Endocrinology and Metabolism

Review Articles

Thyroid
A Narrative Review of the 2023 Korean Thyroid Association Management Guideline for Patients with Thyroid Nodules: Eun Kyung Lee, Young Joo Park, Chan Kwon Jung, Dong Gyu Na; Endocrinol Metab. 2024;39(1):61-72. Published online February 14, 2024; DOI: https://doi.org/10.3803/EnM.2024.1938

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The 2023 Korean Thyroid Association (KTA) Management Guideline for Patients with Thyroid Nodules constitute an update of the 2016 KTA guideline for thyroid nodules and cancers that focuses specifically on nodules. The 2023 guideline aim to offer updated guidance based on new evidence that reflects the changes in clinical practice since the 2016 KTA guideline. To update the 2023 guideline, a comprehensive literature search was conducted from January 2022 to May 2022. The literature search included studies, reviews, and other evidence involving human subjects that were published in English in MEDLINE (PubMed), Embase, and other relevant databases. Additional significant clinical trials and research studies published up to April 2023 were also reviewed. The limitations of the current evidence are discussed, and suggestions for areas in need of further research are identified. The purpose of this review is to provide a summary of the 2023 KTA guideline for the management of thyroid nodules released in May 2023 and to give a balanced insight with comparison of recent guidelines from other societies.

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2023 Update of the Korean Thyroid Association Guidelines for the Management of Thyroid Nodules
Eun Kyung Lee, Young Joo Park
Clinical Thyroidology®.2024; 36(4): 153. CrossRef

Hypothalamus and pituitary gland
Update on Current Evidence for the Diagnosis and Management of Nonfunctioning Pituitary Neuroendocrine Tumors: Elizabeth Whyte, Masahiro Nezu, Constance Chik, Toru Tateno; Endocrinol Metab. 2023;38(6):631-654. Published online November 15, 2023; DOI: https://doi.org/10.3803/EnM.2023.1838

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Abstract PDF PubReader ePub: Pituitary neuroendocrine tumors (PitNETs) are the third most frequently diagnosed intracranial tumors, with nonfunctioning PitNETs (nfPitNETs) accounting for 30% of all pituitary tumors and representing the most common type of macroPitNETs. NfPitNETs are usually benign tumors with no evidence of hormone oversecretion except for hyperprolactinemia secondary to pituitary stalk compression. Due to this, they do not typically present with clinical syndromes like acromegaly, Cushing’s disease or hyperthyroidism and instead are identified incidentally on imaging or from symptoms of mass effects (headache, vision changes, apoplexy). With the lack of effective medical interventions, first-line treatment is transsphenoidal surgical resection, however, nfPitNETs often have supra- or parasellar extension, and total resection of the tumor is often not possible, resulting in residual tumor regrowth or reoccurrence. While functional PitNETs can be easily followed for recurrence using hormonal biomarkers, there is no similar parameter to predict recurrence in nfPitNETs, hence delaying early recognition and timely management. Therefore, there is a need to identify prognostic biomarkers that can be used for patient surveillance and as therapeutic targets. This review focuses on summarizing the current evidence on nfPitNETs, with a special focus on potential new biomarkers and therapeutics.

Special Article

Adrenal gland
2023 Korean Endocrine Society Consensus Guidelines for the Diagnosis and Management of Primary Aldosteronism: Jeonghoon Ha, Jung Hwan Park, Kyoung Jin Kim, Jung Hee Kim, Kyong Yeun Jung, Jeongmin Lee, Jong Han Choi, Seung Hun Lee, Namki Hong, Jung Soo Lim, Byung Kwan Park, Jung-Han Kim, Kyeong Cheon Jung, Jooyoung Cho, Mi-kyung Kim, Choon Hee Chung, The Committee of Clinical Practice Guideline of Korean Endocrine Society, The Korean Adrenal Study Group of Korean Endocrine Society; Endocrinol Metab. 2023;38(6):597-618. Published online October 13, 2023; DOI: https://doi.org/10.3803/EnM.2023.1789

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Primary aldosteronism (PA) is a common, yet underdiagnosed cause of secondary hypertension. It is characterized by an overproduction of aldosterone, leading to hypertension and/or hypokalemia. Despite affecting between 5.9% and 34% of patients with hypertension, PA is frequently missed due to a lack of clinical awareness and systematic screening, which can result in significant cardiovascular complications. To address this, medical societies have developed clinical practice guidelines to improve the management of hypertension and PA. The Korean Endocrine Society, drawing on a wealth of research, has formulated new guidelines for PA. A task force has been established to prepare PA guidelines, which encompass epidemiology, pathophysiology, clinical presentation, diagnosis, treatment, and follow-up care. The Korean clinical guidelines for PA aim to deliver an evidence-based protocol for PA diagnosis, treatment, and patient monitoring. These guidelines are anticipated to ease the burden of this potentially curable condition.

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Correlation of Histopathologic Subtypes of Primary Aldosteronism with Clinical Phenotypes and Postsurgical Outcomes
Chang Ho Ahn, You-Bin Lee, Jae Hyeon Kim, Young Lyun Oh, Jung Hee Kim, Kyeong Cheon Jung
The Journal of Clinical Endocrinology & Metabolism.2023;[Epub] CrossRef

Original Articles

Adrenal Gland
Outcome-Based Decision-Making Algorithm for Treating Patients with Primary Aldosteronism: Jung Hee Kim, Chang Ho Ahn, Su Jin Kim, Kyu Eun Lee, Jong Woo Kim, Hyun-Ki Yoon, Yu-Mi Lee, Tae-Yon Sung, Sang Wan Kim, Chan Soo Shin, Jung-Min Koh, Seung Hun Lee; Endocrinol Metab. 2022;37(2):369-382. Published online April 14, 2022; DOI: https://doi.org/10.3803/EnM.2022.1391

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Background
Optimal management of primary aldosteronism (PA) is crucial due to the increased risk of cardiovascular and cerebrovascular diseases. Adrenal venous sampling (AVS) is the gold standard method for determining subtype but is technically challenging and invasive. Some PA patients do not benefit clinically from surgery. We sought to develop an algorithm to improve decision- making before engaging in AVS and surgery in clinical practice.
Methods
We conducted the ongoing Korean Primary Aldosteronism Study at two tertiary centers. Study A involved PA patients with successful catheterization and a unilateral nodule on computed tomography and aimed to predict unilateral aldosterone-producing adenoma (n=367). Study B involved similar patients who underwent adrenalectomy and aimed to predict postoperative outcome (n=330). In study A, we implemented important feature selection using the least absolute shrinkage and selection operator regression.
Results
We developed a unilateral PA prediction model using logistic regression analysis: lowest serum potassium level ≤3.4 mEq/L, aldosterone-to-renin ratio ≥150, plasma aldosterone concentration ≥30 ng/mL, and body mass index <25 kg/m2 (area under the curve, 0.819; 95% confidence interval, 0.774 to 0.865; sensitivity, 97.6%; specificity, 25.5%). In study B, we identified female, hypertension duration <5 years, anti-hypertension medication <2.5 daily defined dose, and the absence of coronary artery disease as predictors of clinical success, using stepwise logistic regression models (sensitivity, 94.2%; specificity, 49.3%). We validated our algorithm in the independent validation dataset (n=53).
Conclusion
We propose this new outcome-driven diagnostic algorithm, simultaneously considering unilateral aldosterone excess and clinical surgical benefits in PA patients.

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Subtype-specific Body Composition and Metabolic Risk in Patients With Primary Aldosteronism
Seung Shin Park, Chang Ho Ahn, Sang Wan Kim, Ji Won Yoon, Jung Hee Kim
The Journal of Clinical Endocrinology & Metabolism.2024; 109(2): e788. CrossRef
Prognostic models to predict complete resolution of hypertension after adrenalectomy in primary aldosteronism: A systematic review and meta‐analysis
Luigi Marzano, Amir Kazory, Faeq Husain‐Syed, Claudio Ronco
Clinical Endocrinology.2023; 99(1): 17. CrossRef
2023 Korean Endocrine Society Consensus Guidelines for the Diagnosis and Management of Primary Aldosteronism
Jeonghoon Ha, Jung Hwan Park, Kyoung Jin Kim, Jung Hee Kim, Kyong Yeun Jung, Jeongmin Lee, Jong Han Choi, Seung Hun Lee, Namki Hong, Jung Soo Lim, Byung Kwan Park, Jung-Han Kim, Kyeong Cheon Jung, Jooyoung Cho, Mi-kyung Kim, Choon Hee Chung
Endocrinology and Metabolism.2023; 38(6): 597. CrossRef
Correlation of Histopathologic Subtypes of Primary Aldosteronism with Clinical Phenotypes and Postsurgical Outcomes
Chang Ho Ahn, You-Bin Lee, Jae Hyeon Kim, Young Lyun Oh, Jung Hee Kim, Kyeong Cheon Jung
The Journal of Clinical Endocrinology & Metabolism.2023;[Epub] CrossRef

Adrenal Gland
Contralateral Suppression at Adrenal Venous Sampling Is Associated with Renal Impairment Following Adrenalectomy for Unilateral Primary Aldosteronism: Ye Seul Yang, Seung Hun Lee, Jung Hee Kim, Jee Hee Yoo, Jung Hyun Lee, Seo Young Lee, A Ram Hong, Dong-Hwa Lee, Jung-Min Koh, Jae Hyeon Kim, Sang Wan Kim; Endocrinol Metab. 2021;36(4):875-884. Published online August 11, 2021; DOI: https://doi.org/10.3803/EnM.2021.1047

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Background
Adrenal venous sampling (AVS) is performed to distinguish the subtype of primary aldosteronism (PA). The clinical implication of contralateral suppression (CS; aldosterone/cortisol_nondominantperipheral) at AVS remains unclear. We aimed to investigate the clinical significance of CS and its impact on postoperative outcomes after unilateral adrenalectomy.
Methods
In this retrospective observational multi-center study, we analyzed PA patients who underwent both successful adrenocorticotropin hormone-stimulated AVS and unilateral adrenalectomy. Successful cannulation was defined as the selectivity index (cortisol_adrenal/ cortisol_peripheral) ≥3. Clinical and biochemical outcomes after unilateral adrenalectomy were evaluated based on the international Primary Aldosteronism Surgical Outcome consensus.
Results
Among 263 patients analyzed, 247 had CS (93.9%). Patients with CS had lower serum potassium levels, higher plasma aldosterone concentration, higher aldosterone-to-renin ratio (ARR), and larger adenoma size than those without CS. Those with CS showed significantly higher lateralization index than those without CS (P<0.001). Although postoperative blood pressure and ARR significantly decreased in those with CS, clinical and biochemical outcomes were comparable in both groups. When the cut-off value of age was determined using receiver operating characteristic (ROC) analysis, patients aged ≥50 years old with contralateral suppression index (CSI; the ratio between aldosterone/cortisol_nondominant and aldosterone/cortisol_peripheral) ≤0.26 had greater odds ratio (6.43; 95% confidence interval, 1.30 to 31.69) of incident chronic kidney disease than those aged <50 years with CSI >0.26 after adjusting for other factors.
Conclusion
CS may not predict postoperative clinical and biochemical outcomes in subjects with unilateral aldosterone excess, but it is associated with postsurgical deterioration of renal function in subjects over 50 years with CSI ≤0.26.

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Treatment decision based on unilateral index from nonadrenocorticotropic hormone-stimulated and adrenocorticotropic hormone-stimulated adrenal vein sampling in primary aldosteronism
Xizi Zhang, Xiaoyu Shu, Feifei Wu, Jun Yang, Qingfeng Cheng, Zhipeng Du, Ying Song, Yi Yang, Jinbo Hu, Yue Wang, Qifu Li, Shumin Yang
Journal of Hypertension.2024; 42(3): 450. CrossRef
Prognostic value of contralateral suppression on kidney function after surgery in patients with primary aldosteronism
Nathalie Voss, Sara Mørup, Caroline Clausen, Claus larsen Feltoft, Jan Viberg Jepsen, Mads Hornum, Mikkel Andreassen, Jesper Krogh
Clinical Endocrinology.2023; 98(3): 306. CrossRef
Factors Predicting Long-term Estimated Glomerular Filtration Rate Decrease, a Reliable Indicator of Renal Function After Adrenalectomy in Primary Aldosteronism
Qiyu He, Zhimin Tan, Yu Liu, Liang Zhou
Endocrine Practice.2023; 29(3): 199. CrossRef
Correlation of Histopathologic Subtypes of Primary Aldosteronism with Clinical Phenotypes and Postsurgical Outcomes
Chang Ho Ahn, You-Bin Lee, Jae Hyeon Kim, Young Lyun Oh, Jung Hee Kim, Kyeong Cheon Jung
The Journal of Clinical Endocrinology & Metabolism.2023;[Epub] CrossRef
Prognostic value of contralateral suppression for remission after surgery in patients with primary aldosteronism
Sara Mørup, Nathalie Voss, Caroline Clausen, Claus Larsen Feltoft, Mikkel Andreassen, Jesper Krogh
Clinical Endocrinology.2022; 96(6): 793. CrossRef
Contralateral Suppression at Adrenal Venous Sampling Is Associated with Renal Impairment Following Adrenalectomy for Unilateral Primary Aldosteronism (Endocrinol Metab 2021;36:875-84, Ye Seul Yang et al.)
Zhimin Tan, Qiyu He, Liang Zhou
Endocrinology and Metabolism.2022; 37(6): 951. CrossRef
Contralateral Suppression at Adrenal Venous Sampling Is Associated with Renal Impairment Following Adrenalectomy for Unilateral Primary Aldosteronism (Endocrinol Metab 2021;36:875-84, Ye Seul Yang et al.)
Ye Seul Yang, Sang Wan Kim
Endocrinology and Metabolism.2022; 37(6): 953. CrossRef

Review Article

Thyroid
Subclinical Hypothyroidism: Prevalence, Health Impact, and Treatment Landscape: Won Sang Yoo, Hyun Kyung Chung; Endocrinol Metab. 2021;36(3):500-513. Published online June 18, 2021; DOI: https://doi.org/10.3803/EnM.2021.1066

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Subclinical hypothyroidism (sHypo) is defined as normal serum free thyroid hormone levels coexisting with elevated serum thyroid-stimulating hormone (TSH) levels. sHypo is a common condition observed in clinical practice with several unique features. Its diagnosis should be based on an understanding of geographic and demographic differences in biochemical criteria versus a global reference range for TSH that is based on the 95% confidence interval of a healthy population. During the differential diagnosis, it is important to remember that a considerable proportion of sHypo cases are transient and reversible in nature; the focus is better placed on persistent or progressive forms, which mainly result from chronic autoimmune thyroiditis. Despite significant evidence documenting the health impacts of sHypo, the effects of levothyroxine treatment (LT4-Tx) in patients with sHypo remains controversial, especially in patients with grade 1 sHypo and older adults. Existing evidence suggests that it is reasonable to refrain from immediate LT4-Tx in most patients if they are closely monitored, except in women who are pregnant or in progressive cases. Future research is needed to further characterize the risks and benefits of LT4-Tx in different patient cohorts.

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THYROID FUNCTION ABNORMALITIES IN PATIENTS WITH CHOLELITHIASIS: A HOSPITAL-BASED CROSS-SECTIONAL STUDY
AVANISH KUMAR SAXENA, ANAM FATIMA, KUNDRAPU VEERA VENKATA SIVA, ANUSHKA PARIYA, VAYALAPALLI SYAMA CHINMAYI
Asian Journal of Pharmaceutical and Clinical Research.2024; : 138. CrossRef
Subclinical hypothyroidism and clinical outcomes after cardiac surgery: A systematic review and meta-analysis
Michele Dell’Aquila, Camilla S. Rossi, Tulio Caldonazo, Gianmarco Cancelli, Lamia Harik, Giovanni J. Soletti, Kevin R. An, Jordan Leith, Hristo Kirov, Mudathir Ibrahim, Michelle Demetres, Arnaldo Dimagli, Mohamed Rahouma, Mario Gaudino
JTCVS Open.2024; 18: 64. CrossRef
The Relationship between Subclinical Hypothyroidism and Carotid Intima-Media Thickness as a Potential Marker of Cardiovascular Risk: A Systematic Review and a Meta-Analysis
Oana-Maria Isailă, Victor Eduard Stoian, Iuliu Fulga, Alin-Ionut Piraianu, Sorin Hostiuc
Journal of Cardiovascular Development and Disease.2024; 11(4): 98. CrossRef
Variability of Thyroid Hormones in Newborns from Mothers with Endemic Goiter
Turdieva Shokhida Tolkunovna, Ganieva Durdona Kamalovna
Journal of Nature and Science of Medicine.2024; 7(2): 129. CrossRef
Thyroid dysfunction in the ageing patient
O.V. Bilookyi, V.L. Vasiuk, O.A. Shupik
INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (Ukraine).2024; 20(2): 143. CrossRef
Hormonal influences on cerebral aneurysms: unraveling the complex connections
Zahra Hasanpour Segherlou, Mahdieh Shakeri, Armin Khavandegar, Sara Stephenson, Kimberly Ciccone, Forough Masheghati, Mohammad Reza Hosseini Siyanaki, Mac Lyerly, Brandon Lucke-Wold
Expert Review of Endocrinology & Metabolism.2024;[Epub] CrossRef
Subclinical hypothyroidism, outcomes and management guidelines: a narrative review and update of recent literature
Bogumila Urgatz, Salman Razvi
Current Medical Research and Opinion.2023; 39(3): 351. CrossRef
Indicator of thyroid hormones in newborns from mothers with diffuse-endemic goiter
G. T. Makhkamova, Sh. T. Turdieva
Meditsinskiy sovet = Medical Council.2023; (1): 212. CrossRef
Diagnóstico y tratamiento del hipotiroidismo subclínico en adultos mayores
Debbie Noelia Tebanta Albán, Gabriel Aníbal Hugo Merino, María Valentina Muñoz Arteaga, Ariana Lisseth Vázquez López
Ciencia Digital.2023; 7(1): 6. CrossRef
2023 Korean Thyroid Association Management Guidelines for Patients with Subclinical Hypothyroidism
Hyun Kyung Chung, Eu Jeong Ku, Won Sang Yoo, Yea Eun Kang, Kyeong Jin Kim, Bo Hyun Kim, Tae-Yong Kim, Young Joo Park, Chang Ho Ahn, Jee Hee Yoon, Eun Kyung Lee, Jong Min Lee, Eui Dal Jung, Jae Hoon Chung, Yun Jae Chung, Won Bae Kim, Ka Hee Yi, Ho-Cheol Ka
International Journal of Thyroidology.2023; 16(1): 32. CrossRef
Gut microbiota short-chain fatty acids and their impact on the host thyroid function and diseases
María José Mendoza-León, Ashutosh K. Mangalam, Alejandro Regaldiz, Enrique González-Madrid, Ma. Andreina Rangel-Ramírez, Oscar Álvarez-Mardonez, Omar P. Vallejos, Constanza Méndez, Susan M. Bueno, Felipe Melo-González, Yorley Duarte, Ma. Cecilia Opazo, Al
Frontiers in Endocrinology.2023;[Epub] CrossRef
Human amnion-derived mesenchymal stem cells improve subclinical hypothyroidism by immunocompetence mediating apoptosis inhibition on thyroid cells in aged mice
Chuyu Li, Qiang Rui, Xiaohan Dong, Song Ning, Jing Zhou, Huimin Wu, Chunyan Jiang, Yugui Cui, Jiayin Liu, Jun Jiang, Lianju Qin
Cell and Tissue Research.2023; 394(2): 309. CrossRef
Is Thyroid Dysfunction Associated with Unruptured Intracranial Aneurysms? A Population-Based, Nested Case–Control Study from Korea
Hyeree Park, Sun Wook Cho, Sung Ho Lee, Kangmin Kim, Hyun-Seung Kang, Jeong Eun Kim, Aesun Shin, Won-Sang Cho
Thyroid®.2023; 33(12): 1483. CrossRef
The Role of Global Longitudinal Strain in Subclinical Hypothyroid Patients With Heart Failure
Nismat Javed, Vibha Hayagreev, Angel DeLaCruz, Muhammad Saad, Amandeep Singh, Timothy Vittorio
Cureus.2023;[Epub] CrossRef
Association between shift work and the risk of hypothyroidism in adult male workers in Korea: a cohort study
Seonghyeon Kwon, Yesung Lee, Eunhye Seo, Daehoon Kim, Jaehong Lee, Youshik Jeong, Jihoon Kim, Jinsook Jeong, Woncheol Lee
Annals of Occupational and Environmental Medicine.2023;[Epub] CrossRef
Estimation of left ventricular functions in patients with subclinical hypothyroidism: a meta-analysis
Binyi Li, Yong Huang, Zheng Li
Frontiers in Endocrinology.2023;[Epub] CrossRef
Comparison of Five Different Criteria for Diagnosis of Subclinical Hypothyroidism in a Large-Scale Chinese Population
Yan-song Zheng, Sheng-yong Dong, Yan Gong, Jia-hong Wang, Fei Wang, Qiang Zeng
Frontiers in Endocrinology.2022;[Epub] CrossRef
Subclinical Hypothyroidism and Cognitive Impairment
Jung-Min Pyun, Young Ho Park, SangYun Kim
Journal of Alzheimer's Disease.2022; 88(2): 757. CrossRef
Effect of Levothyroxine Supplementation on the Cardiac Morphology and Function in Patients With Subclinical Hypothyroidism: A Systematic Review and Meta-analysis
Xichang Wang, Haoyu Wang, Qiuxian Li, Ping Wang, Yumin Xing, Fan Zhang, Jiashu Li, Zhongyan Shan
The Journal of Clinical Endocrinology & Metabolism.2022; 107(9): 2674. CrossRef
Natural history of subclinical hypothyroidism and prognostic factors for the development of overt hypothyroidism: Tehran Thyroid Study (TTS)
A. Amouzegar, M. Dehghani, H. Abdi, L. Mehran, S. Masoumi, F. Azizi
Journal of Endocrinological Investigation.2022; 45(12): 2353. CrossRef
Retrospective cohort analysis comparing changes in blood glucose level and body composition according to changes in thyroid‐stimulating hormone level
Hyunah Kim, Da Young Jung, Seung‐Hwan Lee, Jae‐Hyoung Cho, Hyeon Woo Yim, Hun‐Sung Kim
Journal of Diabetes.2022; 14(9): 620. CrossRef
Long working hours and the risk of hypothyroidism in healthy Korean workers: a cohort study
Yesung Lee, Woncheol Lee, Hyoung-Ryoul Kim
Epidemiology and Health.2022; 44: e2022104. CrossRef

Original Articles

Camprison of Diagnostic and Therapeutic scans in Patients with Differentiated Thyroid Cancer.: Yoon Sang Choi, Soo Mi Kim, Shin Gon Kim, Don Hyun Shin, Ie Byung Park, Sei Hyun Baik, Dong Seop Choi, Jae Myung Yu; J Korean Endocr Soc. 1996;11(4):431-437. Published online November 7, 2019

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Abstract PDF: Background
Whole body scan using 131-iodine is performed to detect local recurrence or metastasis after thyroidectorny in differenciated thyroid cancer patients. The sensitivity of this procedure is related to the dose of radiopharmaceutical administered. It was reported that 131I posttreatment whole body scan demonstrate foci of tracer uptake not previously observed in diagnostic scan in 10~30% of cases. Posttreatment scans were most likely to reveal new foci in young patients(<45) and patients who had previously received radioactive iodine therapy. Method: We observed the frequency of discordant posttreatment scans and analysed the clicnical significance in 33 differenciated thyroid cancer patients who were admitted for radioiodine ablation from June, 1995 to April, 1996. Results: In 7 cases(21.2%), post treatment scan demonstrated cme or more foci of uptake and revealed less sites of uptake than diagnostic scan in 3 cases(9.1%). In one case with elevated thyroglobulin level and negative diagnostic scan, post treatment scan revealed new uptake sites with thyroid bed and cervical 1ymph node. The sites of discordant uptake were cervical lymph nodes in 4 cases and rnediastinal lymph node in one case, lung in one case, thyroid bed and cervical lymph nodes in one case, 3 cases of 7 pts(43%), demonstrated ane or more foci of uptake in post treatment scan, had history of previous radioiodine treatent. Conclusion: Post treatment scan confirmed uptake into remnant and metaststic tissues identified on the corresponding low dose diagnostic scans. Scanning after high dose radioiodine treatment frequently demonstrated one or more foci of uptake, especially in patients with previous radioiodine treatment, which were not visualized on the diagnostic low dose scan. Treatment scan may be useful for detection of remnant tissue or metastatic lesion in patients with elevated thyroglobulin and negative diagnostic scan.

Effect of Insulin Like Growth Factor - 1 (IGF - 1) on Energy Restricted Rat - Failure of IGF - 1 injection to promote growth in energy restricted rats despite normalization of serum IGF - 1 concentration -.: Jeh Hoon Shin; J Korean Endocr Soc. 1994;9(3):213-218. Published online November 6, 2019

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Abstract PDF: recombinant human IGF-I in energy-restriction model. Experimental design; Sprague-Dawley rats(n=20) weighing 90-100g were used. Rats were fed a control diet two times a day(AM 8-11, PM 5-8) for four days after arrival and then assigned to one of three groups: control, energy-restricted, energy-restricted IGF-I treatment group. Energy restricted group was given with a decrese of 25% in the energy without changes in the protein by feeding 88% by weight to energy-restricted diet. During the 10days of energy restriction, the growth rate was reduced by 35%(2.70+-0.18g/day in energy restricted group vs. 4.13+-0.75g/day in the control group). At sacrifice, the tail lengh and weight of organs were not significantly decreased except the spleen and thymus(-17%: P<0.05). Serum IGF-I was reduced by 19% at the end of 10days of energy restriction. The glycemia, measured each day by glucometer from blood collected at the tail, was not reduced by energy restriction(105.4+-7.7 in control group vs. 101.3+-4.1mg/dl). The abundance of serum IGF-BPs was unchanged by this restriction.Despite the 1.5 fold increase of IGF-I concentration in energy restricted IGF-I injection group at sacrifice(1994+-172ng/ml vs. 1221+-110 ng/ml energy restricted group), IGF-I treatment(300 ug/day in twice sc injection for 6day) did not significantly accelerate the growth rate(body weight)(2.87+-0.20 vs. 2.70+-0.18g/day in energy restricted group).The glycemia was slightly reduced by IGF-I treatment(91.7+-5.0 mg/dl vs. 101.3+-4.5 mg/dl in energy restricted group), but it was not significant. However, the spleen and thymus weight, decreased by energy restriction, was completely normalized by IGF-I treatment.In summary, lack of a significant anabolic response to injection of IGF-I during energy restriction in this study may be associated with the compensatory growth response(alterations in dietary protein utilization) which followed initial period of energy restriction.

Review Article

Adrenal gland
Hypoparathyroidism: Replacement Therapy with Parathyroid Hormone: Lars Rejnmark, Line Underbjerg, Tanja Sikjaer; Endocrinol Metab. 2015;30(4):436-442. Published online December 31, 2015; DOI: https://doi.org/10.3803/EnM.2015.30.4.436

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Hypoparathyroidism (HypoPT) is characterized by low serum calcium levels caused by an insufficient secretion of parathyroid hormone (PTH). Despite normalization of serum calcium levels by treatment with activated vitamin D analogues and calcium supplementation, patients are suffering from impaired quality of life (QoL) and are at increased risk of a number of comorbidities. Thus, despite normalization of calcium levels in response to conventional therapy, this should only be considered as an apparent normalization, as patients are suffering from a number of complications and calcium-phosphate homeostasis is not normalized in a physiological manner. In a number of recent studies, replacement therapy with recombinant human PTH (rhPTH(1-84)) as well as therapy with the N-terminal PTH fragment (rhPTH(1-34)) have been investigated. Both drugs have been shown to normalize serum calcium while reducing needs for activated vitamin D and calcium supplements. However, once a day injections cause large fluctuations in serum calcium. Twice a day injections diminish fluctuations, but don't restore the normal physiology of calcium homeostasis. Recent studies using pump-delivery have shown promising results on maintaining normocalcemia with minimal fluctuations in calcium levels. Further studies are needed to determine whether this may improve QoL and lower risk of complications. Such data are needed before replacement with the missing hormone can be recommended as standard therapy.

Citations

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Point-of-Care Peptide Hormone Production Enabled by Cell-Free Protein Synthesis
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Effects of Multi-stage Procurement on the Viability and Function of Human Donor Parathyroid Glands
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Kidney Complications and Hospitalization in Patients With Chronic Hypoparathyroidism: A Cohort Study in Sweden
Oskar Swartling, Marie Evans, Tim Spelman, Wafa Kamal, Olle Kämpe, Michael Mannstadt, Ylva Trolle Lagerros, Sigridur Björnsdottir
The Journal of Clinical Endocrinology & Metabolism.2022; 107(10): e4098. CrossRef
Hypocalcaemia
Zaki Hassan-Smith, Neil Gittoes
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Safety and Efficacy of 5 Years of Treatment With Recombinant Human Parathyroid Hormone in Adults With Hypoparathyroidism
Michael Mannstadt, Bart L Clarke, John P Bilezikian, Henry Bone, Douglas Denham, Michael A Levine, Munro Peacock, Jeffrey Rothman, Dolores M Shoback, Mark L Warren, Nelson B Watts, Hak-Myung Lee, Nicole Sherry, Tamara J Vokes
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Management of Endocrine Emergencies in the ICU
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Microencapsulated parathyroid allotransplantation in the omental tissue
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Die HypAus-Studie
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Sustained release of parathyroid hormone via in situ cross‐linking gelatin hydrogels improves the therapeutic potential of tonsil‐derived mesenchymal stem cells for hypoparathyroidism
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Journal of Tissue Engineering and Regenerative Medicine.2018;[Epub] CrossRef
Hypocalcaemia
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Original Articles

Pituitary Apoplexy in Korea - Characteristics, Treatment Options and Outcomes.: Jung Ah Lim, Jin Taek Kim, Min Joo Kim, Tae Hyuk Kim, Yenna Lee, Hwa Young Cho, Chan Soo Shin, Kyong Soo Park, Hak Chul Jang, Bo Youn Cho, Hong Kyu Lee, Seong Yeon Kim; J Korean Endocr Soc. 2009;24(4):247-253. Published online December 1, 2009; DOI: https://doi.org/10.3803/jkes.2009.24.4.247

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BACKGROUND
Reports on pituitary apoplexy in Korea are limited. There are two treatment options for pituitary apoplexy - surgical decompression and conservative management. In this study, we examined clinical presentation and outcomes following different therapies in Korean patients with pituitary apoplexy. METHODS: Clinical data and treatment outcomes from 52 patients with pituitary apoplexy who visited Seoul National University Hospital between January 1992 and June 2008 were reviewed retrospectively. Patients were divided into 2 groups according to management options (a surgery group vs. a conservative management group) and their outcomes were compared. For patients who underwent surgery due to neurological symptoms, outcomes were compared between early and late surgery groups. RESULTS: Headache (73.1%) was the most common presenting symptom, and more than half of the patients were reported to have visual symptoms. The most common type of pathology was a nonfunctioning pituitary adenoma (67.3%). Nine patients received conservative management and 43 underwent surgical decompression. Their recovery from neurological and endocrinological abnormalities were similar. Among patients who showed neurological symptoms, 9 underwent surgery within 1 week of symptom onset and 24 underwent surgery after 1 week. There was no significant difference between outcomes of early and late surgery groups except recovery from impaired visual deficit was greater in the late surgery group. CONCLUSION: Patients with pituitary apoplexy in Korea show similar clinical features as similar patients in other countries. In our study, there was no significant difference between clinical outcomes of the surgery group and the conservative treatment group.

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The Outcomes of Pituitary Apoplexy with Conservative Treatment: Experiences at a Single Institution
Youngbeom Seo, Yong Hwy Kim, Yun-Sik Dho, Jung Hee Kim, Jin Wook Kim, Chul-Kee Park, Dong Gyu Kim
World Neurosurgery.2018; 115: e703. CrossRef
Characteristics and Treatment Options of Pituitary Apoplexy
Dong-Sun Kim
Journal of Korean Endocrine Society.2009; 24(4): 237. CrossRef

A Retrospective Review of the Effectiveness of Recombinant Human TSH-Aided Radioiodine Treatment of Differentiated Thyroid Carcinoma.: Min Ah Na, Sun Hae Shin, Yang Ho Kang, Seok Man Son, In Joo Kim, Yong Ki Kim; J Korean Endocr Soc. 2006;21(4):274-280. Published online August 1, 2006; DOI: https://doi.org/10.3803/jkes.2006.21.4.274

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The aim of the study was to evaluate the biochemical effects of recombinant human thyroid stimulating hormone (rhTSH) as an adjunct to radioiodine (RI) treatment of a differentiated thyroid carcinoma (DTC). We retrospectively reviewed the clinical response rates of DTC patients treated with RI after thyroid hormone withdrawal and compared with those after rhTSH stimulation. METHOD: We included the patients treated with RI for locally recurrent DTC from February 1, 2002 to August 31, 2005 and followed with diagnostic studies at our hospital. Forty totally (or near totally) thyroidectomized adults were included in this study. Nine patients underwent RI treatment after rhTSH stimulation while euthyoid on L-thyroxine (LT4), and 31 patients were treated with RI after thyroid hormone withdrawal. The clinical response was defined as >25% decrease in serum thyroglobulin (Tg) level on LT4 3 months after the RI treatment. RESULTS: In each group, serum Tg levels were significantly decreased 3 months after the RI treatment. And we found that 77.8 and 71.0% of those prepared by rhTSH and LT4 withdrawal, respectively, had clinical responses 3 months after the RI treatment by our criteria and there was no significant difference in response rates between two groups (P=0.238). CONCLUSIONS: Given the biases that exist in retrospective studies, at the current time we cannot recommend the routine use of rhTSH to prepare RI treatment of DTC. However, our study provided preliminary evidence that rhTSH effectively aided RI treatment of DTC at least to an equivalent degree as LT4 withdrawal.

The Effect of Treatment Modalities on Survival Rates of Patients with Anaplastic Thyroid Carcinoma.: Jae Myoung Choi, Mi Jeong Kim, Seung Won Lee, Kyoung Eun Song, Yoon Sok Chung, Kwan Woo Lee, Dae Jung Kim, Sung Hee Choi, So Hun Kim, Min Ho Cho, Yumie Rhee, Chul Woo Ahn, Sung Kil Lim, Kyung Rae Kim; J Korean Endocr Soc. 2005;20(2):127-133. Published online April 1, 2005; DOI: https://doi.org/10.3803/jkes.2005.20.2.127

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BACKGROUND
Anaplastic thyroid carcinoma represents 2% to 5% of all thyroid cancers and it is one of the most aggressive human cancers. Local extension at the time of diagnosis and distant metastases are almost always the rule. Its lethality is evidenced by a 5-year survival rate of 3.6% and a median survival time of 4 months. We retrospectively reviewed patients with this disease at 4 tertiary referral centers. METHODS: From 1990 to 2003, 19 cases(9 men and 10 women, mean age: 65.1+/-7.1 years) of anaplastic thyroid carcinoma were reviewed via the medical records. The overall survival rates according to the prognostic factors and the treatment modalities were analyzed. RESULTS: The presenting symptoms included rapidly enlarged neck masses in 16 patients, shortness of breath in 3 patients, hoarseness in 4 patients, dysphagia in 2 patients and chest wall pain in 1 patient. The mean diameter of tumor was 7.2cm. Local extension was seen in all of the cases that had undergone surgery. Distant metastases(lung 6, bone 2, abdominal carcinomatosis 2, brain 1 and mediastinum 1) were seen in 9 patients. Surgical treatment was performed in 10 patients. Radiotherapy was performed in 9 patients and chemotherapy was done in 5 patients; radiotherapy was performed alone in 2 patients, combination chemo-radiotherapy was performed in 3 patients, postoperative radiotherapy was performed in 2 patients and postoperative combination chemo-radiotherapy was performed in 2 patients. 4 patients were treated cons ervatively after the confirmative diagnosis. The overall median survival time was 123 days(range: 23~621 days); the median survival time was 129 days in the treatment group(n=15), and 27 days in the no treatment group (n=4), and significantly higher survival rates were observed for the treated patients(p=0.02). According to the treatment modalities, patients who underwent surgical treatment and postoperative radiotherapy and/or chemotherapy were observed to have significantly higher survival rates than patients in the radiotherapy and/or chemotherapy group(p=0.03), and also than those patients in the surgical treatment only group(p=0.04). CONCLUSION: We found that aggressive surgical treatment and postoperative radiotherapy and/or chemotherapy improved the survival rates of patients with anaplastic thyroid carcinoma even though local invasion and distant metastases was generally observed to occur

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Anaplastic Thyroid Carcinoma: Experience of a Single Institute
Dongbin Ahn, Jin Ho Sohn
Korean Journal of Otorhinolaryngology-Head and Neck Surgery.2012; 55(1): 37. CrossRef

Adequate Duration of Medical Therapy for Koreans with Graves' Disease.: Hyoung Suk Lee, Dong Hun Lee, Hee Sun Chung, Jong Woo Lee, Jung Eun Kim, Seung Soo Shin, Yoon Sok Chung, Kwan Woo Lee, Hyeon Man Kim; J Korean Endocr Soc. 2003;18(1):24-31. Published online February 1, 2003

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Abstract PDF: BACKGROUND
Graves' disease is an organ specific autoimmune disease. Three kinds of therapeutic modalities(antithyroid drugs, ablation with radioactive iodine and subtotal thyroidectomy) are frequently performed for the management of this disease. The most popular therapeutic policy for the disease in Korea is antithyroid treatment. We analysed and compared the remission rates of all three modalities for Graves' disease, and evaluated the antithyroid modality to determine the correct duration of treatment. SUBJECTS AND METHODS: The medical records of 205 patients with Graves' disease were reviewed. For the evaluation of the antithyroid modality medical treatment, antithyroid drugs were administered for more than 1 year. The prognostic factors associated with remission were analysed by means of an ROC curve. RESULTS: 1) Of the 205 patients, proportions that received medical therapy, subtotal thyroidectomy and radioiodine therapy were 83.0, 14.1 and 2.9%, respectively. 2) The remission rates of the medical therapy, surgery and radioiodine therapy were 60.0, 96.5 and 83.0%, respectively. 3) The remission rate of the medical therapy was associated with the duration of medication and TBII activity. The determined proper duration for the antithyroid treatment was 26 months from the ROC curve analysis. CONCLUSION: The above results suggest that the proper duration of antithyroid treatment for Graves' disease is 26 months, after which time the subtotal thyroidectomy or radioiodine therapy should be considered if the disease has not remitted.

Korean Adult Growth Hormone Deficiency Treatment Registry.: Sung Woon Kim, Seong Yeon Kim, Su Youn Nam, Yoon Sok Chung, Jae Hoon Chung, In Kyung Jung, Jong Ryeal Hahm, Minho Shong, Dong Sun Kim, Seong Keun Lee, Sung Dae Moon, Hyun Koo Yoon, Doo Man Kim, Sang Woo Kim, Hye Kyung Park; J Korean Endocr Soc. 2002;17(1):43-47. Published online February 1, 2002

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Abstract PDF: BACKGROUND
Adult growth hormone (GH) deficiency is related with decreased lean body mass, increased body fat, and poor quality of life. In western countries, adult GH deficiency treatment registriesy provide a database of the effects and safety of GH deficiency treatment. The Korean Adult Growth Hormone Study Group of the Korean Society of Endocrinology register adult GH deficiency since 1996. METHEODS: Subjects were aged over 15 years, had organic hypothalamo-pituitary disease, and GH deficiency as documented by GH stimulation test or serum insulin-like growth factor-I (IGF-I) level. The underlying etiology for GH deficiency, serum IGF-I level, starting and maintenance dose, and adult GH deficiency assessment (AGHDA) score were investigated. RESULTS: From January 1996 to May 2001. 115 patients were enrolled. Mean age was 43.7 13.8 years and 60% were female. Thirteen medical institutions were involved in the registry. The most common underlying diseases were Sheehan's syndrome and pituitary adenomas. GH starting dose was from 0.4 to 1.0 units. Maintenance dose was between 0.5 and 1.2 units. Serum IGF-I levels were increased after GH treatment (0-week, 93.7 69.7 ng/mL; 2-weeks, 184.9 89.0 ng/mL; 6-weeks, 188.4 94.8 ng/mL; 10-weeks, 207.6 111.1 ng/mL; 6 months, 281.9 95.5 ng/mL). AGHDA scores slightly improved from 10.25 6.70 to 8.58 5.47 after 6 months of GH deficiency treatment. CONCLUSION: The GH Treatment Registry will be beneficial in monitoring the effects of GH deficiency treatment on Korean adult GH deficient subjects

Comparison of Treatment Modalities in Hyperprolactinemia.: Sun Hee Park, Hyeon Jeong Jeon, Do Joon Park, Kyong Soo Park, Seong Yeon Kim, Bo Youn Cho, Hong Kyu Lee; J Korean Endocr Soc. 2002;17(1):32-42. Published online February 1, 2002

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Prolactinomas have been treated primarily with bromocriptine, a dopamine agonists, rather than by transsphenoidal pituitary adenomectomy. However, lower success rates, as well as intolerance or resistance to medical therapy, have been reported in some recent series. The purpose of this study was to compare the effects of surgery and bromocriptine in the treatment of prolactinomas patients. Also we investigated the natural history and effects of bromocriptine on patients with idiopathic hyperprolactinemia. METHEODS: We retrospectively compared the effects of treatment with surgery and with bromocriptine in 27 idiopathic hyperprolactinemia patients, 35 microprolactinoma patients and 61 macroprolactinoma patients. RESULTS: (1) In 14 patients with untreated idiopathic hyperprolactinemia, 8 (57%) achieved remission. In patients without remission, preoperative serum prolactin level was significantly higher than patients with remission (p<0.05). In 13 patients on bromocriptine, 11 (85%) achieved remission, while the other 2, taking bromocriptine irregularly because of side effects, had persistent hyperprolactinemia. (2) In 35 patients with microprolactinoma, 11 (30%) surgery as initial therapy and surgical remission was achieved in only 5 of the 11 (45%). In 23 patients on bromocriptine, 17 (74%) achieved remission. Among the 6 patients without remission, 5 patients took bromocriptine irregularly because of side effect. (3) In 61 patients with macroprolactinoma, 49 (80%) underwent surgery as initial therapy and surgical remission was achieved in only 9 of the 49 (18%). In 50 patients on bromocriptine, 30 (60%) achieved remission. Among the 20 patients without remission, 13 took bromocriptine irregularly because of side effect and 5 were resistant to bromocriptine. CONCLUSION: In idiopathic hyperprolactinemia, the requirement for medical treatment is doubtful because of a high tendency to ward spontaneous cure. In spite of the low success rate, surgery has been used as the primary therapy for prolactinoma in Korea. And yet, medical treatment with bromocriptine is superior to surgery. However, irrgular administration of medication due to drug side effects was the main cause of the low success rate. Therefore, the necessity for new drug development is emphasized

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