Endocrinology and Metabolism

Hye Seung Jung (Jung HS)

22 Articles

Diabetes, obesity and metabolism
Partial Deletion of Perk Improved High-Fat Diet-Induced Glucose Intolerance in Mice: Jooyeop Lee, Min Joo Kim, Seoil Moon, Ji Yoon Lim, Kyong Soo Park, Hye Seung Jung; Endocrinol Metab. 2023;38(6):782-787. Published online November 13, 2023; DOI: https://doi.org/10.3803/EnM.2023.1738

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Abstract PDF Supplementary Material PubReader ePub: Although pancreatic endoplasmic reticulum kinase (PERK) is indispensable to beta cells, low-dose PERK inhibitor improved glucose- stimulated insulin secretion (GSIS) and hyperglycemia in diabetic mice. Current study examined if partial deletion of Perk (Perk^+/-) recapitulated the effects of PERK inhibitor, on the contrary to the complete deletion. Perk^+/- mice and wild-type controls were fed with a high-fat diet (HFD) for 23 weeks. Glucose tolerance was evaluated along with serum insulin levels and islet morphology. Perk^+/- mice on normal chow were comparable to wild-type mice in various metabolic features. HFD-induced obesity was not influenced by Perk reduction; however, HFD-induced glucose intolerance was significantly improved since 15-week HFD. HFD-induced compromises in GSIS were relieved by Perk reduction, accompanied by reductions in phosphorylated PERK and activating transcription factor 4 (ATF4) in the islets. Meanwhile, HFD-induced islet expansion was not significantly affected. In summary, partial deletion of Perk improved glucose tolerance and GSIS impaired by diet-induced obesity, without changes in body weights or islet mass.

Diabetes
Response: Favorable Glycemic Control with Once-Daily Insulin Degludec/Insulin Aspart after Changing from Basal Insulin in Adults with Type 2 Diabetes (Endocrinol Metab 2019; 34:382-9, Han Na Jang et al.): Han Na Jang, Hye Seung Jung; Endocrinol Metab. 2020;35(1):194-195. Published online March 19, 2020; DOI: https://doi.org/10.3803/EnM.2020.35.1.194; [Original]

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Clinical Study
Favorable Glycemic Control with Once-Daily Insulin Degludec/Insulin Aspart after Changing from Basal Insulin in Adults with Type 2 Diabetes: Han Na Jang, Ye Seul Yang, Seong Ok Lee, Tae Jung Oh, Bo Kyung Koo, Hye Seung Jung; Endocrinol Metab. 2019;34(4):382-389. Published online December 23, 2019; DOI: https://doi.org/10.3803/EnM.2019.34.4.382

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Background

Conflicting results have been reported on the efficacy of insulin degludec/insulin aspart (IDegAsp) compared to basal insulin in type 2 diabetes. We investigated the effects of changing basal insulin to IDegAsp on glycemic control and sought to identify factors related to those effects.

Methods

In this retrospective study of patients from three referral hospitals, patients with type 2 diabetes using basal insulin with hemoglobin A1c (HbA1c) levels less than 11.0% were enrolled. Basal insulin was replaced with IDegAsp, and data were analyzed from 3 months before to 3 months after the replacement.

Results

Eighty patients were recruited (52.5% male; mean age, 67.0±9.8 years; mean duration of diabetes, 18.9±8.5 years; mean HbA1c, 8.7%±1.0%). HbA1c levels increased during 3 months of basal insulin use, but significantly decreased after changing to IDegAsp (8.28%±1.10%, P=0.0001). The reduction was significant at 6 months in 35 patients whose longer-term data were available. Patients with a measured fasting plasma glucose (m-FPG) lower than their predicted FPG (p-FPG) by regression from HbA1c showed a significant HbA1c reduction caused by the change to IDegAsp, even without a significantly increased insulin dose. However, patients whose m-FPG was higher than their p-FPG did not experience a significant HbA1c reduction, despite a significantly increased insulin dose. Furthermore, the HbA1c reduction caused by IDegAsp was significant in patients with low fasting C-peptide levels and high insulin doses.

Conclusion

We observed a significant glucose-lowering effect by replacing basal insulin with IDegAsp, especially in patients with a lower m-FPG than p-FPG.

Citations

Citations to this article as recorded by

Evaluation of the efficiency of insulin degludec/insulin aspart therapy in controlling hyperglycemia and hypoglycemia in patients with type 2 diabetes mellitus: a real-life experience
Gökçen Güngör Semiz, İsmail Selimoğlu, Mehmet Emin Arayici, Serkan Yener, Abdurrahman Çömlekçi, Tevfik Demir
International Journal of Diabetes in Developing Countries.2023; 43(4): 544. CrossRef
Low fasting glucose‐to‐estimated average glucose ratio was associated with superior response to insulin degludec/aspart compared with basal insulin in patients with type 2 diabetes
Han Na Jang, Ye Seul Yang, Tae Jung Oh, Bo Kyung Koo, Seong Ok Lee, Kyong Soo Park, Hak Chul Jang, Hye Seung Jung
Journal of Diabetes Investigation.2022; 13(1): 85. CrossRef
Efficacy and Safety of Insulin Degludec/Insulin Aspart (IDegAsp) in Type 2 Diabetes: Systematic Review and Meta-Analysis
Brenda C Edina, Jeremy R Tandaju, Lowilius Wiyono
Cureus.2022;[Epub] CrossRef
Comparing Time to Intensification between insulin Degludec/Insulin Aspart and Insulin Glargine
Rajiv Kovil
Journal of Diabetology.2022; 13(2): 171. CrossRef
Efficacy and Safety of Insulin Degludec/Insulin Aspart Compared with a Conventional Premixed Insulin or Basal Insulin: A Meta-Analysis
Shinje Moon, Hye-Soo Chung, Yoon-Jung Kim, Jae-Myung Yu, Woo-Ju Jeong, Jiwon Park, Chang-Myung Oh
Metabolites.2021; 11(9): 639. CrossRef
Fear of Hypoglycemia in Adults with diabetes mellitus switching to Treatment with IDegAsp Co-formulation to Examine real-world setting: an observational study (The HATICE study)
Ulaş Serkan Topaloğlu, Hatice Kayış Topaloğlu, Melih Kızıltepe, Mesut Kılıç, Sami Bahçebaşı, Sibel Ata, Şeyma Yıldız, Yasin Şimşek
Drug Metabolism and Drug Interactions.2021; 36(2): 129. CrossRef
Response: Favorable Glycemic Control with Once-Daily Insulin Degludec/Insulin Aspart after Changing from Basal Insulin in Adults with Type 2 Diabetes (Endocrinol Metab 2019; 34:382-9, Han Na Jang et al.)
Han Na Jang, Hye Seung Jung
Endocrinology and Metabolism.2020; 35(1): 194. CrossRef
Letter: Favorable Glycemic Control with Once-Daily Insulin Degludec/Insulin Aspart after Changing from Basal Insulin in Adults with Type 2 Diabetes (Endocrinol Metab 2019; 34:382-9, Han Na Jang et al.)
Sang Youl Rhee
Endocrinology and Metabolism.2020; 35(1): 192. CrossRef
Fear of hypoglycemia in adults with diabetes mellitus switching to treatment with IDegAsp co-formulation to examine real-world setting: an observational study (The HATICE study)
Ulaş Serkan Topaloğlu, Hatice Kayış Topaloğlu, Melih Kızıltepe, Mesut Kılıç, Sami Bahçebaşı, Sibel Ata, Şeyma Yıldız, Yasin Şimşek
Drug Metabolism and Personalized Therapy.2020;[Epub] CrossRef

Obesity and Metabolism
Prediction of Diabetes Using Serum C-Peptide: Hye Seung Jung; Endocrinol Metab. 2016;31(2):275-276. Published online June 22, 2016; DOI: https://doi.org/10.3803/EnM.2016.31.2.275

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Clinical Study
1,5-Anhydro-D-Glucitol Could Reflect Hypoglycemia Risk in Patients with Type 2 Diabetes Receiving Insulin Therapy: Min Kyeong Kim, Hye Seung Jung, Soo Heon Kwak, Young Min Cho, Kyong Soo Park, Seong Yeon Kim; Endocrinol Metab. 2016;31(2):284-291. Published online May 27, 2016; DOI: https://doi.org/10.3803/EnM.2016.31.2.284

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Background

The identification of a marker for hypoglycemia could help patients achieve strict glucose control with a lower risk of hypoglycemia. 1,5-Anhydro-D-glucitol (1,5-AG) reflects postprandial hyperglycemia in patients with well-controlled diabetes, which contributes to glycemic variability. Because glycemic variability is related to hypoglycemia, we aimed to evaluate the value of 1,5-AG as a marker of hypoglycemia.

Methods

We enrolled 18 adults with type 2 diabetes mellitus (T2DM) receiving insulin therapy and assessed the occurrence of hypoglycemia within a 3-month period. We measured 1,5-AG level, performed a survey to score the severity of hypoglycemia, and applied a continuous glucose monitoring system (CGMS).

Results

1,5-AG was significantly lower in the high hypoglycemia-score group compared to the low-score group. Additionally, the duration of insulin treatment was significantly longer in the high-score group. Subsequent analyses were adjusted by the duration of insulin treatment and mean blood glucose, which was closely associated with both 1,5-AG level and hypoglycemia risk. In adjusted correlation analyses, 1,5-AG was negatively correlated with hypoglycemia score, area under the curve at 80 mg/dL, and low blood glucose index during CGMS (P=0.068, P=0.033, and P=0.060, respectively).

Conclusion

1,5-AG level was negatively associated with hypoglycemia score determined by recall and with documented hypoglycemia after adjusting for mean glucose and duration of insulin treatment. As a result, this level could be a marker of the risk of hypoglycemia in patients with well-controlled T2DM receiving insulin therapy.

Citations

Citations to this article as recorded by

Neurological dysfunction screening in a cohort of adolescents with type 1 diabetes: a six-year follow-up
Davide Tinti, Carlotta Canavese, Cecilia Nobili, Daniele Marcotulli, Erika Daniele, Ivana Rabbone, Luisa de Sanctis
Frontiers in Medicine.2024;[Epub] CrossRef
The progress of clinical research on the detection of 1,5-anhydroglucitol in diabetes and its complications
Huijuan Xu, Junhua Pan, Qiu Chen
Frontiers in Endocrinology.2024;[Epub] CrossRef
Mobile Healthcare System Provided by Primary Care Physicians Improves Quality of Diabetes Care
Tae Jung Oh, Jie-Eun Lee, Seok Kim, Sooyoung Yoo, Hak Chul Jang
CardioMetabolic Syndrome Journal.2021; 1(1): 88. CrossRef
Effects of mobile phone application combined with or without self‐monitoring of blood glucose on glycemic control in patients with diabetes: A randomized controlled trial
Yuan Yu, Qun Yan, Huizhi Li, Hongmei Li, Lin Wang, Hua Wang, Yiyun Zhang, Lei Xu, Zhaosheng Tang, Xinfeng Yan, Yinghua Chen, Huili He, Jie Chen, Bo Feng
Journal of Diabetes Investigation.2019; 10(5): 1365. CrossRef
Articles inEndocrinology and Metabolismin 2016
Won-Young Lee
Endocrinology and Metabolism.2017; 32(1): 62. CrossRef
A Diet Diverse in Bamboo Parts is Important for Giant Panda (Ailuropoda melanoleuca) Metabolism and Health
Hairui Wang, Heju Zhong, Rong Hou, James Ayala, Guangmang Liu, Shibin Yuan, Zheng Yan, Wenping Zhang, Yuliang Liu, Kailai Cai, Zhigang Cai, He Huang, Zhihe Zhang, De Wu
Scientific Reports.2017;[Epub] CrossRef
Low and exacerbated levels of 1,5-anhydroglucitol are associated with cardiovascular events in patients after first-time elective percutaneous coronary intervention
Shuhei Takahashi, Kazunori Shimada, Katsumi Miyauchi, Tetsuro Miyazaki, Eiryu Sai, Manabu Ogita, Shuta Tsuboi, Hiroshi Tamura, Shinya Okazaki, Tomoyuki Shiozawa, Shohei Ouchi, Tatsuro Aikawa, Tomoyasu Kadoguchi, Hamad Al Shahi, Takuma Yoshihara, Makoto Hi
Cardiovascular Diabetology.2016;[Epub] CrossRef

Clinical Study
Clinical Characteristics of Subjects with Sulfonylurea-Dependent Type 2 Diabetes: Se Hee Min, Soo Heon Kwak, Young Min Cho, Kyong Soo Park, Hye Seung Jung; Endocrinol Metab. 2015;30(4):509-513. Published online December 31, 2015; DOI: https://doi.org/10.3803/EnM.2015.30.4.509

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Background

Even though several oral anti-diabetic drugs (OAD) with various modes of action are replacing sulfonylurea (SU), some patients seem to be dependent on SU for adequate glycemic control. Therefore, we evaluated the clinical characteristics of such patients.

Methods

We selected the patients with type 2 diabetes who met following criteria from 2009 to 2014 at Seoul National University Hospital: glycated hemoglobin (HbA1c) was maintained below 7.5% for at least 6 months under small dose of SU (glimepiride ≤2 mg/day or equivalent dose); after discontinuation of SU, HbA1c increased ≥1.2% within 3 months or ≥1.5% within 6 months; and after resuming SU, HbA1c reduction was ≥0.8% or reduction of fasting plasma glucose was ≥40 mg/dL within 3 months. Patients with impaired hepatic or renal function, and steroid users were excluded.

Results

Nineteen subjects were enrolled: after averaged 4.8±1.5 months of SU-free period, HbA1c increased from 6.7%±0.4% to 8.8%±0.8% even though adding other OAD such as gliptins. However, HbA1c decreased to 7.4%±0.7% after resuming SU within 2.4±0.8 months. There was no sexual predominance. Despite their old age (67±11 years) and long duration of diabetes (18±10 years), fasting C-peptide was relatively well-reserved (3.9±2.6 ng/mL), and nephropathy was not observed (albumin-creatinine ratio 21.2±16.6 mg/g and estimated glomerular filtration rate 75.8±18.0 mL/min/1.73 m²). Strong family history was also noted (73.7%).

Conclusion

Despite hypoglycemia risk of SU, it seemed indispensable for a subset of patients with regard to insulin secretion. Genetic influences would be evaluated.

Citations

Citations to this article as recorded by

Incident Hepatocellular Carcinoma Risk in Patients Treated with a Sulfonylurea: A Nationwide, Nested, Case-Control Study
Ji-Yeon Lee, Suk-Yong Jang, Chung Mo Nam, Eun Seok Kang
Scientific Reports.2019;[Epub] CrossRef
A genetic variant in GLP1R is associated with response to DPP-4 inhibitors in patients with type 2 diabetes
Eugene Han, Hye Sun Park, Obin Kwon, Eun Yeong Choe, Hye Jin Wang, Yong-ho Lee, Sang-Hak Lee, Chul Hoon Kim, Lee-Kyung Kim, Soo Heon Kwak, Kyong Soo Park, Chul Sik Kim, Eun Seok Kang
Medicine.2016; 95(44): e5155. CrossRef

Obesity and Metabolism
Clinical Implications of Glucose Variability: Chronic Complications of Diabetes: Hye Seung Jung; Endocrinol Metab. 2015;30(2):167-174. Published online June 30, 2015; DOI: https://doi.org/10.3803/EnM.2015.30.2.167

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Glucose variability has been identified as a potential risk factor for diabetic complications; oxidative stress is widely regarded as the mechanism by which glycemic variability induces diabetic complications. However, there remains no generally accepted gold standard for assessing glucose variability. Representative indices for measuring intraday variability include calculation of the standard deviation along with the mean amplitude of glycemic excursions (MAGE). MAGE is used to measure major intraday excursions and is easily measured using continuous glucose monitoring systems. Despite a lack of randomized controlled trials, recent clinical data suggest that long-term glycemic variability, as determined by variability in hemoglobin A1c, may contribute to the development of microvascular complications. Intraday glycemic variability is also suggested to accelerate coronary artery disease in high-risk patients.

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Glycemic variability is associated with sural nerve conduction velocity in outpatients with type 2 diabetes: Usefulness of a new point‐of‐care device for nerve conduction studies
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Glycemic Variability and Diabetes Mellitus
Han Na Jang, Hye Seung Jung
The Journal of Korean Diabetes.2022; 23(1): 12. CrossRef
Comparison of the Impact of Insulin Degludec U100 and Insulin Glargine U300 on Glycemic Variability and Oxidative Stress in Insulin-Naive Patients With Type 2 Diabetes Mellitus: Pilot Study for a Randomized Trial
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Junpeng Yang, Xueli Yang, Dongni Zhao, Xiaobing Wang, Wei Wei, Huijuan Yuan
Journal of Diabetes Investigation.2021; 12(5): 828. CrossRef
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Current concepts and clinical importance of glycemic variability
Ramya Ravi, V Balasubramaniam, Gowthamarajan Kuppusamy, Sivasankaran Ponnusankar
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Yizhou Zou, Wanli Wang, Dongmei Zheng, Xu Hou
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Tatiana Valente, Fernando Valente, Maria Beatriz Bastos Lucchesi, Giovana Rita Punaro, Margaret Gori Mouro, Monica Andrade Lima Gabbay, Elisa Mieko Suemitsu Higa, Sergio Atala Dib
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Alexandra D Monzon, Laura B Smith, Scott W Powers, Lawrence M Dolan, Susana R Patton
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Zinab Alatawi, Hyder Mirghani
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Epigenetic regulation by polyphenols in diabetes and related complications
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David R. Luke, Karen Ka Yan Lee, Carl W. Rausch, Camille Cheng
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Information Technology for Supporting Self-Control in the Formation of a Rational Lifestyle for Diabetics Patients
S. KIFORENKO, T. HONTAR, V. ORLENKO, K. IVASKIVA, T. OBELETS
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Yi-Hsuan Lin, Yu-Yao Huang, Hsin-Yun Chen, Sheng-Hwu Hsieh, Jui-Hung Sun, Szu-Tah Chen, Chia-Hung Lin
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Obesity and Metabolism
Mitochondrial Complexes I and II Are More Susceptible to Autophagy Deficiency in Mouse β-Cells: Min Joo Kim, Ok Kyong Choi, Kyung Sil Chae, Min Kyeong Kim, Jung Hee Kim, Masaaki Komatsu, Keiji Tanaka, Hakmo Lee, Sung Soo Chung, Soo Heon Kwak, Young Min Cho, Kyong Soo Park, Hye Seung Jung; Endocrinol Metab. 2015;30(1):65-70. Published online March 27, 2015; DOI: https://doi.org/10.3803/EnM.2015.30.1.65

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Background

Damaged mitochondria are removed by autophagy. Therefore, impairment of autophagy induces the accumulation of damaged mitochondria and mitochondrial dysfunction in most mammalian cells. Here, we investigated mitochondrial function and the expression of mitochondrial complexes in autophagy-related 7 (Atg7)-deficient β-cells.

Methods

To evaluate the effect of autophagy deficiency on mitochondrial function in pancreatic β-cells, we isolated islets from Atg7^F/F:RIP-Cre+ mice and wild-type littermates. Oxygen consumption rate and intracellular adenosine 5'-triphosphate (ATP) content were measured. The expression of mitochondrial complex genes in Atg7-deficient islets and in β-TC6 cells transfected with siAtg7 was measured by quantitative real-time polymerase chain reaction.

Results

Baseline oxygen consumption rate of Atg7-deficient islets was significantly lower than that of control islets (P<0.05). Intracellular ATP content of Atg7-deficient islets during glucose stimulation was also significantly lower than that of control islets (P<0.05). By Oxygraph-2k analysis, mitochondrial respiration in Atg7-deficient islets was significantly decreased overall, although state 3 respiration and responses to antimycin A were unaffected. The mRNA levels of mitochondrial complexes I, II, III, and V in Atg7-deficient islets were significantly lower than in control islets (P<0.05). Down-regulation of Atg7 in β-TC6 cells also reduced the expression of complexes I and II, with marginal significance (P<0.1).

Conclusion

Impairment of autophagy in pancreatic β-cells suppressed the expression of some mitochondrial respiratory complexes, and may contribute to mitochondrial dysfunction. Among the complexes, I and II seem to be most vulnerable to autophagy deficiency.

Citations

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Proteomic pathways to metabolic disease and type 2 diabetes in the pancreatic islet
Belinda Yau, Sheyda Naghiloo, Alexis Diaz-Vegas, Austin V. Carr, Julian Van Gerwen, Elise J. Needham, Dillon Jevon, Sing-Young Chen, Kyle L. Hoehn, Amanda E. Brandon, Laurence Macia, Gregory J. Cooney, Michael R. Shortreed, Lloyd M. Smith, Mark P. Keller,
iScience.2021; 24(10): 103099. CrossRef
Natural compound oblongifolin C inhibits autophagic flux, and induces apoptosis and mitochondrial dysfunction in human cholangiocarcinoma QBC939 cells
Aiqing Zhang, Wei He, Huimin Shi, Xiaodan Huang, Guozhong Ji
Molecular Medicine Reports.2016; 14(4): 3179. CrossRef
Autophagy deficiency in β cells blunts incretin-induced suppression of glucagon release from α cells
Min Joo Kim, Ok Kyong Choi, Kyung Sil Chae, Hakmo Lee, Sung Soo Chung, Dong-Sik Ham, Ji-Won Kim, Kun-Ho Yoon, Kyong Soo Park, Hye Seung Jung
Islets.2015; 7(5): e1129096. CrossRef

Obesity and Metabolism
A Novel Mutation in the Von Hippel-Lindau Tumor Suppressor Gene Identified in a Patient Presenting with Gestational Diabetes Mellitus: Yun Hyi Ku, Chang Ho Ahn, Chan-Hyeon Jung, Jie Eun Lee, Lee-Kyung Kim, Soo Heon Kwak, Hye Seung Jung, Kyong Soo Park, Young Min Cho; Endocrinol Metab. 2013;28(4):320-325. Published online December 12, 2013; DOI: https://doi.org/10.3803/EnM.2013.28.4.320

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Background

Von Hippel-Lindau (VHL) disease is an autosomal dominantly inherited, multisystemic tumor syndrome caused by mutations in the VHL gene. To date, more than 1,000 germline and somatic mutations of the VHL gene have been reported. We present a novel mutation in the VHL tumor suppressor gene that presented with gestational diabetes mellitus.

Methods

A 30-year-old woman presented with gestational diabetes mellitus. She sequentially showed multiple pancreatic cysts, spinal cord hemangioblastoma, cerebellar hemangioblastoma, and clear cell type renal cell carcinomas. Also, her father and brother had brain hemangioblastomas. Each of the three exons of the VHL gene was individually amplified by polymerase chain reaction and direct sequencing was performed using an ABI 3730 DNA analyzer.

Results

DNA sequence analysis to determine the presence of VHL mutation in her family revealed del291C, a novel frameshift mutation.

Conclusion

We found a novel mutation in the VHL tumor suppressor gene that presented with gestational diabetes mellitus.

Citations

Citations to this article as recorded by

Diversities of Mechanism in Patients with VHL Syndrome and diabetes: A Report of Two Cases and Literature Review
Yanlei Wang, Zhaoxiang Liu, Wenhui Zhao, Chenxiang Cao, Luqi Xiao, Jianzhong Xiao
Diabetes, Metabolic Syndrome and Obesity.2024; Volume 17: 1611. CrossRef
Retinal hemangioblastoma in a patient with Von Hippel-Lindau disease: A case report and literature review
Yikeng Huang, Weiwen Hu, Xionggao Huang
Frontiers in Oncology.2022;[Epub] CrossRef
Updates on the Role of Molecular Alterations and NOTCH Signalling in the Development of Neuroendocrine Neoplasms
Claudia von Arx, Monica Capozzi, Elena López-Jiménez, Alessandro Ottaiano, Fabiana Tatangelo, Annabella Di Mauro, Guglielmo Nasti, Maria Lina Tornesello, Salvatore Tafuto
Journal of Clinical Medicine.2019; 8(9): 1277. CrossRef
Brief Review of Articles in 'Endocrinology and Metabolism' in 2013
Won-Young Lee
Endocrinology and Metabolism.2014; 29(3): 251. CrossRef

Letter: A1c Variability Can Predict Coronary Artery Disease in Patients with Type 2 Diabetes with Mean A1c Level Greater than 7 (Endocrinol Metab 2013;28:125-32, Eun Ju Lee et al.): Hye Seung Jung; Endocrinol Metab. 2013;28(4):346-347. Published online December 12, 2013; DOI: https://doi.org/10.3803/EnM.2013.28.4.346

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Transformation of Nonfunctioning Pancreatic Neuroendocrine Carcinoma Cells into Insulin Producing Cells after Treatment with Sunitinib: Jung Hun Ohn, Yeong Gi Kim, Se-Hoon Lee, Hye Seung Jung; Endocrinol Metab. 2013;28(2):149-152. Published online June 18, 2013; DOI: https://doi.org/10.3803/EnM.2013.28.2.149

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We report a rare case of severe hypoglycemia after sunitinib treatment for pancreatic neuroendocrine carcinoma. We describe the initial clinical presentation, laboratory results, pathologic findings, and managment in a patient with a nonfunctioning pancreatic neuroendocrine carcinoma with liver metastases who developed life threatening hypoglycemia after 2 months of sunitinib therapy. A 46-year-old woman presented to the emergency department with loss of consciousness from hypoglycemia. Serum C-peptide and insulin levels at fasting state revealed that the hypoglycemia resulted from endogenous hyperinsulinemia. She had been diagnosed with nonfunctioning pancreatic neuroendocrine carcinoma based on a biopsy of metastatic cervical lymph node and was being treated with sunitinib, a small molecule tyrosine kinase inhibitor. Immunohistochemical stain of the metastatic liver mass demonstrated that the initially nonfunctioning neuroendocrine carcinoma cells had changed into insulin-producing cells after sunitinib therapy. Transarterial chemoembolization of the liver masses and systemic chemotherapy with streptozotocin/adriamycin relieved the hypoglycemia. A nonfunctioning pancreatic neuroendocrine carcinoma was transformed into an insulin-producing tumor after treatment with sunitinib, causing endogenous hyperinsulinemia and severe hypoglycemia.

Citations

Citations to this article as recorded by

Small Insulinoma Followed-up as an Indolent Pancreatic Tumor: A Case Report
Hiroki Sato, Shozaburo Fujii, Tetsuhiro Okada, Hidemasa Kawabata, Yuki Kamikokura, Mikihiro Fujiya
Internal Medicine.2024;[Epub] CrossRef
A Case of a Metastatic Pancreatic Neuroendocrine Tumor: A Surgical Conundrum Wrapped in Functionality's Embrace
Adam Mylonakis, Michail Vailas, Panagiotis Sakarellos, Lysandros Karydakis, Eleandros Kyros, Spyridon Davakis, Alexandros Papalampros, Evaggelos Felekouras
Cureus.2024;[Epub] CrossRef
Malignant Insulinoma Arising From Nonfunctioning Pancreatic Neuroendocrine Tumor
Ritodhi Chatterjee, Basim Ali, Son H. Nguyen, Rui Chen, Yvonne H. Sada
ACG Case Reports Journal.2023; 10(1): e00954. CrossRef
Case Report: Giant insulinoma, a very rare tumor causing hypoglycemia
Georges Tarris, Alexia Rouland, Kévin Guillen, Romaric Loffroy, Anne-Cécile Lariotte, Patrick Rat, Benjamin Bouillet, Haingo Andrianiaina, Jean-Michel Petit, Laurent Martin
Frontiers in Endocrinology.2023;[Epub] CrossRef
Case Reports: Transformation of End-Stage Neuroendocrine Tumors With Uncontrollable Liver Metastasis Into a Novel or Additional Functional Phenotype
Takaomi Kessoku, Noritoshi Kobayashi, Masato Yoneda, Yuki Kasai, Anna Ozaki, Naoki Okubo, Michihiro Iwaki, Takashi Kobayashi, Tsutomu Yoshihara, Yusuke Kurita, Yasushi Honda, Motohiko Tokuhisa, Hiroto Ishiki, Takashi Hibiya, Satoshi Fujii, Atsushi Nakajim
Frontiers in Oncology.2020;[Epub] CrossRef
Transformation of a non-secretory neuroendocrine tumor to insulinoma after treatment with Sunitinib: A case report and review of the literature
Todd Clover, Amrou Abdelkader, Guru Subramanian Guru Murthy
Journal of Oncology Pharmacy Practice.2019; 25(6): 1516. CrossRef
Hyperglycaemia Induced by Novel Anticancer Agents: An Undesirable Complication or a Potential Therapeutic Opportunity?
Rashmi R. Shah
Drug Safety.2017; 40(3): 211. CrossRef
Medical management of secretory syndromes related to gastroenteropancreatic neuroendocrine tumours
Georgios K Dimitriadis, Martin O Weickert, Harpal S Randeva, Gregory Kaltsas, Ashley Grossman
Endocrine-Related Cancer.2016; 23(9): R423. CrossRef
Different Hormonal Expression Patterns Between Primary Pancreatic Neuroendocrine Tumors and Metastatic Sites
Hideyo Kimura, Takao Ohtsuka, Takaaki Fujimoto, Kenjiro Date, Taketo Matsunaga, Ana Ines Cases, Atsushi Abe, Yusuke Mizuuchi, Yoshihiro Miyasaka, Tetsuhide Ito, Yoshinao Oda, Masafumi Nakamura, Masao Tanaka
Pancreas.2016; 45(7): 947. CrossRef
Tyrosine Kinase Inhibitors and Diabetes: A Novel Treatment Paradigm?
Athanasios Fountas, Leonidas-Nikolaos Diamantopoulos, Agathocles Tsatsoulis
Trends in Endocrinology & Metabolism.2015; 26(11): 643. CrossRef
Transformation of nonfunctioning pancreatic tumor into malignant insulinoma after 3 years: an uncommon clinical course of insulinoma
Muyesser Sayki Arslan, Mustafa Ozbek, Melia Karakose, Esra Tutal, Bekir Ucan, Demet Yilmazer, Alper Dilli, Salih Sinan Gultekin, Erman Cakal, Tuncay Delibasi
Archives of Endocrinology and Metabolism.2015; 59(3): 270. CrossRef
Pancreatic neuroendocrine tumors with transformation to insulinoma: an unusual presentation of a rare disease
Avital Nahmias, Simona Grozinsky-Glasberg, Asher Salmon, David J Gross
Endocrinology, Diabetes & Metabolism Case Reports.2015;[Epub] CrossRef
Brief Review of Articles in 'Endocrinology and Metabolism' in 2013
Won-Young Lee
Endocrinology and Metabolism.2014; 29(3): 251. CrossRef

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

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.

Management Guidelines for Patients with Thyroid Nodules and Thyroid Cancer.: Won Bae Kim, Tae Yong Kim, Hyuk Sang Kwon, Won Jin Moon, Jae Bok Lee, Young Sik Choi, Seok Ki Kim, Sun Wook Kim, Ki wook Chung, Jung Hwan Baek, Byung Il Kim, Do Joon Park, Dong Gyu Na, Jun Ho Choe, Jae Hoon Chung, Hye Seung Jung, Jeong Han Kim, Kee Hyun Nam, Hang Seok Chang, Woong Youn Chung, Soon Won Hong, Suck Joon Hong, Jeong Hyun Lee, Ka Hee Yi, Young Suk Jo, Ho Cheol Kang, Minho Shong, Jin Woo Park, Jong Ho Yoon, Seong Joon Kang, Kwang Woo Lee; J Korean Endocr Soc. 2007;22(3):157-187. Published online June 1, 2007; DOI: https://doi.org/10.3803/jkes.2007.22.3.157

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Abstract PDF

No abstract available.

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Sonographic Index for Extrathyroidal Extension of Papillary Thyroid Carcinoma
Ye Won Lee, Tae Hwan Kim, Ho Joon Jang, Min Ju Park, Chang Ki Yeo
Korean Journal of Otorhinolaryngology-Head and Neck Surgery.2015; 58(9): 622. CrossRef
History of Korean Thyroid Association and Recent Debates on Diagnosis and Treatment of Thyroid Cancer in Korea
Kwang Woo Lee
Journal of Korean Thyroid Association.2015; 8(1): 36. CrossRef
RAI Treatment of Distant Metastasis of Thyroid Cancer
Keon Wook Kang
Journal of Korean Thyroid Association.2013; 6(1): 49. CrossRef
Updated guidelines for the diagnosis and management of thyroid nodules
Ka Hee Yi
Journal of the Korean Medical Association.2011; 54(6): 629. CrossRef
Elevated risk of papillary thyroid cancer in Korean patients with Hashimoto's thyroiditis
Kyung Won Kim, Young Joo Park, Eun Hye Kim, So Yeon Park, Do Joong Park, Soon‐Hyun Ahn, Do Joon Park, Hak C. Jang, Bo Youn Cho
Head & Neck.2011; 33(5): 691. CrossRef
Is Comprehensive Neck Dissection a Sole Choice for the Treatment of Recurrent Papillary Thyroid Carcinoma in the Lateral Neck?
Dongbin Ahn, Sun Jae Lee, Sun-Kyun Park, Jin Ho Sohn, June Sik Park
Korean Journal of Otorhinolaryngology-Head and Neck Surgery.2011; 54(1): 62. CrossRef
Revised Korean Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Thyroid Cancer
Ka Hee Yi, Young Joo Park, Sung-Soo Koong, Jung-Han Kim, Dong Gyu Na, Jin-Sook Ryu, So Yeon Park, In Ae Park, Chung-Hwan Baek, Young Kee Shong, Young Don Lee, Jaetae Lee, Jeong Hyun Lee, Jae Hoon Chung, Chan Kwon Jung, Seung-Ho Choi, Bo Youn Cho
Korean Journal of Otorhinolaryngology-Head and Neck Surgery.2011; 54(1): 8. CrossRef
Revised Korean Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Thyroid Cancer
Ka Hee Yi, Young Joo Park, Sung-Soo Koong, Jung-Han Kim, Dong Gyu Na, Jin-Sook Ryu, So Yeon Park, In Ae Park, Chung-Hwan Baek, Young Kee Shong, Young Don Lee, Jaetae Lee, Jeong Hyun Lee, Jae Hoon Chung, Chan Kwon Jung, Seung-Ho Choi, Bo Youn Cho
Endocrinology and Metabolism.2010; 25(4): 270. CrossRef
Can Review of Sonographic Findings Spare Diagnostic Thyroidectomy in Patients with Thyroid Nodules Suspicious of Follicular Neoplasm Cytologically?
Han-Lim Choi, Dong-Ju Kim, Woo-Young Sun, Hyo-Young Yun, Lee-Chan Jang, Jae-Woon Choi, Sung-Young Lee, Ok-Jun Lee, Jin-Woo Park
Journal of the Korean Surgical Society.2010; 79(2): 86. CrossRef
Diagnostic Approaches to Patients with Thyroid Nodules
Ho-Cheol Kang
Journal of the Korean Medical Association.2009; 52(4): 405. CrossRef
Prevalence of Thyroid Nodules Detected by Ultrasonography in Adults for Health Check-up and Analysis of Fine Needle Aspiration Cytology
Jae Hoon Chung
Journal of Korean Endocrine Society.2008; 23(6): 391. CrossRef
The Diagnostic Accuracy of Fine Needle Aspiration Cytology and the Diagnostic Usefulness of Galectin-3 Immunostaining for the Follicular Variant of Papillary Thyroid Carcinoma
Chan-Kwon Jung, Jung-Ha Shin, Hyun-Seung Lee, Ahwon Lee, Eun-Sun Jung, Yeong-Jin Choi, Kyo-Young Lee
The Korean Journal of Cytopathology.2008; 19(2): 160. CrossRef
Prevalence of Thyroid Nodules Detected by Ultrasonography in Adults for Health Check-Ups and Analysis of Fine Needle Aspiration Cytology
Won Jun Kim, Joo Hyong Kim, Dong Won Park, Chang Beom Lee, Yong Soo Park, Dong Sum Kim, Woong Hwan Choi, Tae Wha Kim, You Hern Ahn
Journal of Korean Endocrine Society.2008; 23(6): 413. CrossRef

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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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.

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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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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.

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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

Analysis of Clinical Features of Korean Patients with Adrenocortical Carcinoma.: Chan Ho Yoon, Tae Sik Jung, Hye Seung Jung, Eun Yonug Lee, Sung Jin Bae, Ji Youn Kim, Jae Hoon Chung, Yong Ki Min, Myung Shik Lee, Moon Kyu Lee, Kwang Won Kim; J Korean Endocr Soc. 2006;21(1):47-52. Published online February 1, 2006; DOI: https://doi.org/10.3803/jkes.2006.21.1.47

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BACKGROUND
Adrenocortical carcinoma (ACC) is an extremely rare tumor. Its early detection is difficult and its prognosis is poor. METHOD: We retrospectively analyzed the medical records of 13 patients with ACC between 1995 and 2005 at Samsung Medical Center. Their clinical features and prognosis were evaluated. RESULTS: The average age of the patients with ACC was 40 years (2~75 years). Eight patients were men and five were women. On the first visit, eight of 13 patients (62%) complained abdominal pain, and abdominal mass was palpable in five of 13 patients (38%). Urinary concentration of 17-ketosteroid collected for 24 hours was increased in two of eight patients (25%). Three out of 13 patients were identified as having functioning adrenal tumors (1 Cushing's syndrome and 2 androgen-producing tumors), and the other 10 patients had hormonally inactive adrenal tumors. Ten patients had tumors in left adrenal gland, and three had in right adrenal gland. At the time of diagnosis, four patients were classified as having stage II, seven as stage III, and two as stage IV. Twelve patients underwent adrenalectomy. One of them received additional chemotherapy, and two patients were treated with external radiation therapy after surgery. The other one patient was treated only with chemotherapy due to the presence of liver metastasis. It was possible to continue the regular follow-up in eight of 13 patients. The median duration of follow-up was 39 months (7~114 months). Six of them are still alive (three have no evidence of disease, one had persistence of disease, and two had recurrence of disease during follow-up period). Two patients died of multiple metastases and lung metastasis, respectively. CONCLUSION: Radical surgery is the only curative approach and is recommended for all patients with resectable tumors, even though in those patients with recurrent disease. There is no consensus concerning adjuvant therapy.

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A Case Report of Bilateral Adrenocortical Carcinoma Complicated by Adrenal Insufficiency
Min Joo Kim, Jung Hee Kim, Tae Young Kim, Sang Wan Kim
Endocrinology and Metabolism.2011; 26(3): 243. CrossRef

Upper Airway Obstruction Caused by Intratracheal Ectopic Thyroid Tissue during Pregnancy.: Eun Young Lee, Byung Wan Lee, Jhingook Kim, Sung Jin Bae, Tae Sik Jung, Hye Seung Jung, Yong Ki Min, Myung Shik Lee, Moon Kyu Lee, Kwang Won Kim, Jae Hoon Chung; J Korean Endocr Soc. 2005;20(4):413-420. Published online August 1, 2005; DOI: https://doi.org/10.3803/jkes.2005.20.4.413

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Herein is report an extremely rare case of an intratracheal ectopic thyroid gland related with pregnancy. A 34-year-old woman, in gestational week 11, presented with stridor, progressive dyspnea and a choking sensation during her second pregnancy. Computed tomography of the neck and chest revealed a round intratracheal mass obstructing the airway. A bronchoscopic biopsy with LASER cauterization was performed, and the histological finding revealed normal thyroid tissue. The external thyroid of the patient was evaluated, but only found benign nodules in the thyroid gland. She underwent a segmental resection of the trachea, including the mass and the 1st tracheal cartilage. The histological findings revealed the intratracheal mass to be composed of benign thyroid tissue with nodular hyperplasia. After surgery, no pulmonary symptoms were evident. This case suggested the effect of pregnancy on thyroid tissue stimulatied due to a combination of an increasing human chorionic gonadotropin(hCG) level and relative iodine deficiency during pregnancy. This is the first report on the detection of intratracheal ectopic thyroid tissue during pregnancy in Korea.

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A case of mediastinal ectopic thyroid presenting with a paratracheal mass
Eun Roh, Eun Shil Hong, Hwa Young Ahn, So-Yeon Park, Ho Il Yoon, Kyong Soo Park, Young Joo Park
The Korean Journal of Internal Medicine.2013; 28(3): 361. CrossRef

Determination of Glucocorticoid Replacement Therapy and Adequate Maintenance Dose in Patients with Secondary Adrenal Insufficiency.: Sang Wan Kim, Hye Seung Jung, Seong Hee Kwon, Do Joon Park, Chan Soo Shin, Kyung Soo Park, Seong Yeon Kim, Bo Youn Cho, Hong Kyu Lee; J Korean Endocr Soc. 2003;18(5):456-464. Published online October 1, 2003

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Abstract PDF: BACKGROUND
Determination of the adequate dose of glucocorticoid replacement therapy, in patients with secondary adrenal insufficiency, is of great importance to avoid the consequences of under or over treatment. The aims of this study were: 1) to assess the value of adrenal cortical function tests in determining whether glucocorticoid replacement should be given, and 2) to investigate the adequate maintenance dose of glucocorticoid in patients with secondary adrenal insufficiency. METHODS: Forty patients, with secondary adrenal insufficiency, confirmed by the insulin-induced hypoglycemia test (IHT), were studied. All subjects underwent basal serum cortisol measurement, IHT and 250 g rapid ACTH stimulation tests (AST). The clinical usefulness of these tests, for the determination of glucocorticoid replacement therapy, was evaluated in patients with secondary adrenal insufficiency. 26 of the 40 patients had received prednisolone (Pd) (5 mg per day) replacement due to symptoms from adrenal insufficiency. The dose of Pd was serially changed from 5 to 3.75, and then to 6.25 mg per day, every 3 month. The measured lipid parameters, serum osteocalcin and urinary N-telopeptide were measured and the quality of life evaluated by the administration of an Addisonian questionnaire, both before and after the dose changes. RESULTS: 1) For all tests, cut-offs were selected that would provide adequate specificity and sensitivity. When the cut-offs were set to provide 95% specificity, the corresponding sensitivitycut-off values, obtained with basal serum cortisol, peak serum cortisol in IHT and AST were: 88.4% <5 microgram/dL, 80.7% <11 microgram/dL and 76.9% <16 microgram/dL. 2) The urinary type I collagen N-telopeptide, total cholesterol, HDL- and LDL-cholesterol levels were significantly increased, and the serum osteocalcin levels significantly decreased when the daily dose of Pd was increased to 6.25 from 3.75 or 5 mg. The LDL-cholesterol levels especially, were significantly increased, even though the change in the Pd from 3.75 to 5 mg per day was subtle. CONCLUSION: The basal cortisol levels, HPA axis tests and the symptoms of patients may be helpful to determine whether prednisolone replacement therapy should be given. It is suggest that an adequate dose of glucocorticoid replacement therapy should be not exceed Pd 5mg per day, so as not to have adverse effects on the bone and lipid metabolisms.

A Case of Renal Cell Carcinoma with Thyroid Metastasis.: Hye Seung Jung, Young Joo Park, Hee Sun Chung, Mee Soo Chang, Tae Hoon Jin, Cheol Soo Choi, Sung Woo Park, Tae Young Kim, Do Joon Park, Bo Youn Cho; J Korean Endocr Soc. 2003;18(3):318-324. Published online June 1, 2003

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Abstract PDF: Metastatic thyroid cancer is uncommon but must be distinguished from primary thyroid cancer because of the differences in management and prognosis. Although renal cell carcinoma is one of the most common tumors that metastasize to the thyroid gland, such a case has never been reported in Korea. We describe the first case of metastatic renal cell carcinoma in the thyroid gland. A 66-year-old man presented with a neck mass detected about 6 weeks previously. He had undergone left nephrectomy due to renal cell carcinoma 8 years before and had remained disease-free thereafter. Computed tomography of the neck showed a 5 cm-sized thyroid mass. Fine needle aspiration cytology revealed some malignant cells containing intranuclear inclusions which were assumed to be papillary thyroid carcinoma. The patient underwent total thyroidectomy. Histologic diagnosis of the thyroid mass was metastatic renal cell carcinoma and further evaluation with chest computed tomography showed two enlarged mediastinal lymph nodes suggesting metastases. The previous history of malignancy should be scrutinized when managing a thyroid mass in patients with a prior or concomitant malignancy, and the possibility of metastasis should be carefully considered.

Changes in Plasma Leptin Levels Relating to Short-Term Thyroid Manipulation in Rats.: Min Seon Kim, Cho Ya Yoon, Young Min Cho, Hye Seung Jung, Chan Soo Shin, Kyong Soo Park, Seong Yeon Kim, Bo Youn Cho, Hong Kyu Lee, Stephen R Bloom; J Korean Endocr Soc. 2002;17(2):197-205. Published online April 1, 2002

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Abstract PDF: BACKGROUND
Leptin, an adipocyte derived hormone, and thyroid hormone have similar effects on energy homeostasis, such that a shortage of both hormones is associated with decreased energy expenditure and increased body weight. Therefore, for the maintenance of energy homeostasis may require a close interaction between leptin and thyroid hormone. This study was performed to investigate the change in plasma leptin levels relating to short-term thyroid manipulation causing no significant change in body weight. METHODS: Hypothyroidism was induced by surgical thyroidectomy and hyperthyroidism by subcutaneous injection of 50 g of L-T3/100 g body weight/day, for 5 days, in 6~8 weeks old male Wistar rats. Body weights and food intakes were monitored daily until sacrifice. Plasma samples were collected, and the thyroid stimulating hormone (TSH), free triiodothyronine (T3) and leptin levels measured. The plasma leptin levels in rats with hypothyroidism and hyperthyroidism were compared with those of body weights at death and food intakes during the study, atched controls. RESULTS: The rats treated with L-T3 consumed equal amount of food as freely fed, rats but their final body weights were significantly lower (L-T3 treated 220.0 +/- 1.8 vs. freely fed 226.0 +/- 2.0 g, p<0.05). There was no difference in food intake during study, and final body weight, between the thyroidectomised rats and their paired controls (thyroidectomised 220.4 +/- 1.7 vs. paired 223.9 +/- 4.7 g, P=NS). Plasma leptin levels in the L-T3 treated rats were significantly lower than those in freely fed rats (L-T3 treated 1.7 +/- 0.1 vs. freely fed 4.8 +/- 0.2 ng/ml, p<0.005). Conversely, the thyroidectomised rats had higher plasma leptin levels, compared to those of their paired controls (thyroidectomised 4.8 +/- 0.3 vs. paired 1.7 +/- 0.1 ng/ml, p<0.005). CONCLUSION: The Plasma leptin levels in the rats were decreased by short term hyperthyroidism, while they were increased by short term hypothyroidism. These findings suggest that thyroid hormones may affect the production or secretion of leptin

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

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