes.2009.24.3.206

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Abstract PDF: Here we describe a male patient who attained normal height despite combined hypopituitarism with an abnormal growth hormone-insulin-like growth factor (IGF)-I axis. When he was an 18-year-old, he presented with a short stature and underdeveloped external genitalia. The patient had not undergone normal pubertal development and he displayed a height below the fifth percentile. Hormonal and radiological studies revealed the findings of severe anterior pituitary hormone deficiency and an atrophic pituitary gland. There had been no recent follow-ups with the patient or medical treatment since that time. In the current presentation, the patient, now 22 years of age, had attained normal height, yet he remained prepubertal and showed manifestations of delayed bone age and combined hypopituitarism. In addition, the patient's IGF-II levels were increased for his age.

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.

Solitary Papillary Thyroid Microcarcinoma (0.3 cm in Diameter) Presenting Multiple Distant Metastases at the Time of Diagnosis.: Tae Hyun Kim, Jung Han Kim, Young Lyun Oh, You Cheol Hwang, Jung Hwa Jung, Hye Seung Jung, Mira Kang, Yong Ki Min, Myung Shik Lee, Moon Kyu Lee, Kwang Won Kim, Jae Hoon Chung; J Korean Endocr Soc. 2007;22(4):287-291. Published online August 1, 2007; DOI: https://doi.org/10.3803/jkes.2007.22.4.287

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Abstract PDF

Papillary thyroid microcarcinoma (PTMC) is defined as being 1 cm or less in diameter. Although the prognosis of PTMC is known to be more favorable than that of papillary thyroid carcinoma greater than 1 cm in diameter, pathologic factors suggesting aggressiveness, such as multifocality and lymph node invasion, have been reported to be highly prevalent in PTMC. However, the rate of distant metastasis in patients with PTMC is very low. Many investigators have reported that initial distant metastasis was detected only in patients with PTMC greater than 0.4 cm in diameter, however these cases have involved only one organ, usually the lung. We report here on an extremely unusual case of solitary PTMC (0.3 cm in diameter) presenting multiple distant metastases at the time of diagnosis.

Citations

Citations to this article as recorded by

Clinico-pathologic Characteristics of the Primary Thyroid Cancer in Patients with Breast Cancer
Hyun Won Shin, Hye Won Jang, Ji Young Park, Jae Hoon Chung, Young-Ki Min, Myung-Shik Lee, Moon-Kyu Lee, Kwang-Won Kim, Sun Wook Kim
Journal of Korean Endocrine Society.2009; 24(4): 240. CrossRef

Original Articles

ras Mutation in Korean Papillary Thyroid Carcinomas.: Jung Hwa Jung, Keun Sook Kim, Tae Sik Jung, Young Lyun Oh, Hye Won Jang, Hye Seung Jung, Yong Ki Min, Myung Shik Lee, Moon Kyu Lee, Kwang Won Kim, Jae Hoon Chung; J Korean Endocr Soc. 2007;22(3):203-209. Published online June 1, 2007; DOI: https://doi.org/10.3803/jkes.2007.22.3.203

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Abstract PDF: BACKGROUND
RET/PTC rearrangement and mutations of BRAF and ras are well-known oncogenes involved in the pathogenesis of papillary thyroid carcinoma (PTC). The prevalence of RET/PTC rearrangement and BRAF mutations were 0~13% and 66~83% in Korean patients with PTC, respectively. We evaluated the prevalence of ras mutations in surgical specimens of PTC, and we compared them with the patients' clinical features. SUBJECTS AND METHODS: We included the surgical specimens of 49 PTCs and a few follicular thyroid carcinomas (FTCs) and follicular adenomas (FAs) as positive controls. Polymerase chain reaction, single strand conformation polymorphism and direct sequence analysis were consecutively performed to detect ras mutations. RESULTS: No mutations of the ras oncogenes were detected in 49 PTCs. However, heterozygous mutations of the ras oncogenes were found in a FTC and FA as positive controls, respectively. CONCLUSION: These findings suggested that ras mutation is not or rarely related to the tumorigenesis of PTCs in Koreans. Therefore, BRAF mutations and RET/PTC rearrangement, rather than ras mutation, might contribute the development of PTC in Koreans.

p53, p21 and bcl-2 Protein Expressions and the Clinical Significance in Papillary Thyroid Carcinoma.: Tae Sik Jung, Keun Sook Kim, Young Lyun Oh, Jung Hwa Jung, Eun Young Lee, Hye Seung Jung, Yong Ki Min, Myung Shik Lee, Moon Kyu Lee, Kwang Won Kim, Jae Hoon Chung; J Korean Endocr Soc. 2007;22(2):98-104. Published online April 1, 2007; DOI: https://doi.org/10.3803/jkes.2007.22.2.98

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Abstract PDF

BACKGROUND
There have been some investigations concerning the role of p53, p21 and bcl-2 protein expressions for the tumorigenesis of thyroid cancer. It had been debated that these protein expressions were associated with aggressive features of papillary thyroid carcinoma. We studied to evaluate the prevalence of these protein expressions and their clinical significances in papillary thyroid carcinoma. METHODS: We selected 49 patients with papillary thyroid carcinoma who had been operated on at Samsung Medical Center during the last 10 years. Immunohistochemical staining for p53, p21 and bcl-2 was done by the use of paraffin embedded tissues. We analyzed the results of immunohistochemical staining for p53, p21 and bcl-2 and the correlation with the patients' age, gender, tumor size, multifocality, tumor invasion to both lobes, extrathyroidal invasion, cervical lymph node invasion, distant metastasis and the clinical outcomes. RESULTS: Immunohistochemical staining for p53 was positive in 10 patients (20%), p21 was positive in 36 patients (73%) and bcl-2 was positive in 18 patients (37%). The p53 and bcl-2 expressions were not associated with the clinical parameters. Tumor multifocality and extrathyroidal invasion were significantly higher in the p21 positive group (both P < 0.05). CONCLUSION: This study showed that the p21 protein expression was associated with tumor multifocality and extrathyroidal invasion in the patients with papillary thyroid carcinoma. Immunohistochemical stains for p21 may be used as a parameter for tumor aggressiveness in papillary thyroid carcinoma.

Citations

Citations to this article as recorded by

Clinicopathologic and Diagnostic Significance of p53 Protein Expression in Papillary Thyroid Carcinoma
Mi Kyung Shin, Jeong Won Kim
Asian Pacific Journal of Cancer Prevention.2014; 15(5): 2341. CrossRef

Analysis of the Pharmacokinetics of Recombinant Human TSH in Patients with Thyroid Papillary Carcinoma.: Tae Sik Jung, Hye Seung Jung, Jung Hwa Jung, Yun Jae Chung, Eun Young Oh, Young Ki Min, Myung Shik Lee, Moon Kyu Lee, Kwang Won Kim, Jae Hoon Chung; J Korean Endocr Soc. 2006;21(3):204-212. Published online June 1, 2006; DOI: https://doi.org/10.3803/jkes.2006.21.3.204

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Abstract PDF

BACKGROUND
Individual variations of the pharmacokinetics of recombinant human TSH (rhTSH) might influence the efficacy of the radioactive iodine (RAI) uptake. We studied to investigate the individual pharmacokinetics of rhTSH and the effect of the anthropometric parameters on the serum TSH levels in patients with thyroid papillary carcinoma. METHODS: We selected 16 patients with conventional rhTSH administration for the preparation of RAI administration between June 2004 and May 2005. We measured serum TSH levels at 24-hour (prior to second rhTSH injection), 48-hour (peak level, prior to RAI administration) and 96-hour (prior to scanning) after the first rhTSH injection. We analyzed the correlation of each TSH levels with age, height, weight, creatinine clearance, body mass index (BMI), and body surface area (BSA). RESULTS: Peak TSH levels were negatively correlated with weight, BMI, and BSA. Among them, weight was an independent parameter by multivariate analysis. Decrement of serum TSH levels from the peak to the level at 96-hour was negatively correlated with weight, BMI, and BSA. It was positively correlated with increment of serum TSH levels from the level at 24-hour to the peak level. Serum TSH level at 96-hour was lower than 25 mU/L in nine of 16 patients. CONCLUSION: Body weight was inversely correlated with peak TSH level after rhTSH administration. rhTSH-stimulated TSH levels might be exaggerated to unwanted levels, and very rapidly degraded in lower-weighted patients. We should make up for the rhTSH regimen considering the individual variations of its pharmacokinetics.

Citations

Citations to this article as recorded by

Efficacy of Low-dose and High-dose Radioactive Iodine Ablation With rhTSH in Korean Patients With Differentiated Thyroid Carcinoma
Ji Young Joung, Ji Hun Choi, Yoon Young Cho, Na Kyung Kim, Seo Young Sohn, Sun Wook Kim, Jae Hoon Chung
American Journal of Clinical Oncology.2016; 39(4): 374. CrossRef

Case Reports

A Case of Pituitary Tumor Causing Diabetes Insipidus and Associating with Adenoid Cystic Carcinoma in the Bronchus.: Kang Wan Lee, Jong Ryeal Hahm, Mi Yean Kang, Jung Hwa Jung, Gi Dong Lee, Hyun Jin Kim, Sun Il Chung; J Korean Endocr Soc. 2003;18(3):311-317. Published online June 1, 2003

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Abstract PDF: The metastatic tumor occurs in about 6% to 20% of all cases with central diabetes insipidus. Many kinds of cancers such as breast, lung, colon, prostate, leukemia, and lymphoma can metastasize to the pituitary and its stalk. Primary adenoid cystic carcinoma arising in the bronchus is an uncommon disease. It is histologically and ultrastructurally identical to salivary gland adenoid cystic tumor and is regarded as a slowly growing, low graded-malignancy. This is a case report of a 52-year-old woman with diabetes insipidus caused by a pituitary tumor that might have been associated with adenoid cystic carcinoma arising in the bronchus. The patient was diagnosed by water deprivation test, chest CT scan, bronchoscopic biopsy, and brain MRI scan. The water deprivation test showed the patient had central diabetes insipidus, while chest CT scan revealed a lung mass lesion with distal right intermediate bronchial obstruction. The primary malignancy was confirmed by bronchoscopic biopsy. Finally, we confirmed that the patient had a 7mm-sized mass in the posterior pituitary gland and a thickened stalk by brain MRI scan.

A Case of Anterior Pituitary Agenesis in an Adult Woman.: Tae Sik Jung, Jong Ryeal Hahm, Kang Wan Lee, Jung Hwa Jung, Soo Hee Kim, Jong Ha, Hwal Suk Cho, Sun Il Chung; J Korean Endocr Soc. 2002;17(2):263-268. Published online April 1, 2002

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Abstract PDF: Dear Author, You have used abbreviations that will need to be defined in the main paper, i.e. PIT1, PROP1 and MRI. This is just for your advice. Pituitary agenesis is an uncommon cause of panhypopituitarism. It has been proposed that breech delivery, or birth trauma, is a major factor causing pituitary agenesis. Recent studies have suggested that genetic defects in the PIT1 or PROP1 gene might be involved in the pathogenesis of pituitary agenesis. In this case we report on the diagnosis of a 33-years old female patient with-growth retardation and sexual infantilism. We diagnosed anterior pituitary hormones deficiencies, with the exception of adrenocorticotropic hormone, by a combined pituitary stimulation test. We observed pituitary agenesis using sella MRI. Involvement of the PIT1 or PROP1 genes in this case remains to be determined. Here we report a case of pituitary agenesis found in an adult woman together with a brief review about this disease entity.

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