- A Case of Cushing's Syndrome Complicating Pregnancy Adrenalectomized after Delivery.
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Jeong Soo Cho, Jae Seok Jeon, Kyu Jeong Ahn, Byoung Joon Kim, Sung Ho Kwon, Eun Gyu Lee, Won Wook Choi, Sang Won Park, Won Mee Lee
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J Korean Endocr Soc. 2003;18(5):489-495. Published online October 1, 2003
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- Pregnancy is rare in women with Cushing's syndrome, as the associated infertility is related to excess cortisol and/or androgen. However, approximately 100 such cases have been reported, with 50% due to an adrenal cortical adenoma. Establishing a diagnosis and cause can be difficult. Clinically, striae, hypertension and gestational diabetes are common features in pregnancy, with hypertension and diabetes being the most common signs of Cushing's syndrome in pregnant women. Furthermore, biochemically, a normal pregnancy is associated with a several fold increase in plasma cortisol, as the increased cortisol production rate also increases the cortisol binding protein. Untreated, the condition results in high maternal and fetal morbidity and mortality. An adrenal or pituitary adenoma should be excised, but a metyrapone, which is not teratogenic, has been effective in controlling many cases of excess cortisol. Here, a case of Cushing's syndrome, complicating a pregnancy due to an adrenal cortical adenoma, with thorough obstetric and medical management, including a metyrapone, which was adrenalectomized after delivery, is reported.
- The Change of Insulin Sensitivity and Insulin Secretion According to Glucose Metabolism Status in Patients with Cushing's Syndrome.
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In Kyung Jeong, Sung Hoon Kim, Jae Hoon Chung, Yong Ki Min, Myung Shik Lee, Moon Kyu Lee, Hyung Joon Yoo, Kyu Jeong Ahn, Jung Hynun Noh, Dong Jun Kim, Kwang Won Kim
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J Korean Endocr Soc. 2003;18(4):392-403. Published online August 1, 2003
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- BACKGROUND
Glucocorticoid plays an important role in the control of carbohydrate metabolism. Patients with Cushing's syndrome have been reported to have an increased incidence of carbohydrate intolerance due to peripheral insulin resistance and hyperinsulinemia, although the exact incidence and nature of this disorder have remained unclear. Few results have been published about insulin resistance and insulin secretion according to the level of glucose concentration, or about the reversibility of such defects in patients with Cushing's syndrome. METHODS: To assess the effect of glucocorticoid on the insulin sensitivity and insulin secretion in Cushing's syndrome, 15 patients with Cushing's syndrome were classified into 3 groups (normal glucose tolerance: NGT, impaired glucose tolerance: IGT, diabetes: DM) according to the degree of glucose tolerance based on the oral glucose tolerance test (OGTT). Insulin modified, frequentlysampled, intravenous glucose tolerance test (FSIGT) was performed before and after curative surgery on these patients and on 15 healthy control subjects. Data were evaluated by non-parametric statistical analysis. RESULTS: 1) Among the 15 patients with Cushing's syndrome, 3 (20%) were NGT, 4 (27%) IGT, and 8 (53%) DM, based on OGTT. Twenty-four hour urinary free cortisol (UFC) was significantly higher in the DM group. 2) Insulin sensitivity index (SI) of Cushing's syndrome was significantly lower than that of the control group (P=0.0024), but was not significantly different among the three Cushing's syndrome groups of NGT, IGT and DM. 3) Glucose mediated glucose disposal (SG) (Ed- confirm this abbreviation; it does not seem to match the definition) of Cushing's syndrome was not significantly different from that of the control group. 4) Insulin secretion (AIRg) of Cushing's syndrome tended to be high, but it was not significantly different from that of control. However, according to the level of glucose concentration there was significant difference in AlRg among the three Cushing's syndrome groups (P=0.0031); AIRg of DM was significantly lower than that of NGT. 5) After surgical treatment, parameters of insulin sensitivity and insulin secretion were normalized in 6 cured patients; 1 with NGT, 1 with IGT, and 4 with DM, preoperatively. Median SI of all 6 patients was significantly improved up to the normal range postoperatively (P=0.0022). Median AIRg of these 6 patients was balanced around that of normal control postoperatively (P=0.0286). CONCLUSION: Eighty percent of patients with Cushing's syndrome had abnormality of carbohydrate metabolism. Insulin sensitivity was significantly decreased in Cushing's syndrome. Insulin secretion was significantly higher only in the NGT and IGT groups of Cushing's syndrome. As the hypercortisolemia is exacerbated, insulin secretion is significantly decreased and causes DM, suggesting that glucocorticoid has a direct or indirect toxic effect on the pancreatic beta cell.
- Comparison of Immunohistochemical and Clinical Characteristics in Pituitary Adenoma with Acromegaly.
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Jae Hoon Chung, Eun Mi Koh, Kwang Won Kim, Byoung Joon Kim, Sung Hoon Kim, Kyung Ah Kim, Myung Sik Lee, Moon Gyu Lee, Yong Ki Min, Yeon Rim Seo, Dong Kyu Na, Jong Hyun Kim, Kyu Jeong Ahn, Jin Seok Kim
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J Korean Endocr Soc. 1998;13(3):324-330. Published online January 1, 2001
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- BACKGROUND
It assumed that plurihormonal pituitary adenomas in acromegaly, which were immunohistochemically stained with other pituitary hormones in addition to GH and prolactin, would be originated from poorly differentiated cells. Therefore, we speculated that they might have higher growth rates and worse prognosis than monohormonal adenomas. To verify this speculation, we analyzed the frequency of plurihormonal adenomas and compared the clinical parameters and radiological invasiveness between plurihormonal adenoma and GH-prolactin adenoma in acromegaly. METHODS: We studied 38 patients with acromegaly (22 males and 16 females, mean age 40.7 years) who were underwent surgical removal of pituitary adenomas by TSA from January 1995 to February 1998. We performed immunohistochemical staining in these tumors using avidinbiotin peroxidase complex method. An adenoma was considered as immunoreactive when above 50 percents of tumor cells were stained with anti-hormonal antibodies. Invasiveness of tumors were evaluated by preoperative MRI findings on the basis of Hardys classification. RESULTS: The frequencies of plurihormonal and GH-prolactin adenomas were 42% and 58%, respectively. Plurihormonal adenoma included an adenoma which was not stained with prolactin, but with GH and other hormones. Prolactin immunoreactivity was found in 97%(37/38) of the tumors. Immunoreactivities to FSH, ACTH, LH, and TSH were found in 37.8%, 13.1%, 2.6% and 2.7%, respectively. There were no significant differences in age, basal serum GH and IGF-1 concentrations between plurihormonal and GH-prolactin adenomas. There were also no significant differences in response to TRH & LH stimulation tests and somatostatin & bromocriptine suppression tests between two groups. There were no differences in radiological invasiveness between two groups (plurihormonal adenoma, grade I 2, grade II 3, grade III 7, grade IV 4; GH-prolactin adenoma, grade I 3, grade II 6, grade III 9, grade IV 4). CONCLUSION: Plurihormonal adenomas were 44% and immunoreactivity to prolactin was 97% in pituitary adenomas in acromegaly. There were no significant differences in clinical parameters and radiological invasiveness between plurihormonal and GH-prolactin adenomas in acromegaly.
- The Responses of Pituitary Hormones to the Combined Pituitary Stimulation Test in Hypogonadotropic Hypogonadism.
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In Myung Yang, Jeong Taek Woo, Sung Woon Kim, Jin Woo Kim, Young Seol Kim, Young Kil Choi, Eun Kyung Park, Kyu Jeong Ahn
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J Korean Endocr Soc. 1994;9(2):93-107. Published online November 6, 2019
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- To classify the causes of hypogonadotropic hypogonadism in Korean patients, and to improve the endocrinologic evaluation for the disease, we retrospectively studied the clinical findings and result of combined pituitary stimulation test in 35 patients with hypogonadotropic hypogonadism. The following results were obtained.1) The ratio of male to female was 1.3:1, and the 50% of male patients was under 20 years of age and the 20% of female patients in 30th decades. 2) The chief complaints of male patients on the admission were the failure of secondary sexual characteristics(95.0%) and loss of hair(5.0%), those of female patients were amenorrhea(46.7%), infertility(26.7%), failure of secondary characteristics(13.3%) and loss of hair(13.3%). 3) The causes of male hypogonadotropic hypogonadism were craniopharyngioma(35.0%), idiopathic(30.0%), Kallmann's syndrome(15.0%), pituitary adenoma(10.0%) and germinoma(5.0%), and those of female hypogonadotropic hypogonadism were prolactinoma(13.3%), Sheehan's syndrome(26.6%), pituitary adenoma(6.7%), tuberculous granuloma(6.7%), germinoma(6.7%), idiopathic hypogonadotropic hypogonadism(40.0%).4) The responses of LH and FSH to GnRH test were absent or markedly blunted in diffuse pituitary diseases such as pituitary tuberculous granuloma, pituitary macroadenomas, Sheehan's syndrome. However those were also absent or blunted in Cushing's disease and hypothalamic disease such as Kallmann's syndrome, germinoma, craniopharyngioma, idiopathic hypogonadotropic hypogonadism. 5) The responses of LH, FSH increased after repeated injection of GnRH in a patient with germinoma. 6) In diffuse destructive pituitary diseases such as Sheehan's syndrome, nonfunctioning macroadenomas, tuberculous granuloma, large prolactinoma, the combined deficiency of pituitary hormones other than gonadotropins was observed. 7) In many cases with hypothalamic diseases, the combined defects of pituitary hormone response were also seen.These data suggest that GnRH test is not always useful to localize the lesion between pituitary and hypothalamus, and combined pituitary stimulation test revealed defects of pituitary hormones other than gonadotropin in various hypothalamic diseases.Therefore repeated GnRH test would be useful for the differential diagnosis, and CRH test and GRH test would be necessary to demonstrate whether pituitary abnormality is present.
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