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Seong Yeon Kim  (Kim SY) 91 Articles
Clinical Study
Stimulated Salivary Cortisol as a Noninvasive Diagnostic Tool for Adrenal Insufficiency
Yoon Ji Kim, Jung Hee Kim, A Ram Hong, Kyeong Seon Park, Sang Wan Kim, Chan Soo Shin, Seong Yeon Kim
Endocrinol Metab. 2020;35(3):628-635.   Published online September 22, 2020
DOI: https://doi.org/10.3803/EnM.2020.707
  • 5,388 View
  • 192 Download
  • 10 Web of Science
  • 11 Crossref
AbstractAbstract PDFPubReader   ePub   
Background
Salivary cortisol is routinely used as a diagnostic test for Cushing syndrome. The diagnostic use of salivary cortisol for adrenal insufficiency (AI), however, is less established. We aimed to investigate the utility of morning basal and adrenocorticotropic hormone-stimulated salivary cortisol in diagnosing AI in Korean adults.
Methods
We prospectively included 120 subjects (female, n=70) from Seoul National University Hospital. AI was defined as a stimulated serum cortisol level of <496.8 nmol/L during the short Synacthen test (SST). Serum and saliva samples were drawn between 8:00 AM and 10:00 AM. Salivary cortisol levels were measured using an enzyme immunoassay kit.
Results
Thirty-four patients were diagnosed with AI according to the SST results. Age, sex, body mass index, serum albumin levels, and serum creatinine levels did not significantly differ between the normal and AI groups. Basal and stimulated salivary cortisol levels were positively correlated with basal (r=0.538) and stimulated serum cortisol levels (r=0.750), respectively (all P<0.001). Receiver operating characteristic curve analysis yielded a cutoff level of morning basal salivary cortisol of 3.2 nmol/L (sensitivity, 84.9%; specificity, 73.5%; area under the curve [AUC]=0.822). The optimal cutoff value of stimulated salivary cortisol was 13.2 nmol/L (sensitivity, 90.7%; specificity, 94.1%; AUC=0.959). Subjects with a stimulated salivary cortisol level above 13.2 nmol/L but a stimulated serum cortisol level below 496.8 nmol/L (n=2) had lower serum albumin levels than those showing a concordant response.
Conclusion
The diagnostic performance of stimulated salivary cortisol measurements after the SST was comparable to serum cortisol measurements for diagnosing AI.

Citations

Citations to this article as recorded by  
  • Extensive expertise in endocrinology: adrenal crisis in assisted reproduction and pregnancy
    Ulla Feldt-Rasmussen
    European Journal of Endocrinology.2024; 190(1): R10.     CrossRef
  • Turning Antibodies into Ratiometric Bioluminescent Sensors for Competition-Based Homogeneous Immunoassays
    Eva A. van Aalen, Joep J. J. Lurvink, Leandra Vermeulen, Benice van Gerven, Yan Ni, Remco Arts, Maarten Merkx
    ACS Sensors.2024;[Epub]     CrossRef
  • Diagnostic strategies in adrenal insufficiency
    Vasiliki Siampanopoulou, Elisavet Tasouli, Anna Angelousi
    Current Opinion in Endocrinology, Diabetes & Obesity.2023; 30(3): 141.     CrossRef
  • The association between neuropeptide oxytocin and neuropsychiatric disorders after orthopedic surgery stress in older patients
    Wanru Dong, Zengbo Ding, Xiao Wu, Ran Wan, Ying Liu, Liubao Pei, Weili Zhu
    BMC Geriatrics.2023;[Epub]     CrossRef
  • The Reliability of Salivary Cortisol Compared to Serum Cortisol for Diagnosing Adrenal Insufficiency with the Gold Standard ACTH Stimulation Test in Children
    Silvia Ciancia, Sjoerd A. A. van den Berg, Erica L. T. van den Akker
    Children.2023; 10(9): 1569.     CrossRef
  • РІВЕНЬ СТРЕСУ В ДІТЕЙ ШКІЛЬНОГО ВІКУ З COVID-19
    Г. А. Павлишин, О. І. Панченко
    Здобутки клінічної і експериментальної медицини.2023; (4): 119.     CrossRef
  • Secondary adrenal suppression related to high doses of inhaled corticosteroids in patients with severe asthma
    Mariana Lobato, João Gaspar-Marques, Pedro Carreiro-Martins, Paula Leiria-Pinto
    Annals of Allergy, Asthma & Immunology.2022; 128(4): 464.     CrossRef
  • Clinical and Technical Aspects in Free Cortisol Measurement
    Man Ho Choi
    Endocrinology and Metabolism.2022; 37(4): 599.     CrossRef
  • Continuous biomarker monitoring with single molecule resolution by measuring free particle motion
    Alissa D. Buskermolen, Yu-Ting Lin, Laura van Smeden, Rik B. van Haaften, Junhong Yan, Khulan Sergelen, Arthur M. de Jong, Menno W. J. Prins
    Nature Communications.2022;[Epub]     CrossRef
  • Reversible Immunosensor for the Continuous Monitoring of Cortisol in Blood Plasma Sampled with Microdialysis
    Laura van Smeden, Annet Saris, Khulan Sergelen, Arthur M. de Jong, Junhong Yan, Menno W. J. Prins
    ACS Sensors.2022; 7(10): 3041.     CrossRef
  • Adrenal insufficiency in HIV/AIDS: a review
    Simon Mifsud, Zachary Gauci, Mark Gruppetta, Charles Mallia Azzopardi, Stephen Fava
    Expert Review of Endocrinology & Metabolism.2021; 16(6): 351.     CrossRef
Close layer
Clinical Study
Characteristics of Korean Patients with Primary Adrenal Insufficiency: A Registry-Based Nationwide Survey in Korea
A Ram Hong, Ohk-Hyun Ryu, Seong Yeon Kim, Sang Wan Kim
Endocrinol Metab. 2017;32(4):466-474.   Published online December 14, 2017
DOI: https://doi.org/10.3803/EnM.2017.32.4.466
  • 5,458 View
  • 63 Download
  • 14 Web of Science
  • 12 Crossref
AbstractAbstract PDFSupplementary MaterialPubReader   
Background

Primary adrenal insufficiency (PAI) is a rare, potentially life-threatening condition. There are few Korean studies on PAI, and most have had small sample sizes. We aimed to examine the etiology, clinical characteristics, treatment, and mortality of PAI in Korean patients.

Methods

A nationwide, multicenter, registry-based survey was conducted to identify adults diagnosed with or treated for PAI at 30 secondary or tertiary care institutions in Korea between 2000 and 2014.

Results

A total of 269 patients with PAI were identified. The prevalence of PAI was 4.17 per million. The estimated incidence was 0.45 per million per year. The mean age at diagnosis was 49.0 years, and PAI was more prevalent in men. Adrenal tuberculosis was the most common cause of PAI in patients diagnosed before 2000; for those diagnosed thereafter, adrenal metastasis and tuberculosis were comparable leading causes. The etiology of PAI was not identified in 34.9% of cases. Of the patients receiving glucocorticoid replacement therapy, prednisolone was more frequently administered than hydrocortisone (69.4% vs. 26.5%, respectively), and only 27.1% of all patients received fludrocortisone. We observed an increased prevalence of metabolic disease and osteoporosis during the follow-up period (median, 60.2 months). The observed overall mortality and disease-specific mortality rates were 11.9% and 3.1%, respectively.

Conclusion

The prevalence of PAI is significantly lower in Koreans than in reports from Western countries. The high frequency undetermined etiology in patients with PAI suggests the need to reveal accurate etiology of PAI in Korea.

Citations

Citations to this article as recorded by  
  • Genetic and phenotypic spectrum of non-21-hydroxylase-deficiency primary adrenal insufficiency in childhood: data from 111 Chinese patients
    Ying Duan, Wanqi Zheng, Yu Xia, Huiwen Zhang, Lili Liang, Ruifang Wang, Yi Yang, Kaichuang Zhang, Deyun Lu, Yuning Sun, Lianshu Han, Yongguo Yu, Xuefan Gu, Yu Sun, Bing Xiao, Wenjuan Qiu
    Journal of Medical Genetics.2024; 61(1): 27.     CrossRef
  • Approach to the Patient: Diagnosis of Primary Adrenal Insufficiency in Adults
    Marianne Øksnes, Eystein S Husebye
    The Journal of Clinical Endocrinology & Metabolism.2023; 109(1): 269.     CrossRef
  • Epidemiology and Causes of Primary Adrenal Insufficiency in Children: A Population-Based Study
    Joonatan Borchers, Eero Pukkala, Outi Mäkitie, Saila Laakso
    The Journal of Clinical Endocrinology & Metabolism.2023; 108(11): 2879.     CrossRef
  • Primary Adrenal Insufficiency in Acute Progressive Systemic Inflammation Accompanied by Latent Tuberculosis: A Case Report
    Kasumi Nishikawa, Mizuki Nitta, Shoma Tanaka, Chiaki Sano, Ryuichi Ohta
    Cureus.2023;[Epub]     CrossRef
  • What factors have impact on glucocorticoid replacement in adrenal insufficiency: a real-life study
    S. Puglisi, A. Rossini, I. Tabaro, S. Cannavò, F. Ferrau’, M. Ragonese, G. Borretta, M. Pellegrino, F. Dughera, A. Parisi, A. Latina, A. Pia, M. Terzolo, G. Reimondo
    Journal of Endocrinological Investigation.2021; 44(4): 865.     CrossRef
  • Adrenal insufficiency
    Eystein S Husebye, Simon H Pearce, Nils P Krone, Olle Kämpe
    The Lancet.2021; 397(10274): 613.     CrossRef
  • Towards the tailoring of glucocorticoid replacement in adrenal insufficiency: the Italian Society of Endocrinology Expert Opinion
    A. M. Isidori, G. Arnaldi, M. Boscaro, A. Falorni, C. Giordano, R. Giordano, R. Pivonello, C. Pozza, E. Sbardella, C. Simeoli, C. Scaroni, A. Lenzi
    Journal of Endocrinological Investigation.2020; 43(5): 683.     CrossRef
  • Novel ABCD1 Gene Mutation in a Korean Patient with X-Linked Adrenoleukodystrophy Presenting with Addison's Disease
    Yun Kyung Cho, Seo-Young Lee, Sang-Wook Kim
    Endocrinology and Metabolism.2020; 35(1): 188.     CrossRef
  • Encountering COVID-19 as Endocrinologists
    Eun-Jung Rhee, Jung Hee Kim, Sun Joon Moon, Won-Young Lee
    Endocrinology and Metabolism.2020; 35(2): 197.     CrossRef
  • Prednisolone is associated with a worse bone mineral density in primary adrenal insufficiency
    Kathrin R Frey, Tina Kienitz, Julia Schulz, Manfred Ventz, Kathrin Zopf, Marcus Quinkler
    Endocrine Connections.2018; 7(6): 811.     CrossRef
  • The potential role for infections in the pathogenesis of autoimmune Addison’s disease
    A Hellesen, E Bratland
    Clinical and Experimental Immunology.2018; 195(1): 52.     CrossRef
  • Evaluation and Treatment of Adrenal Dysfunction in the Primary Care Environment
    Shannon Cole
    Nursing Clinics of North America.2018; 53(3): 385.     CrossRef
Close layer
Clinical Guidelines for the Management of Adrenal Incidentaloma
Jung-Min Lee, Mee Kyoung Kim, Seung-Hyun Ko, Jung-Min Koh, Bo-Yeon Kim, Sang Wan Kim, Soo-Kyung Kim, Hae Jin Kim, Ohk-Hyun Ryu, Juri Park, Jung Soo Lim, Seong Yeon Kim, Young Kee Shong, Soon Jib Yoo
Endocrinol Metab. 2017;32(2):200-218.   Published online June 23, 2017
DOI: https://doi.org/10.3803/EnM.2017.32.2.200
  • 14,962 View
  • 654 Download
  • 78 Web of Science
  • 77 Crossref
AbstractAbstract PDFPubReader   

An adrenal incidentaloma is an adrenal mass found in an imaging study performed for other reasons unrelated to adrenal disease and often accompanied by obesity, diabetes, or hypertension. The prevalence and incidence of adrenal incidentaloma increase with age and are also expected to rise due to the rapid development of imaging technology and frequent imaging studies. The Korean Endocrine Society is promoting an appropriate practice guideline to meet the rising incidence of adrenal incidentaloma, in cooperation with the Korean Adrenal Gland and Endocrine Hypertension Study Group. In this paper, we discuss important core issues in managing the patients with adrenal incidentaloma. After evaluating core proposition, we propose the most critical 20 recommendations from the initially organized 47 recommendations by Delphi technique.

Citations

Citations to this article as recorded by  
  • The improvement of postoperative blood pressure and associated factors in patients with hormone‐negative adrenal adenoma and hypertension
    Jiaxing Sun, Yingchun Dong, Hanbo Wang, Xudong Guo, Ning Suo, Shangjian Li, Xiangbin Ren, Shaobo Jiang
    Journal of Surgical Oncology.2024;[Epub]     CrossRef
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    Jack Junchi Xu, Peter Sommer Ulriksen, Camilla Wium Bjerrum, Michael Patrick Achiam, Timothy Andrew Resch, Lars Lönn, Kristoffer Lindskov Hansen
    Acta Radiologica.2023; 64(3): 945.     CrossRef
  • Metastatic Adrenal PEComa: Case Report and Short Review of the Literature
    Enrico Battistella, Luca Pomba, Marica Mirabella, Michele Gregianin, Antonio Scapinello, Marco Volante, Antonio Toniato
    Medicina.2023; 59(1): 149.     CrossRef
  • Surgical management and outcomes of spinal metastasis of malignant adrenal tumor: A retrospective study of six cases and literature review
    Xiangzhi Ni, Jing Wang, Jiashi Cao, Kun Zhang, Shuming Hou, Xing Huang, Yuanjin Song, Xin Gao, Jianru Xiao, Tielong Liu
    Frontiers in Oncology.2023;[Epub]     CrossRef
  • An adrenal incidentaloma that had appeared to produce dehydroepiandrosterone-sulfate in excess before immunohistochemical study of the tumor
    Toshihide Yamamoto, Takuma Kimura, Yuki Kubo, Shin-ichi Nakatsuka, Hiromasa Harada, Takashi Suzuki, Hironobu Sasano
    Endocrine Journal.2023; 70(1): 43.     CrossRef
  • Mortality Not Increased in Patients With Nonfunctional Adrenal Adenomas: A Matched Cohort Study
    Albin Kjellbom, Ola Lindgren, Malin Danielsson, Henrik Olsen, Magnus Löndahl
    The Journal of Clinical Endocrinology & Metabolism.2023; 108(8): e536.     CrossRef
  • Construction of a novel clinical nomogram to predict cancer-specific survival in patients with primary malignant adrenal tumors: a large population-based retrospective study
    Mingzhen Li, Xiaoying Duan, Di You, Linlin Liu
    Frontiers in Medicine.2023;[Epub]     CrossRef
  • Primary Aldosteronism Prevalence – An Unfolding Story
    Suranut Charoensri, Adina F. Turcu
    Experimental and Clinical Endocrinology & Diabetes.2023; 131(07/08): 394.     CrossRef
  • Management of Adrenal Cortical Adenomas: Assessment of Bone Status in Patients with (Non-Functioning) Adrenal Incidentalomas
    Alexandra-Ioana Trandafir, Mihaela Stanciu, Simona Elena Albu, Vasile Razvan Stoian, Irina Ciofu, Cristian Persu, Claudiu Nistor, Mara Carsote
    Journal of Clinical Medicine.2023; 12(13): 4244.     CrossRef
  • Clinical manifestations of functionally autonomous cortisol secretion in patients with adrenal masse
    T. R. Chzhen, T. P. Kiseleva
    Ural Medical Journal.2023; 22(3): 13.     CrossRef
  • Tumor enlargement in adrenal incidentaloma is related to glaucoma: a new prognostic feature?
    M. Caputo, T. Daffara, A. Ferrero, M. Romanisio, E. Monti, C. Mele, M. Zavattaro, S. Tricca, A. Siani, A. Clemente, C. Palumbo, S. De Cillà, A. Carriero, A. Volpe, P. Marzullo, G. Aimaretti, F. Prodam
    Journal of Endocrinological Investigation.2023; 47(2): 377.     CrossRef
  • Adrenal ganglioneuroma: Features and outcomes of cases series
    Pei Li, Rongchang Zhang, Guang Wang, Jiongming Li
    Asian Journal of Surgery.2023; 46(11): 5272.     CrossRef
  • Recent Updates on the Management of Adrenal Incidentalomas
    Seung Shin Park, Jung Hee Kim
    Endocrinology and Metabolism.2023; 38(4): 373.     CrossRef
  • Adrenal malakoplakia a rare lesion that mimics a neoplasm
    Orión Erenhú Rodríguez González, Jesus Eduardo Osorio, Edgar Iván Bravo Castro
    Urology Case Reports.2023; 51: 102568.     CrossRef
  • LC-MS based simultaneous profiling of adrenal hormones of steroids, catecholamines, and metanephrines
    Jongsung Noh, Chaelin Lee, Jung Hee Kim, Seung Woon Myung, Man Ho Choi
    Journal of Lipid Research.2023; 64(11): 100453.     CrossRef
  • Incidentaloma adrenal. Del hallazgo casual al diagnóstico definitivo
    Mercedes Retamal Ortíz, Ana Belén Vicario Parada, Elena Vázquez Jarén
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    Medicina.2023; 60(1): 72.     CrossRef
  • Computer-assisted Reporting and Decision Support Increases Compliance with Follow-up Imaging and Hormonal Screening of Adrenal Incidentalomas
    Renata R. Almeida, Bernardo C. Bizzo, Ramandeep Singh, Katherine P. Andriole, Tarik K. Alkasab
    Academic Radiology.2022; 29(2): 236.     CrossRef
  • Incidental Adrenal Masses: Adherence to Guidelines and Methods to Improve Initial Follow-Up: A Systematic Review
    Timothy Feeney, Andrea Madiedo, Philip E. Knapp, Avneesh Gupta, David McAneny, Frederick Thurston Drake
    Journal of Surgical Research.2022; 269: 18.     CrossRef
  • Incidental Adrenal Lesions May Not Always Require Further Imaging Work-up
    Deborah A. Baumgarten
    Radiology.2022; 302(1): 138.     CrossRef
  • Adrenal Nodules Detected at Staging CT in Patients with Resectable Gastric Cancers Have a Low Incidence of Malignancy
    Hae Young Kim, Won Chang, Yoon Jin Lee, Ji Hoon Park, Jungheum Cho, Hee Young Na, Hyungwoo Ahn, Sung Il Hwang, Hak Jong Lee, Young Hoon Kim, Kyoung Ho Lee
    Radiology.2022; 302(1): 129.     CrossRef
  • Management of incidental adrenal nodules: a survey of abdominal radiologists conducted by the Society of Abdominal Radiology Disease-Focused Panel on Adrenal Neoplasms
    Michael T. Corwin, Nicola Schieda, Erick M. Remer, Elaine M. Caoili
    Abdominal Radiology.2022; 47(4): 1360.     CrossRef
  • Primary hyperaldosteronism: indications for screening
    Novella M. Chikhladze
    Terapevticheskii arkhiv.2022; 94(1): 107.     CrossRef
  • Pathophysiological Link between Insulin Resistance and Adrenal Incidentalomas
    Jordan A. Higgs, Alyssa P. Quinn, Kevin D. Seely, Zeke Richards, Shad P. Mortensen, Cody S. Crandall, Amanda E. Brooks
    International Journal of Molecular Sciences.2022; 23(8): 4340.     CrossRef
  • Can Radiomics Provide Additional Diagnostic Value for Identifying Adrenal Lipid-Poor Adenomas From Non-Adenomas on Unenhanced CT?
    Binhao Zhang, Huangqi Zhang, Xin Li, Shengze Jin, Jiawen Yang, Wenting Pan, Xue Dong, Jin Chen, Wenbin Ji
    Frontiers in Oncology.2022;[Epub]     CrossRef
  • Adrenal Surgery in the Era of Multidisciplinary Endocrine Tumor Boards
    Costanza Chiapponi, Daniel Pinto Dos Santos, Milan Janis Michael Hartmann, Matthias Schmidt, Michael Faust, Roger Wahba, Christiane Josephine Bruns, Anne Maria Schultheis, Hakan Alakus
    Hormone and Metabolic Research.2022; 54(05): 294.     CrossRef
  • Optimal and novel imaging of the adrenal glands
    Patrick J. Navin, Michael R. Moynagh
    Current Opinion in Endocrinology, Diabetes & Obesity.2022; 29(3): 253.     CrossRef
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    Małgorzata Zdrojewska, Emilia Mech-Siebieszuk, Renata Świątkowska-Stodulska, Bartosz Regent, Michał Kunc, Łukasz Zdrojewski, Krzysztof Sworczak
    Medicina.2022; 58(6): 746.     CrossRef
  • Incidence of malignancy in adrenal nodules detected on staging CTs of patients with potentially resectable colorectal cancer
    Hae Young Kim, Yoon Jin Lee, Won Chang, Ji Hoon Park, Jungheum Cho, Hyeon Jeong Oh, Young Hoon Kim, Kyoung Ho Lee
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    Adam Kelly, Stacy O’Connor, Diana Kane, Chiang-Ching Huang, Harveshp Mogal
    Annals of Surgical Oncology.2022; 29(13): 8265.     CrossRef
  • Laparoscopic large adrenal mass resection: why we should be more careful?
    Mohsen Varyani, Mahmood Parvin, Hamidreza Akbari Gilani
    African Journal of Urology.2022;[Epub]     CrossRef
  • Serum Visfatin/NAMPT as a Potential Risk Predictor for Malignancy of Adrenal Tumors
    Nadia Sawicka-Gutaj, Hanna Komarowska, Dawid Gruszczyński, Aleksandra Derwich, Anna Klimont, Marek Ruchała
    Journal of Clinical Medicine.2022; 11(19): 5563.     CrossRef
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    Cureus.2022;[Epub]     CrossRef
  • Forty Years Together, New Leap Forward! The 40th Anniversary of the Korean Endocrine Society
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    International Journal of General Medicine.2021; Volume 14: 673.     CrossRef
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    Enrico Battistella, Stefania Ferrari, Luca Pomba, Antonio Toniato
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    Yusef Hazimeh, Carlie Sigel, Carsello Carie, Mathew Leinung, Zaynab Khalaf
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    E. Marchal
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    Caren G. Solomon, Electron Kebebew
    New England Journal of Medicine.2021; 384(16): 1542.     CrossRef
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    Mehmet Gürkan Arıkan, Göktan Altuğ Öz, Nur Gülce İşkan, Necdet Süt, İlkan Yüksel, Ersan Arda
    Uro.2021; 1(2): 39.     CrossRef
  • Incidental Adrenal Nodules
    Daniel I. Glazer, Michael T. Corwin, William W. Mayo-Smith
    Radiologic Clinics of North America.2021; 59(4): 591.     CrossRef
  • Antioxidant Barrier and Oxidative Damage to Proteins, Lipids, and DNA/RNA in Adrenal Tumor Patients
    Barbara Choromańska, Piotr Myśliwiec, Tomasz Kozłowski, Magdalena Łuba, Piotr Wojskowicz, Jacek Dadan, Hanna Myśliwiec, Katarzyna Choromańska, Anna Gibała, Anna Starzyńska, Małgorzata Żendzian-Piotrowska, Anna Zalewska, Mateusz Maciejczyk, Jos L. Quiles
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    Kristin McCoy, Katherine Howe, Daniel Tershak
    Journal of Endocrine Surgery.2021; 21(3): 70.     CrossRef
  • Metabolic Subtyping of Adrenal Tumors: Prospective Multi-Center Cohort Study in Korea
    Eu Jeong Ku, Chaelin Lee, Jaeyoon Shim, Sihoon Lee, Kyoung-Ah Kim, Sang Wan Kim, Yumie Rhee, Hyo-Jeong Kim, Jung Soo Lim, Choon Hee Chung, Sung Wan Chun, Soon-Jib Yoo, Ohk-Hyun Ryu, Ho Chan Cho, A Ram Hong, Chang Ho Ahn, Jung Hee Kim, Man Ho Choi
    Endocrinology and Metabolism.2021; 36(5): 1131.     CrossRef
  • Cross-Talk Between Nitrosative Stress, Inflammation and Hypoxia-Inducible Factor in Patients with Adrenal Masses
    Barbara Choromańska, Piotr Myśliwiec, Tomasz Kozłowski, Magdalena Łuba, Piotr Wojskowicz, Jacek Dadan, Hanna Myśliwiec, Katarzyna Choromańska, Katarzyna Makarewicz, Anna Zalewska, Mateusz Maciejczyk
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  • Cirugía laparoscópica en incidentaloma suprarrenal para el cirujano general: serie de casos
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Close layer
Erratum: Correction of Figure. Clinical Implications of Various Criteria for the Biochemical Diagnosis of Insulinoma
Chang Ho Ahn, Lee-Kyung Kim, Jie Eun Lee, Chan-Hyeon Jung, Se-Hee Min, Kyong Soo Park, Seong Yeon Kim, Young Min Cho
Endocrinol Metab. 2017;32(2):306.   Published online June 23, 2017
DOI: https://doi.org/10.3803/EnM.2017.32.2.306
  • 2,749 View
  • 30 Download
PDFPubReader   
Close layer
Clinical Study
Diagnostic Role of Captopril Challenge Test in Korean Subjects with High Aldosterone-to-Renin Ratios
Jung Hee Kim, Kyeong Seon Park, A Ram Hong, Chan Soo Shin, Seong Yeon Kim, Sang Wan Kim
Endocrinol Metab. 2016;31(2):277-283.   Published online May 13, 2016
DOI: https://doi.org/10.3803/EnM.2016.31.2.277
  • 5,079 View
  • 52 Download
  • 13 Web of Science
  • 13 Crossref
AbstractAbstract PDFPubReader   
Background

Diagnosis of primary aldosteronism (PA) begins with aldosterone-to-renin ratio (ARR) measurement followed by confirmative tests. However, the ARR has high false positive rates which led to unnecessary confirmatory tests. Captopril challenge test (CCT) has been used as one of confirmatory tests, but the accuracy of it in the diagnosis of PA is still controversial. We aimed to examine the clinical efficacy of CCT as a post-screening test in PA.

Methods

In a prospective study, we enrolled subjects with suspected PA who had hypertension and ARR >20 (ng/dL)/(ng/mL/hr). Sixty-four patients who underwent both the saline infusion test and the CCT were included.

Results

The diagnostic performance of plasma aldosterone concentration (PAC) post-CCT was greater than that of ARR post-CCT and ARR pre-CCT in PA (area under the curve=0.956, 0.797, and 0.748, respectively; P=0.001). A cut-off value of 13 ng/dL showed the highest diagnostic odds ratio considering PAC post-CCT at 60 and 90 minutes. A PAC post-CCT of 19 ng/dL had a specificity of 100%, which can be used as a cut-off value for the confirmative test. Determining the diagnostic performance of PAC post-CCT at 90 minutes was sufficient for PA diagnosis. Subjects with PAC post-CCT at 90 minutes <13 ng/dL are less likely to have PA, and those with PAC post-CCT at 90 minutes ≥13 but <19 ng/dL should undergo secondary confirmatory tests.

Conclusion

The CCT test may be a reliable post-screening test to avoid the hospitalization in the setting of falsely elevated ARR screening tests.

Citations

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  • Exclusion Tests in Unilateral Primary Aldosteronism (ExcluPA) Study
    Rui Zhu, Tungalagtamir Shagjaa, Giacomo Rossitto, Brasilina Caroccia, Teresa Maria Seccia, Dario Gregori, Gian Paolo Rossi
    The Journal of Clinical Endocrinology & Metabolism.2023; 108(2): 496.     CrossRef
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    Xinyu Liu, Chao Guo, Jin Bian, Sufang Hao, Ying Lou, Huimin Zhang, Xianliang Zhou, Jun Cai, Wenjun Ma
    Frontiers in Endocrinology.2023;[Epub]     CrossRef
  • Performance of Confirmatory Tests for Diagnosing Primary Aldosteronism: a Systematic Review and Meta-Analysis
    Alexander A. Leung, Christopher J. Symonds, Gregory L. Hundemer, Paul E. Ronksley, Diane L. Lorenzetti, Janice L. Pasieka, Adrian Harvey, Gregory A. Kline
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  • Baseline Plasma Aldosterone Level and Renin Activity Allowing Omission of Confirmatory Testing in Primary Aldosteronism
    Junji Kawashima, Eiichi Araki, Mitsuhide Naruse, Isao Kurihara, Katsutoshi Takahashi, Kouichi Tamura, Hiroki Kobayashi, Shintaro Okamura, Shozo Miyauchi, Koichi Yamamoto, Shoichiro Izawa, Tomoko Suzuki, Akiyo Tanabe
    The Journal of Clinical Endocrinology & Metabolism.2020; 105(5): e1990.     CrossRef
  • The number of positive confirmatory tests is associated with the clinical presentation and incidence of cardiovascular and cerebrovascular events in primary aldosteronism
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    Won-Young Lee
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    A Ram Hong, Jung Hee Kim, Kyeong Seon Park, Kyong Young Kim, Ji Hyun Lee, Sung Hye Kong, Seo Young Lee, Chan Soo Shin, Sang Wan Kim, Seong Yeon Kim
    European Journal of Endocrinology.2017; 177(6): 475.     CrossRef
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Close layer
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
  • 4,195 View
  • 40 Download
  • 4 Web of Science
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AbstractAbstract PDFPubReader   
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.

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Close layer
Clinical Study
Radiographic Characteristics of Adrenal Masses in Oncologic Patients
Ji Hyun Lee, Eun Ky Kim, A Ram Hong, Eun Roh, Jae Hyun Bae, Jung Hee Kim, Chan Soo Shin, Seong Yeon Kim, Sang Wan Kim
Endocrinol Metab. 2016;31(1):147-152.   Published online March 16, 2016
DOI: https://doi.org/10.3803/EnM.2016.31.1.147
  • 4,119 View
  • 35 Download
  • 9 Web of Science
  • 8 Crossref
AbstractAbstract PDFPubReader   
Background

We aimed to assess the usefulness of pre-contrast Hounsfield unit (HU) and mass size on computed tomography to differentiate adrenal mass found incidentally in oncologic patients.

Methods

From 2000 to 2012, 131 oncologic patients with adrenal incidentaloma were reviewed retrospectively. Receiver operating characteristic (ROC) curves were applied to determine the optimal cut-off value of the mean HU and size for detecting adrenal metastasis.

Results

The median age was 18 years, and 80 patients were male. The initial mass size was 18 mm, and 71 (54.2%) of these were on the left side. A bilateral adrenal mass was found in 11 patients (8.4%). Biochemically functional masses were observed in 9.2% of patients. Thirty-six out of 119 patients with nonfunctional masses underwent adrenalectomy, which revealed metastasis in 13. The primary cancers were lung cancer (n=4), renal cell carcinoma (n=2), lymphoma (n=2), hepatocellular carcinoma (n=2), breast cancer (n=1), and others (n=2). The area under the curve for the size and HU for clinically suspicious metastasis were 0.839 (95% confidence interval [CI], 0.761 to 0.900; P<0.001) and 0.959 (95% CI, 0.898 to 0.988; P<0.001), respectively. The cut-off value to distinguish between metastasis and benign masses were 22 mm for size and 20 for HU.

Conclusion

ROC curve results suggest that pre-contrast HU >20 can be used as a diagnostic reference to suggest metastasis in oncologic patients with adrenal masses.

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Close layer
Adrenal gland
Diagnosis and Treatment of Hypopituitarism
Seong Yeon Kim
Endocrinol Metab. 2015;30(4):443-455.   Published online December 31, 2015
DOI: https://doi.org/10.3803/EnM.2015.30.4.443
  • 12,459 View
  • 362 Download
  • 47 Web of Science
  • 55 Crossref
AbstractAbstract PDFPubReader   

Hypopituitarism is a chronic endocrine illness that caused by varied etiologies. Clinical manifestations of hypopituitarism are variable, often insidious in onset and dependent on the degree and severity of hormone deficiency. However, it is associated with increased mortality and morbidity. Therefore, early diagnosis and prompt treatment is necessary. Hypopituitarism can be easily diagnosed by measuring basal pituitary and target hormone levels except growth hormone (GH) and adrenocorticotropic hormone (ACTH) deficiency. Dynamic stimulation tests are indicated in equivocal basal hormone levels and GH/ACTH deficiency. Knowledge of the use and limitations of these stimulation tests is mandatory for proper interpretation. It is necessary for physicians to inform their patients that they may require lifetime treatment. Hormone replacement therapy should be individualized according to the specific needs of each patient, taking into account possible interactions. Long-term endocrinological follow-up of hypopituitary patients is important to monitor hormonal replacement regimes and avoid under- or overtreatment.

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Close layer
Adrenal gland
Limited Diagnostic Utility of Plasma Adrenocorticotropic Hormone for Differentiation between Adrenal Cushing Syndrome and Cushing Disease
A Ram Hong, Jung Hee Kim, Eun Shil Hong, I Kyeong Kim, Kyeong Seon Park, Chang Ho Ahn, Sang Wan Kim, Chan Soo Shin, Seong Yeon Kim
Endocrinol Metab. 2015;30(3):297-304.   Published online August 4, 2015
DOI: https://doi.org/10.3803/EnM.2015.30.3.297
  • 4,405 View
  • 65 Download
  • 9 Web of Science
  • 9 Crossref
AbstractAbstract PDFPubReader   
Background

Measurement of the plasma adrenocorticotropic hormone (ACTH) level has been recommended as the first diagnostic test for differentiating between ACTH-independent Cushing syndrome (CS) and ACTH-dependent CS. When plasma ACTH values are inconclusive, a differential diagnosis of CS can be made based upon measurement of the serum dehydroepiandrosterone sulfate (DHEA-S) level and results of the high-dose dexamethasone suppression test (HDST). The aim of this study was to assess the utility of plasma ACTH to differentiate adrenal CS from Cushing' disease (CD) and compare it with that of the HDST results and serum DHEA-S level.

Methods

We performed a retrospective, multicenter study from January 2000 to May 2012 involving 92 patients with endogenous CS. The levels of plasma ACTH, serum cortisol, 24-hour urine free cortisol (UFC) after the HDST, and serum DHEA-S were measured.

Results

Fifty-seven patients had adrenal CS and 35 patients had CD. The area under the curve of plasma ACTH, serum DHEA-S, percentage suppression of serum cortisol, and UFC after HDST were 0.954, 0.841, 0.950, and 0.997, respectively (all P<0.001). The cut-off values for plasma ACTH, percentage suppression of serum cortisol, and UFC after HDST were 5.3 pmol/L, 33.3%, and 61.6%, respectively. The sensitivity and specificity of plasma ACTH measurement were 84.2% and 94.3%, those of serum cortisol were 95.8% and 90.6%, and those of UFC after the HDST were 97.9% and 96.7%, respectively.

Conclusion

Significant overlap in plasma ACTH levels was seen between patients with adrenal CS and those with CD. The HDST may be useful in differentiating between these forms of the disease, especially when the plasma ACTH level alone is not conclusive.

Citations

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Close layer
Obesity and Metabolism
Clinical Implications of Various Criteria for the Biochemical Diagnosis of Insulinoma
Chang Ho Ahn, Lee-Kyung Kim, Jie Eun Lee, Chan-Hyeon Jung, Se-Hee Min, Kyong Soo Park, Seong Yeon Kim, Young Min Cho
Endocrinol Metab. 2014;29(4):498-504.   Published online December 29, 2014
DOI: https://doi.org/10.3803/EnM.2014.29.4.498
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  • 71 Download
  • 10 Web of Science
  • 8 Crossref
AbstractAbstract PDFPubReader   
Background

Among the various diagnostic criteria for insulinoma, the ratio criteria have been controversial. However, the amended insulin-glucose ratio exhibited excellent diagnostic performance in a recent retrospective cohort study, although it has not yet been validated in other patient cohorts. We examined the diagnostic performance of the current criteria of the Endocrine Society, insulin-glucose ratio, C-peptide-glucose ratio, and amended ratios in terms of differentiating insulinomas.

Methods

We reviewed the medical records of patients who underwent evaluation for hypoglycemia from 2000 to 2013. Fourteen patients with histopathologically confirmed insulinoma and 18 patients without clinical evidence of insulinoma were included. The results of a prolonged fast test were analyzed according to the abovementioned criteria.

Results

Fulfilling all three Endocrine Society criteria-plasma levels of glucose (<3.0 mmol/L), insulin (≥8 pmol/L), and C-peptide (≥0.2 nmol/L)-exhibited 100% sensitivity and 89% specificity. Fulfilling the glucose and C-peptide criteria showed 100% sensitivity and 83% specificity, while fulfilling the glucose and insulin criteria showed 100% sensitivity and 72% specificity. Among the ratio criteria, the insulin-glucose ratio [>24.0 (pmol/L)/(mmol/L)] gave the highest area under the receiver operating characteristic curve, with 93% sensitivity and 94% specificity.

Conclusion

Fulfilling the glucose, insulin, and C-peptide criteria of the Endocrine Society guidelines exhibited the best diagnostic performance for insulinoma. Nonetheless, the insulin-glucose ratio may still have a role in the biochemical diagnosis of insulinoma.

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Close layer
Thyroid
Two Cases of Methimazole-Induced Insulin Autoimmune Syndrome in Graves' Disease
Eun Roh, Ye An Kim, Eu Jeong Ku, Jae Hyun Bae, Hye Mi Kim, Young Min Cho, Young Joo Park, Kyong Soo Park, Seong Yeon Kim, Soo Heon Kwak
Endocrinol Metab. 2013;28(1):55-60.   Published online March 25, 2013
DOI: https://doi.org/10.3803/EnM.2013.28.1.55
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AbstractAbstract PDFPubReader   

We report here the cases of two females with Graves' disease who developed insulin autoimmune syndrome after treatment with methimazole. The patients exhibited a sudden altered mental state after treatment with methimazole for approximately 4 weeks. Patients had hypoglycemia with serum glucose below 70 mg/dL, and laboratory findings showed both high levels of serum insulin and high titers of insulin autoantibodies. The two women had never been exposed to insulin or oral antidiabetic agents, and there was no evidence of insulinoma in imaging studies. After glucose loading, serum glucose, and total insulin levels increased abnormally. One of the patient was found to have HLA-DRB1*0406, which is known to be strongly associated with methimazole-induced insulin autoimmune syndrome. After discontinuation of methimazole, hypoglycemic events disappeared within 1 month. Insulin autoantibody titer and insulin levels decreased within 5 months and there was no further development of hypoglycemic events. We present these cases with a review of the relevant literature.

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Close layer
A Case of Ectopic ACTH Syndrome Associated with Metastatic Prostate Cancer.
Eun Ky Kim, Soo Heon Kwak, Hwa Young Ahn, Ah Reum Khang, Hyo Jin Park, So Yeon Park, Sang Eun Lee, Hak Chul Jang, Seong Yeon Kim, Young Joo Park
Endocrinol Metab. 2012;27(3):237-243.   Published online September 19, 2012
DOI: https://doi.org/10.3803/EnM.2012.27.3.237
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AbstractAbstract PDF
Ectopic adrenocorticotropic hormone (ACTH) syndrome is mostly associated with neuroendocrine tumors and small cell carcinoma of the lung. This syndrome of prostate cancer is rare and has been reported in only a few cases. We report a patient with ectopic ACTH production associated with metastatic prostate cancer. A 70-year-old patient with metastatic prostate cancer was admitted to our hospital with septic shock. He had a history of hormonal therapy and transurethral prostatectomy. Adrenocortical function was checked due to consistent fever and poor general condition, which revealed markedly increased levels of basal plasma ACTH and serum cortisol. The patient did not present typical signs of the Cushing's syndrome, however, hypokalemia and a history of hypertension were found. He died in days as a result of multi-organ failure. On pathology, the prostatectomy specimen showed a tumor composed of mixed populations of adenocarcinoma and small cell carcinoma. The tumor cells in the small cell component were positive for chromogranin and ACTH. Although neuroendocrine differentiation in prostate cancer is rare, etopic ACTH production should be considered in patients with prostate cancer as well as in clinical features of ACTH hypersecretion.
Close layer
Characterization of Incidentally Detected Adrenal Pheochromocytoma.
Ye An Kim, Yul Hwangbo, Min Joo Kim, Hyung Jin Choi, Je Hyun Seo, Yenna Lee, Soo Heun Kwak, Eu Jeong Ku, Tae Jung Oh, Eun Roh, Jae Hyun Bae, Jung Hee Kim, Kyoung Soo Park, Seong Yeon Kim
Endocrinol Metab. 2012;27(2):132-137.   Published online June 20, 2012
DOI: https://doi.org/10.3803/EnM.2012.27.2.132
  • 2,174 View
  • 28 Download
  • 3 Crossref
AbstractAbstract PDF
BACKGROUND
In approach to an adrenal incidentaloma, early exclusion of pheochromocytoma is clinically important, due to the risk of catecholamine crisis. The aims of this study are to investigate the characteristics of incidentally detected pheochromocytomas, compared with that of the other adrenal incidentalomas, and to compare these characteristics with those of symptomatic pheochromocytomas. METHODS: In this retrospective study, we reviewed the medical records of 198 patients with adrenal incidentaloma from 2001 to 2010. We analyzed the clinical, laboratory and radiological data of pheochromocytomas, in comparison with those of the other adrenal incidentalomas. We also compared the characteristics of these incidentally detected pheochromocytomas with the medical records of 28 pathologically proven pheochromocytomas, diagnosed based on typical symptoms. RESULTS: Among the 198 patients with adrenal incidentaloma, nineteen patients were diagnosed with pheochromocytoma. Pheochromocytomas showed larger size and higher Hounsfield unit at precontrast computed tomography (CT) than did non-pheochromocytomas. All pheochromocytomas were larger than 2.0 cm, and the Hounsfield units were 19 or higher in precontrast CT. When both criteria of size > 2.0 cm and Hounsfield unit > 19 were met, the sensitivity and specificity for the diagnosis of pheochromocytoma were 100% and 79.3%, respectively. Compared with patients with pheochromocytoma, diagnosed based on typical symptoms, patients with incidentally detected pheochromocytoma were older, presented less often with hypertension, and showed lower levels of 24-hour urine metanephrine. CONCLUSION: Adrenal incidentaloma with < 2.0 cm in size or < or = 19 Hounsfield units in precontrast CT imaging was less likely to be a pheochromocytoma. Patients with incidentally discovered pheochromocytoma showed lower catecholamine metabolites, compared with those patients with symptomatic pheochromocytoma.

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  • Guidelines for the Management of Adrenal Incidentaloma: the Korean Endocrine Society, Committee of Clinical Practice Guidelines
    Jung-Min Lee, Mee Kyoung Kim, Seung-Hyun Ko, Jung-Min Koh, Bo-Yeon Kim, Sang-Wan Kim, Soo-Kyung Kim, Hae-Jin Kim, Ohk-Hyun Ryu, Juri Park, Jung-Soo Lim, Seong Yeon Kim, Young Kee Shong, Soon Jib Yoo
    The Korean Journal of Medicine.2017; 92(1): 4.     CrossRef
  • Clinical Guidelines for the Management of Adrenal Incidentaloma
    Jung-Min Lee, Mee Kyoung Kim, Seung-Hyun Ko, Jung-Min Koh, Bo-Yeon Kim, Sang Wan Kim, Soo-Kyung Kim, Hae Jin Kim, Ohk-Hyun Ryu, Juri Park, Jung Soo Lim, Seong Yeon Kim, Young Kee Shong, Soon Jib Yoo
    Endocrinology and Metabolism.2017; 32(2): 200.     CrossRef
  • Characterization of Incidentally Detected Adrenal Pheochromocytoma
    Soon Jib Yoo, Woohyeon Kim
    Endocrinology and Metabolism.2012; 27(2): 116.     CrossRef
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Primary Hyperaparathyroidism due to Cystic Parathyroid Adenoma not Detected on 99mTc-Sestamibi Scan.
Ah Reum Khang, Eun Ki Kim, Eun Young Nam, Sun Ju Byeon, Jung Hee Kim, Jung Hun Ohn, Eun Shil Hong, Hyung Jin Choi, Kyeong Cheon Jung, Myung Whun Sung, Chan Soo Shin, Kyong Soo Park, Seong Yeon Kim
Endocrinol Metab. 2012;27(1):83-88.   Published online March 1, 2012
DOI: https://doi.org/10.3803/EnM.2012.27.1.83
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AbstractAbstract PDF
Parathyroid cysts, which can be divided into functional and non-functional cysts, are rare causes of primary hyperparathyroidism. A technetium-99m-methoxyisobutylisonitrile (99mTc-sestamibi) parathyroid scan is a sensitive diagnostic tool for the localization, although it sometimes shows a false-negative result. Here we report a case of presumed cystic parathyroid adenoma based on clinical findings and analysis of cystic fluid with negative findings in a parathyroid scan. A 44-year-old male patient visited the hospital due to leg pain and compressive symptoms (dysphagia, hoarseness) that had started 4-5 months before. His serum calcium level was 14.4 mg/dL and his intact parathyroid hormone (iPTH) had increased to 478.1 pg/mL. On neck computed tomography, a cystic nodule measuring 6.2 cm was detected in the inferior part of the right thyroid gland. Sestamibi uptake for this nodule was not detected on 2-h delayed imaging, and fluorodeoxyglucose positron emission tomography showed only subtle uptake. Fine-needle aspiration was performed and intracystic iPTH had increased to 61,600 pg/mL. Focused parathyroidectomy guided by intraoperative iPTH monitoring led to successful enucleation of the right inferior parathyroid gland. A parathyroid adenoma was confirmed, and his laboratory results had normalized. This study shows that cystic parathyroid adenoma can sometimes be difficult to detect on a 99mTc-sestamibi parathyroid scan.

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  • Functional parathyroid cystic adenoma: A rare cause of hypercalcemic crisis with primary hyperparathyroidism
    BS Sumana, M Sabaretnam, Vijaya Sarathi, Akshatha Savith
    Indian Journal of Pathology and Microbiology.2015; 58(4): 487.     CrossRef
  • Normocalcemic primary hyperparathyroidism: long-term follow-up associated with multiple adenomas
    Larissa Pimentel, Sirley Portela, Alyne Loureiro, Francisco Bandeira
    Arquivos Brasileiros de Endocrinologia & Metabologia.2014; 58(5): 583.     CrossRef
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Androgen Receptor Gene CAG Repeat Polymorphism and Effect of Testosterone Therapy in Hypogonadal Men in Korea.
Min Joo Kim, Jin Taek Kim, Sun Wook Cho, Sang Wan Kim, Chan Soo Shin, Kyong Soo Park, Seong Yeon Kim
Endocrinol Metab. 2011;26(3):225-231.   Published online September 1, 2011
DOI: https://doi.org/10.3803/EnM.2011.26.3.225
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AbstractAbstract PDF
BACKGROUND
As the number of CAG repeats in the androgen receptor (AR) gene increases, transcriptional activities decrease and the effects of testosterone decline. In this study, we evaluated the importance of the CAG repeat polymorphism in regard to the effect/safety of testosterone therapy in hypogonadal Korean men. METHODS: The number of CAG repeats was determined in 42 hypogonadal men who underwent testosterone therapy for more than 24 months between December 1999 and August 2007. Body mass index, lean body mass, body fat, bone mineral density, type I collagen N-telopeptide (NTx), osteocalcin, lipid profile, hematocrit and PSA levels prior to and after 24 months of testosterone therapy were identified in our medical record review. RESULTS: Twenty-four months of testosterone therapy increased lean body mass, hematocrit, and PSA levels and reduced body fat, NTx, and HDL cholesterol levels. The mean number of CAG repeats in the AR gene was 23 +/- 3 (range, 15-29) in hypogonadal Korean men. The number of CAG repeats was not found to be associated with changes in lean body mass, body fat, NTx, HDL cholesterol, hematocrit, or PSA levels during testosterone therapy. CONCLUSIONS: No association between the number of CAG repeats in the AR gene and the effect/safety of testosterone therapy was detected in hypogonadal Korean men.

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  • Androgen Receptor CAG Repeat Length as a Risk Factor of Late-Onset Hypogonadism in a Korean Male Population
    Jong Wook Kim, Young Dae Bae, Sun Tae Ahn, Jin Wook Kim, Je Jong Kim, Du Geon Moon
    Sexual Medicine.2018; 6(3): 203.     CrossRef
  • Positive Correlation between Androgen Receptor CAG Repeat Length and Metabolic Syndrome in a Korean Male Population
    Jong Wook Kim, Young Dae Bae, Sun Tae Ahn, Jin Wook Kim, Je Jong Kim, Du Geon Moon
    The World Journal of Men's Health.2018; 36(1): 73.     CrossRef
  • Genome-Based Approaches in Endocrinology and Metabolism: From Clinical and Research Aspects
    Sihoon Lee
    Endocrinology and Metabolism.2011; 26(3): 208.     CrossRef
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No Significance of the Free Cortisol Index Compared to Total Cortisol in Critically Ill Patients.
Kyung Won Kim, Sang Wan Kim, Hee Joung Kim, Chan Soo Shin, Sung Jae Park, Gil Joon Suh, Seong Yeon Kim
Endocrinol Metab. 2011;26(2):120-125.   Published online June 1, 2011
DOI: https://doi.org/10.3803/EnM.2011.26.2.120
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AbstractAbstract PDF
BACKGROUND
Some patients exhibit an inadequate response of cortisol to stressful conditions; this state is known as critical illness-related corticosteroid insufficiency. These patients have low serum binding protein concentrations, thereby suggesting that total serum cortisol may not be reflective of circulating cortisol activity. As the free cortisol index (FCI = total cortisol/corticosteroid-binding globulin) has been correlated with serum free cortisol, we measured FCI in Korean patients for the first time. In this study, we attempted to determine whether FCI was superior to total cortisol in predicting 30-day mortality. METHODS: We recruited 65 critically ill patients with relatively high Acute Physiology, Age and Chronic Health Evaluation (APACHE III) scores. Fourteen patients with pituitary disease but normal pituitary function were recruited from outpatient clinics. Total cortisol and corticosteroid-binding globulin were measured in patients and controls during the short Synacthen test. RESULTS: The basal cortisol level and basal FCI level were higher in patients (n = 65) than in healthy controls (P < 0.001, respectively). We found that total cortisol was strongly correlated with FCI (P < 0.001) in critically ill patients; however, neither total cortisol nor FCI were associated with 30-day mortality among patients. Only severe clinical criteria (such as APACHE-III scores and low albumin) were associated with 30-day mortality. CONCLUSION: Our results do not suggest that FCI is more accurate than total cortisol in predicting clinical outcomes in critically ill patients.

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  • No Significance of the Free Cortisol Index Compared to Total Cortisol in Critically Ill Patients
    Doo-Man Kim
    Endocrinology and Metabolism.2011; 26(2): 118.     CrossRef
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A Case of von Hippel-Lindau Disease Presenting with Pancreatic Neuroendocrine Tumor.
Jung Hun Ohn, Junghee Kim, Hyun Jung Lee, Won Woo Seo, Yul Hwang-Bo, Eun Shil Hong, Jin Joo Park, Seong Yeon Kim
Endocrinol Metab. 2011;26(1):89-91.   Published online March 1, 2011
DOI: https://doi.org/10.3803/EnM.2011.26.1.89
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AbstractAbstract PDF
Von Hippel-Lindau (VHL) disease is an autosomal dominant disorder that results from a germline mutation of the VHL gene. The affected individuals might develop several benign or malignant tumors such as central nervous system or retinal haemangioblastomas, endolymphatic sac tumors, renal cell carcinomas, pheochromocytomas or pancreatic cysts and neuroendocrine tumors. We report here on a case of a 21 year old female with von Hippel-Lindau disease and she presented with only pancreatic neuroendocrine tumor and no evidence of haemangioblastomas or other visceral complications. Further, direct sequencing of the VHL gene reveals a novel germline frameshift mutation of codon 198 from the deletion of nucleotide 592 (cytosine), leading to truncation of the VHL protein.

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  • Germline mutation of Glu70Lys is highly frequent in Korean patients with von Hippel–Lindau (VHL) disease
    Sena Hwang, Cheol Ryong Ku, Ji In Lee, Kyu Yeon Hur, Myung-Shik Lee, Chul-Ho Lee, Kyo Yeon Koo, Jin-Sung Lee, Yumie Rhee
    Journal of Human Genetics.2014; 59(9): 488.     CrossRef
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Association of the Parathyroid Adenoma Volume and the Biochemical Parameters in Primary Hyperparathyroidism.
Yul Hwang-Bo, Jung Hee Kim, Jee Hyun An, Eun Shil Hong, Jung Hun Ohn, Eun Ky Kim, Ah Reum Khang, Sun Wook Cho, Do Joon Park, Kyong Soo Park, Seong Yeon Kim, Bo Youn Cho, Chan Soo Shin
Endocrinol Metab. 2011;26(1):62-66.   Published online March 1, 2011
DOI: https://doi.org/10.3803/EnM.2011.26.1.62
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AbstractAbstract PDF
BACKGROUND
The objective of this study is to demonstrate the relationship between the volume of a parathyroid adenoma and the preoperative biochemical parameters in patients undergoing surgery for primary hyperparathyroidism. METHODS: The medical records of 68 patients who underwent a parathyroidectomy for a single parathyroid adenoma were retrospectively reviewed. The volume of the adenoma was estimated using its measured size and a mathematical formula. The correlation between the volume of the parathyroid adenoma and the preoperative laboratory data was assessed. RESULTS: There were no correlations between the estimated volume of the adenoma and the serum calcium, alkaline phosphatase and parathyroid hormone levels. However, the volume of the adenoma was associated with the preoperative level of serum phosphorus. After excluding 5 adenomas with cystic degeneration, a positive correlation was noted between the adenoma volume and the preoperative levels of alkaline phosphatase and parathyroid hormone. CONCLUSION: The preoperative serum levels of calcium, alkaline phosphatase and parathyroid hormone are of limited use to predict the volume of the parathyroid adenoma in patients with a single parathyroid adenoma. We suggest that the absence of a correlation between the volume of the adenoma and the biochemical parameters can be attributed to the cystic degeneration of the adenomas.

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  • Differentiating pathologic parathyroid glands from thyroid nodules on neck ultrasound: the PARATH-US cross-sectional study
    Dolly Yazgi, Carine Richa, Sylvie Salenave, Peter Kamenicky, Amel Bourouina, Lorraine Clavier, Margot Dupeux, Jean-François Papon, Jacques Young, Philippe Chanson, Luigi Maione
    The Lancet Regional Health - Europe.2023; 35: 100751.     CrossRef
  • Primer hiperparatiroidide Tc99m-MIBI sintigrafi sonuçlarının biyokimyasal ve histopatolojik bulgular ile ilişkisi
    Seda TURGUT, Ezgi Başak ERDOĞAN
    OSMANGAZİ JOURNAL OF MEDICINE.2020;[Epub]     CrossRef
  • Letter: Association of the Parathyroid Adenoma Volume and the Biochemical Parameters in Primary Hyperparathyroidism (Endocrinol Metab 26:62-66, 2011, Yul Hwang-Bo et al.)
    Dong Jin Chung
    Endocrinology and Metabolism.2011; 26(2): 185.     CrossRef
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Clinical Characteristics of Langerhans Cell Histiocytosis with Hypothalamo-Pituitary Involvement.
Eun Shil Hong, Jung Hun Ohn, Jung Hee Kim, Yul Hwang-Bo, Jin Joo Kim, Jung Hee Kwon, Jung Won Lee, Se Youn Choi, Eun Kyung Lee, Sun Wook Cho, Chan Soo Shin, Kyong Soo Park, Hak Chul Jang, Bo Youn Cho, Hong Kyu Lee, Choong Ho Shin, Sei Won Yang, Seong Yeon Kim
Endocrinol Metab. 2011;26(1):38-43.   Published online March 1, 2011
DOI: https://doi.org/10.3803/EnM.2011.26.1.38
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AbstractAbstract PDF
BACKGROUND
Langerhans cell histiocytosis (LCH) is a rare disease that involves a clonal proliferation of Langerhans cells. LCH has a predilection for hypothalamo-pituitary axis (HPA) dysfunction, and this leads to diabetes insipidus (DI) and/or anterior pituitary dysfunction. Here, we describe the endocrine dysfunction and clinical characteristics of adult patients with LCH and we analyzed the differences between an adult-onset type and a childhood-onset type. METHODS: The data was obtained from a retrospective chart review of the patients with LCH that involved the HPA and who attended Seoul National University Hospital. The patients were classified into the adult-onset type (age at the time of diagnosis > or = 16) and the childhood-onset type (age at the time of diagnosis < or = 15). RESULTS: Ten patients (9 males and 1 female) were diagnosed with LCH involving the HPA. Five patients were classified as an adultonset type and the other five patients were classified as a childhood-onset type. The median follow-up duration was 6 (3-12) years for the adult-onset type and 16 (15-22) years for the childhood-onset type. All the patients presented with DI as the initial manifestation of HPA involvement. Four adult-onset patients and three childhood-onset patients had a multi-system disease. Panhypopituitarism developed in three adult-onset patients and in one childhood-onset patient. The pituitary lesion of the three adult-onset patients had spread to the brain during the follow-up duration. In contrast, the pituitary lesion of the other two adult-onset patients without panhypopituitarism and all the childhood-onset patients had not changed. CONCLUSION: DI was the initial presentation symptom of HPA involvement. Anterior pituitary hormone deficiency followed in some patients. Compared with the childhood-onset patients, the adult-onset patients were more likely to have panhypopituitarism and a poor prognosis.

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  • Pulmonary Langerhans Cell Histiocytosis in an Adult Male Presenting with Central Diabetes Insipidus and Diabetes Mellitus: A Case Report
    Yeun Seoung Choi, Jung Soo Lim, Woocheol Kwon, Soon-Hee Jung, Il Hwan Park, Myoung Kyu Lee, Won Yeon Lee, Suk Joong Yong, Seok Jeong Lee, Ye-Ryung Jung, Jiwon Choi, Ji Sun Choi, Joon Taek Jeong, Jin Sae Yoo, Sang-Ha Kim
    Tuberculosis and Respiratory Diseases.2015; 78(4): 463.     CrossRef
  • Adult Multisystem Langerhans Cell Histiocytosis Presenting with Central Diabetes Insipidus Successfully Treated with Chemotherapy
    Jung-Eun Choi, Hae Ri Lee, Jung Hun Ohn, Min Kyong Moon, Juri Park, Seong Jin Lee, Moon-Gi Choi, Hyung Joon Yoo, Jung Han Kim, Eun-Gyoung Hong
    Endocrinology and Metabolism.2014; 29(3): 394.     CrossRef
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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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AbstractAbstract PDF
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
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Six Cases of Congenital Adrenal Hyperplasia That Were Due to 17alpha-hydroxylase/17,20-lyase Deficiency.
Dong Hoon Shin, Sung Hoon Yu, Young Min Choi, Jung Gu Kim, Sang Wan Kim, Chan Soo Shin, Kyong Soo Park, Seong Yeon Kim
J Korean Endocr Soc. 2009;24(2):109-115.   Published online June 1, 2009
DOI: https://doi.org/10.3803/jkes.2009.24.2.109
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AbstractAbstract PDF
17alpha-hydroxylase/17,20-lyase deficiency is a rare phenotype of congenital adrenal hyperplasia (CAH), and this is characterized by hyporeninemic hypertension, primary amenorrhea and abnormality of the secondary sexual characteristics (pseudohermaphroditism in men). This type of CAH is usually misdiagnosed at first as mineralocorticoid induced hypertension with primary aldosteronism, but primary amenorrhea with deficient sex hormone is a clue for making the correct diagnosis. The authors experienced 6 cases of 17alpha-hydroxylase/17,20-lyase deficiency in patients who ranged from 15 to 42 years of age. 4 cases were diagnosed according to the investigation of their mineralocorticoid-induced hypertension and 2 cases their primary amenorrhea and sexual infantilism. All of them had hypokalemia, hyporeninemic hypertension and an atrophied uterus and ovaries. In the genotypic male (46 XY), the testicles were atrophied in the abdominal cavity. The levels of cortisol, estrogen and dehydroepiandrosterone sulfate (DHEAS) were low, but the levels of progesterone and 11-deoxycorticosterone were high. Therefore, the diagnosis of 17alpha-hydroxylase/17,20-lyase deficiency should be considered in female patients who present with both sexual infantilism and mineralocorticoid hypertension. We report on these cases with a brief review of the literature.

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  • Functional Identification of Compound Heterozygous Mutations in the CYP17A1 Gene Resulting in Combined 17α-Hydroxylase/17,20-Lyase Deficiency
    Eun Yeong Mo, Ji-young Lee, Su Yeon Kim, Min Ji Kim, Eun Sook Kim, Seungok Lee, Je Ho Han, Sung-dae Moon
    Endocrinology and Metabolism.2018; 33(3): 413.     CrossRef
  • 17α-hydroxylase Deficiency Mimicking Hyperaldosteronism by Aldosterone-producing Adrenal Adenoma
    Yun Kyung Cho, Hyeseon Oh, Sun-myoung Kang, Sujong An, Jin-Young Huh, Ji-Hyang Lee, Woo Je Lee
    The Korean Journal of Medicine.2016; 91(2): 191.     CrossRef
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Discrepancy between the Growth Hormone and Insulin-like Growth Factor-I Concentrations in Patients with Acromegaly.
Ji Won Yoon, Mi Yeon Kang, Hwa Young Ahn, Jee Hyun An, Sang Wan Kim, Chan Soo Shin, Kyong Soo Park, Hak Chul Jang, Bo Youn Cho, Hong Kyu Lee, Seong Yeon Kim
J Korean Endocr Soc. 2008;23(6):395-403.   Published online December 1, 2008
DOI: https://doi.org/10.3803/jkes.2008.23.6.395
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AbstractAbstract PDF
BACKGROUND
This study was performed to evaluate the frequency and clinical characteristics of patients with active acromegaly and who show discordance of the growth hormone (GH) level and the insulin-like growth factor-I (IGF-I) level. METHODS: We reviewed the medical records of the patients who were diagnosed with acromegaly between 01/01/1995 and 6/30/2007 at Seoul National University Hospital. We selected only the patients whose basal GH and IGF-I levels were available. We investigated the pre- and post-operative clinical characteristics, as well as the blood concentrations of GH and IGF-I. The concordance rate between the two hormones was examined. The patients were considered to have active disease on the basis of their IGF-I levels above the normal range, after adjustment for age and gender, and their mean basal GH value was > or = 2.5 microgram/L. The hormone levels and the clinical parameters were compared between the hormone concordant and discordant groups. RESULTS: We reviewed the preoperative records of 103 acromegalic patients, and these patients met the above-mentioned criteria. 53 postoperative patients who were not cured by operation were monitored without them receiving radiation or medical therapy. Both the basal GH and IGF-I levels were above normal in 103 patients preoperatively, and the discordant rate was 0% (0/103 cases). Postoperatively, the discordant rate between the two hormones was increased to 30.2% (16/53 cases). Age, gender, body mass index and tumor size were insignificantly different between the concordant and discordant groups. However, postoperative residual tumors were less frequently observed in the discordant group (P = 0.006). CONCLUSION: For the patients with acromegaly, unlike the 0% discordance preoperatively, 30.2% of patients showed a discrepancy between their GH and IGF-I levels postoperatively. The patients who had hormonal discrepancy were less likely to have residual tumors after operation. Considering the frequency of this hormonal discrepancy, both hormone levels should be measured to evaluate the disease activity after treatment. Further, oral glucose tolerance testing should be performed and especially for the patients with an increased GH level, but who have a normal IGF-I concentration.
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Characteristics and Natural Course of Pituitary Incidentaloma in Korea.
You Jin Lee, Sun Wook Cho, Sang Wan Kim, Chan Soo Shin, Kyong Soo Park, Bo Youn Cho, Hong Kyu Lee, Seong Yeon Kim
J Korean Endocr Soc. 2008;23(2):111-116.   Published online April 1, 2008
DOI: https://doi.org/10.3803/jkes.2008.23.2.111
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AbstractAbstract PDF
BACKGROUND
A pituitary incidentaloma is a pituitary mass discovered incidentally by computed tomography (CT) or magnetic resonance (MRI) of the brain performed for evaluation of an unrelated disease, and when the patient did not show neurological or endocrine signs and symptoms. Despite of increasing incidence, only a few studies have reported on characteristics, natural history, treatment, or follow-up strategy. Moreover no epidemiologic data exist on pituitary incidentaloma in Korean. METHODS: We retrospectively enrolled subjects diagnosed as pituitary incidentaloma in Seoul National University Hospital from January 1992 to August 2006. We reviewed baseline demographic findings and the results of basal hormone tests, visual field test, and MRI (or CT) at baseline and during follow-up. RESULTS: Among 1310 patients with pituitary adenoma, 161 subjects were diagnosed with incidentaloma. The subject age at diagnosis was 49.7 +/- 15.5 years, with 84 males. Macroadenoma was more frequent (n = 110, 68.3%). with microadenomas and Rathke's cleft cysts found in 21 and 30 cases, respectively. The mean diameter of the tumor was 1.75 cm. Functional incidentalomas such as prolactinoma or acromegaly were found in 31 cases (19.3%) although there were no symptoms or visual field defects. Of 61 incidentaloma patients who did not undergo surgery or other treatment over one year, only 3 patient showed an increase in tumor size during the mean 38.0 +/- 24.9 months follow-up. CONCLUSION: Pituitary incidentaloma generally showed a benign course despite the high prevalence of macroadenoma (68.3%). However, as about 20% of the patients had functioning tumors, pituitary hormonal evaluation at diagnosis is mandatory. Furthermore, as we experienced 3 cases with increased tumor size during follow up, including a case of pituitary microadenoma, long-term careful follow-up of pituitary incidentaloma seems necessary. A long-term, prospective study with more patients would reveal the characteristics and the natural history of pituitary incidentalomas in Korea.

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  • Sellar Masses: An Epidemiological Study
    Khaled Al-Dahmani, Syed Mohammad, Fatima Imran, Chris Theriault, Steve Doucette, Deborah Zwicker, Churn-Ern Yip, David B. Clarke, Syed Ali Imran
    Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques.2016; 43(2): 291.     CrossRef
  • Optimal Surgical Approaches for Rathke Cleft Cyst With Consideration of Endocrine Function
    Jeong Kyung Park, Eun Jig Lee, Sun Ho Kim
    Operative Neurosurgery.2012; 70: ons250.     CrossRef
  • Clinical Characteristics of 16 Patients with Pituitary Tumor Incidentally Detected by18F-Fluorodeoxyglucose PET-CT (18F-FDG PET-CT)
    Hyung Jin Kim, Gi Jeong Cheon, A Ra Cho, Chang Hoon Lee, Sang Min Youn, Se jin Ahn, Sang Eon Jang, Jung Min Kim, Yun Yong Lee, Ka Hee Yi
    Endocrinology and Metabolism.2010; 25(4): 321.     CrossRef
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The Clinical Implication and Problems of Adrenal Vein Sampling in Patients with Primary Aldosteronism.
Jie Seon Lee, Mi Yeon Kang, Sang Wan Kim, Chan Soo Shin, Seong Yeon Kim, Jin Wook Chung
J Korean Endocr Soc. 2007;22(6):428-435.   Published online December 1, 2007
DOI: https://doi.org/10.3803/jkes.2007.22.6.428
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AbstractAbstract PDF
BACKGROUND
Recently, the significance of primary aldosteronism is being recognized due to an increase in its incidence and its complications. However, it is difficult to differentiate primary aldosteronism based on radiological studies as the size of an aldosterone producing adenoma (APA) is small, and nonfunctioning adrenal incidentalomas are common. Adrenal vein sampling (AVS) has been considered as the gold standard for differentiating an aldosterone producing adenoma (APA) from bilateral idiopathic adrenal hyperplasia (BAH). The clinical implications and problems associated with AVS have not yet been reported in Korea. METHOD: Clinical data of 28 patients with primary aldosteronism who had undergone AVS in a hospital from 1995 to 2006 were retrospectively analyzed. RESULT: The study group comprised 13 males (46.4%) and 15 females (53.5%), with a mean age of 44.5 +/- 11.9 years. Clinical data indicated that 19 patients (67.9%) had APA and nine patients (32.1%) had BAH. AVS data demonstrated that 11 patients had APA and five patients had BAH. Two patients were not diagnosed despite successful AVS. AVS was not successful in 10 patients (37.5%); AV catheterization failed in two patients, was not selective in seven patients on the right side, and was not selective in one patient on the left side. CONCLUSION: AVS was helpful in primary aldosteronism patients with inconclusive CT and MRI findings. Selectivity of AVS should be appropriately assessed because of the technical problem of selective catheterization.

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  • Bilateral Adrenocortical Masses Producing Aldosterone and Cortisol Independently
    Seung-Eun Lee, Jae Hyeon Kim, You-Bin Lee, Hyeri Seok, In Seub Shin, Yeong Hee Eun, Jung-Han Kim, Young Lyun Oh
    Endocrinology and Metabolism.2015; 30(4): 607.     CrossRef
  • Primary Aldosteronism
    Sang Wan Kim
    Korean Journal of Medicine.2012; 82(4): 396.     CrossRef
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Clinical Characteristics for 132 Patients with Adrenal Incidentaloma.
Hyun Seung Jeong, Hee Joung Kim, Hae Sung Kim, Sang Wan Kim, Chan Soo Shin, Do Joon Park, Kyung Soo Park, Hak Cheol Jang, Seong Yeon Kim, Bo Youn Cho, Hong Kyu Lee
J Korean Endocr Soc. 2007;22(4):260-265.   Published online August 1, 2007
DOI: https://doi.org/10.3803/jkes.2007.22.4.260
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AbstractAbstract PDF
BACKGROUND
Recently, the detection rate for adrenal incidentaloma in Korea has been on the increase. We describe here the clinical characteristics of these tumors and describe appropriate guidelines of diagnosis and treatment. METHODS: We analyzed age, sex, location, size, function, and the pathological findings for 132 patients with an adrenal mass by CT, USG, and MRI undertaken for health examinations or non-adrenal disease from January 2000 to March 2005. RESULTS: Adrenal masses were most commonly found in patients in their sixties (31%). 62.1% of the patients were men and 37.9% were women. For the location of the masses, 53% were found in the left gland, 43.2% were found in the right gland and 3.8% were found in both glands. Of all of the masses analyzed, 66% were 1 cm to 4 cm in size, and an adenoma-like appearance was the most common finding (69.7%) seen in images. All of the pheochromocytomas and carcinomas were above 4 cm in size. Patients with a functional mass were seen in 18 cases (13.6%) and pheochromocytomas were seen in 12 cases (67%). Three patients were found with cancer (2.3%), two cases (1.5%) of a primary carcinoma and one case of a metastasis (0.8%). CONCLUSION: The frequency and characteristics of benign nonfunctional, functional and malignant masses that were found in our hospital were similar to those presented in studies conducted outside of Korea. Therefore, it may be possible to apply previously established guidelines to domestic patients.

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  • Guidelines for the Management of Adrenal Incidentaloma: the Korean Endocrine Society, Committee of Clinical Practice Guidelines
    Jung-Min Lee, Mee Kyoung Kim, Seung-Hyun Ko, Jung-Min Koh, Bo-Yeon Kim, Sang-Wan Kim, Soo-Kyung Kim, Hae-Jin Kim, Ohk-Hyun Ryu, Juri Park, Jung-Soo Lim, Seong Yeon Kim, Young Kee Shong, Soon Jib Yoo
    The Korean Journal of Medicine.2017; 92(1): 4.     CrossRef
  • Clinical Guidelines for the Management of Adrenal Incidentaloma
    Jung-Min Lee, Mee Kyoung Kim, Seung-Hyun Ko, Jung-Min Koh, Bo-Yeon Kim, Sang Wan Kim, Soo-Kyung Kim, Hae Jin Kim, Ohk-Hyun Ryu, Juri Park, Jung Soo Lim, Seong Yeon Kim, Young Kee Shong, Soon Jib Yoo
    Endocrinology and Metabolism.2017; 32(2): 200.     CrossRef
  • Clinical Characteristics for 348 Patients with Adrenal Incidentaloma
    Jongho Kim, Kwi Hyun Bae, Yeon Kyung Choi, Ji Yun Jeong, Keun Gyu Park, Jung Guk Kim, In Kyu Lee
    Endocrinology and Metabolism.2013; 28(1): 20.     CrossRef
  • Clinical characteristics and follow-up of Korean patients with adrenal incidentalomas
    Yoon Young Cho, Sunghwan Suh, Ji Young Joung, Hyemin Jeong, Dongmo Je, Hongseok Yoo, Taek Kyu Park, Yong-Ki Min, Kwang-Won Kim, Jae Hyeon Kim
    The Korean Journal of Internal Medicine.2013; 28(5): 557.     CrossRef
  • Characterization of Incidentally Detected Adrenal Pheochromocytoma
    Soon Jib Yoo, Woohyeon Kim
    Endocrinology and Metabolism.2012; 27(2): 116.     CrossRef
  • Different diagnostic cut-off values of urinary fractionated metanephrines according to sex for the diagnosis of pheochromocytoma in Korean subjects
    Seo Young Sohn, Hyung Doo Park, Soo Youn Lee, Jung Han Kim, Byong Chang Jung, Hye Jeong Kim, Hye Won Jang, Kwang Won Kim, Moon Kyu Lee, Yong Ki Min, Jae Hyeon Kim
    Endocrine Journal.2012; 59(9): 831.     CrossRef
  • Characterization of Incidentally Detected Adrenal Pheochromocytoma
    Ye An Kim, Yul Hwangbo, Min Joo Kim, Hyung Jin Choi, Je Hyun Seo, Yenna Lee, Soo Heun Kwak, Eu Jeong Ku, Tae Jung Oh, Eun Roh, Jae Hyun Bae, Jung Hee Kim, Kyoung Soo Park, Seong Yeon Kim
    Endocrinology and Metabolism.2012; 27(2): 132.     CrossRef
  • The Evaluation and Follow-up of Adrenal Incidentaloma
    Sin Gon Kim, Dong Seop Choi
    Journal of Korean Endocrine Society.2007; 22(4): 257.     CrossRef
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A Case of Tumor-induced Osteomalacia with Elevated Fibroblast Growth Factor-23.
Hae Sung Kim, Hyun Seung Jung, Hee Jung Kim, Sung Yeon Kim, Sang Wan Kim, Chan Soo Shin, Chong Jai Kim, Seong Yeon Kim
J Korean Endocr Soc. 2007;22(2):142-148.   Published online April 1, 2007
DOI: https://doi.org/10.3803/jkes.2007.22.2.142
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AbstractAbstract PDF
Tumor-induced osteomalacia (TIO), a paraneoplastic disease, is characterized by hypophosphatemia, and caused by renal phosphate wasting inappropriately, normal or decreased 1, 25(OH)2D3 production, and defective calcification of cartilage and bone. Because the removal of the responsible tumor normalizes phosphate metabolism, unidentified humoral phosphaturic factors (phosphatonin) are believed to be responsible for this syndrome. These factors include fibroblast growth factor (FGF)-23, secreted frizzled-related protein-4 and matrix extracellular phosphoglycoprotein. However, no case of TIO producing FGF-23 has been clearly reported in Korea. Herein, a case of TIO producing FGF-23 in a 45-year-old woman is reported. The patient presented with a large tumor on her buttock, with severe bone and muscle pain. A histological examination of the tumor revealed a mixed connective tissue tumor, consisting of deposition of calcified materials and surrounding primitive spindle cells, with prominent vascularity. Whether FGF-23 is a secreted factor, as well as its levels of expression in tumors were investigated. An immunohistochemical study showed the tumor cells to be FGF-23 positive. Furthermore, the levels of serum FGF-23 were extremely high and an RT-PCR analysis, using total RNA from the tumor, revealed the abundant expression of FGF-23 mRNA. After removal of the tumor, all the biochemical and hormonal abnormalities disappeared, with marked symptomatic improvement.

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    Journal of Rhinology.2017; 24(1): 8.     CrossRef
  • Dietary assessment according to frequency of food consumed away from home among children and adolescents: Based on the 2010~2012 Korea National Health and Nutrition Examination Survey
    Yong-Suk Kwon, Wan-Soo Hong, Seyoung Ju
    Journal of Nutrition and Health.2016; 49(6): 471.     CrossRef
  • Dyslipidemia in Children and Adolescents: When and How to Diagnose and Treat?
    Jung Min Yoon
    Pediatric Gastroenterology, Hepatology & Nutrition.2014; 17(2): 85.     CrossRef
  • Length and Volume of Morphologically Normal Kidneys in Korean Children: Ultrasound Measurement and Estimation Using Body Size
    Jun-Hwee Kim, Myung-Joon Kim, Sok Hwan Lim, Jieun Kim, Mi-Jung Lee
    Korean Journal of Radiology.2013; 14(4): 677.     CrossRef
  • Factors Influencing Obesity among Adolescent: Analysis of 2011 Korean Youth Risk Behavior Survey
    Young-Ju Jee, Young-Hae Kim
    The Korean Journal of Obesity.2013; 22(1): 39.     CrossRef
  • A Case of Nutritional Osteomalacia in Young Adult Male
    Choong-Kyun Noh, Min-Jeong Lee, Bu Kyung Kim, Yoon-Sok Chung
    Journal of Bone Metabolism.2013; 20(1): 51.     CrossRef
  • The Relationship between High Energy/Low Nutrient Food Consumption and Obesity among Korean Children and Adolescents
    Gyu Jin Heo, So-Young Nam, Soo-Kyung Lee, Sang-Jin Chung, Ji hyun Yoon
    Korean Journal of Community Nutrition.2012; 17(2): 226.     CrossRef
  • Changes in Prevalence of Obesity and Underweight among Korean Children and Adolescents: 1998-2008
    Ki Eun Kim, Shin Hye Kim, Sangshin Park, Young-Ho Khang, Mi Jung Park
    The Korean Journal of Obesity.2012; 21(4): 228.     CrossRef
  • A new age-based formula for estimating weight of Korean children
    Jungho Park, Young Ho Kwak, Do Kyun Kim, Jae Yun Jung, Jin Hee Lee, Hye Young Jang, Hahn Bom Kim, Ki Jeong Hong
    Resuscitation.2012; 83(9): 1129.     CrossRef
  • Lipid Profiles and Prevalence of Dyslipidemia in Korean Adolescents
    Shin Hye Kim, Byung Chul Ahn, Hyojee Joung, Mi Jung Park
    Endocrinology and Metabolism.2012; 27(3): 208.     CrossRef
  • Trends in obesity among Korean children using four different criteria
    Young-Ho Khang, Mi Jung Park
    International Journal of Pediatric Obesity.2011; 6(3-4): 206.     CrossRef
  • Usefulness of the Waist Circumference-to-Height Ratio in Screening for Obesity in Korean Children and Adolescents
    Joo Hyun Gil, Mi Na Lee, Hye Ah Lee, Hyesook Park, Jeong Wan Seo
    Korean Journal of Pediatric Gastroenterology and Nutrition.2010; 13(2): 180.     CrossRef
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A Case of Aortic Dissection Associated with Cushing's Syndrome.
Soo Heon Kwak, Eun Jung Lee, Sun Wook Cho, Hyung Jin Choi, Eun Kyung Lee, Young Min Cho, Seong Yeon Kim
J Korean Endocr Soc. 2006;21(6):556-559.   Published online December 1, 2006
DOI: https://doi.org/10.3803/jkes.2006.21.6.556
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AbstractAbstract PDF
Herein is reported the case of a 43-year-old woman, who experienced an acute aortic dissection associated with underlying Cushing's syndrome. The patient had central obesity and a moon face of ten years duration, but had never sought medical consultation. On the day of her presentation, she experienced a severe chest pain radiating to her back. Computed tomography revealed a Stanford type B acute aortic dissection and a left adrenal mass. From her hormonal study results, clinical symptoms and signs, she was diagnosed with Cushing's syndrome, which was due to a left adrenal adenoma. After medical treatment to stabilize the aortic dissection, she underwent left adrenalectomy. The aortic lesion of the present patient suggests that hypercortisolemia arising from Cushing's syndrome might be related to the development of acute aortic dissection.
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Cystic Insulinoma of the Pancreas.
Sun Wook Cho, Eun Jung Lee, Soo Heon Kwak, Young Min Cho, Chan Soo Shin, Kyong Soo Park, Seong Yeon Kim, Bo Youn Cho, Hong Kyu Lee
J Korean Endocr Soc. 2006;21(6):552-555.   Published online December 1, 2006
DOI: https://doi.org/10.3803/jkes.2006.21.6.552
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AbstractAbstract PDF
Cystic islet cell neoplasms are among the rarest entities in the differential diagnosis of cystic tumor of the pancreas, and this malady raises difficult clinical problems. The diagnosis of insulinoma could be difficult if the functional activity is incomplete, which possibly leads to blunted symptoms of hypoglycemia and failure in the laboratory to provide evidence of hyperinsulinemia. Furthermore, if the imaging shows a smaller tumor than usual or an unusual morphology like cyctic tumor, then physicians can become somewhat confused. We report here on a clinical case of cystic insulinoma with the typical neuroglycopenic symptoms and laboratory-confirmed hyperinsulinemia. At resection, a 2-cm cavitary mass without central necrosis was excised and this was confirmed histologically as a purely cystic insulioma. This is the first report of a functional cystic insulinoma of the pancreas in Korea. We suggest that the differential diagnosis of endocrine tumor must be considered for any pancreatic cyst, and especially when it is discovered in a patient who is clinically suggestive of having the associated syndrome.
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Retrospective Observation of Long-Term Clinical Courses of Idiopathic Central Diabetes Insipidus in Adults.
Hee Joung Kim, Mi Yeon Kang, Kyung Won Kim, Hyun Seung Jeong, Hae Sung Kim, Sang Wan Kim, Seong Yeon Kim
J Korean Endocr Soc. 2006;21(6):482-489.   Published online December 1, 2006
DOI: https://doi.org/10.3803/jkes.2006.21.6.482
  • 1,661 View
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  • 1 Crossref
AbstractAbstract PDF
BACKGROUND
Idiopathic central diabetes insipidus (CDI) can be diagnosed when it occurs in the absence of a genetic or secondary cause known to be responsible for diabetes insipidus (DI). Some studies have reported that idiopathic CDI in adults shows a more benign clinical course than in children and young patients. However, the clinical characteristics and progress of this disorder have not been fully described. Therefore, we investigated the clinical courses of adult patients over the age of sixteen years with idiopathic central DI. METHODS: We reviewed the medical records of all patients who had documented cases of idiopathic CDI from 1989 to 2005, and studied clinical features, hormone data, and imaging studies at diagnosis and during at least 1-year of follow-up. RESULTS: There were 9 male (30.0%) and 21 female (70.0%) patients with a mean age of 39.3 years at diagnosis and a mean follow-up duration of 6.9 years. At diagnosis, deficits in anterior pituitary hormones were documented in 6 patients (20%), hyperprolactinemia in 4, and hypogonadism in 2. Two patients had an anterior pituitary hormone deficiency that was newly detected at a mean 3.4 years after the onset of DI. On initial MRI, the posterior pituitary was not hyperintense in 7 of the 30 patients (23.3%), but pituitary stalk thickening was observed in 15 (50.0%). After a mean follow-up of 6.9 years (range: 1 to 18), follow-up pituitary MRI showed improvement or no changes in patients with initial MRI findings of a pituitary abnormality, and no development of new lesions in 7 patients with a normal pituitary finding on initial MRI. CONCLUSION: Two of the 30 patients with idiopathic CDI developed an anterior pituitary hormone deficiency during follow-up, but no subject showed any aggravation on follow-up MRI. No patient showed a newly developed pituitary abnormality on follow-up MRI after a negative finding on the initial MRI.

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  • Central Diabetes Insipidus Surmised as from Post-obstructive Diuresis after Decompression Treatment for Neurogenic Bladder
    Kang-Woo Lee, Chul-Woo Yang, Dong-Jun Lim, Hyuk-Sang Kwon, Mi-Ja Kang, Eun-Sook Kim, Kun-Ho Yoon, Ho-Young Son, Bong-Yun Cha
    Journal of Korean Endocrine Society.2009; 24(2): 144.     CrossRef
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Evaluation and Treatment of Adult Growth Hormone Deficiency: An American Endocrine Society Clinical Practice Guideline.
Sung Woon Kim, Yoon Sok Chung, Eun Jig Lee, Seong Yeon Kim
J Korean Endocr Soc. 2006;21(6):460-475.   Published online December 1, 2006
DOI: https://doi.org/10.3803/jkes.2006.21.6.460
  • 1,758 View
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  • 1 Crossref
AbstractAbstract PDF
No abstract available.

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  • Reassessment of GH Status and GH Therapy in Adults with Childhood-onset GHD: Transitional Care from Adolescence to Adulthood
    Jin-Ho Choi, Han-Wook Yoo
    Journal of Korean Society of Pediatric Endocrinology.2011; 16(1): 1.     CrossRef
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A Case of Adrenocortical Carcinoma showing Variable Cortisol Production during the Clinical Course.
Yun Hyi Ku, Hyung Jin Choi, Jin Taek Kim, Ji Won Yoon, Eun Kyung Lee, Hwa Young Cho, Mi Yeon Kang, Jie Seon Lee, Young Min Cho, Seong Yeon Kim
J Korean Endocr Soc. 2006;21(5):419-423.   Published online October 1, 2006
DOI: https://doi.org/10.3803/jkes.2006.21.5.419
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AbstractAbstract PDF
Patients with adrenocortical carcinoma (ACC) present with evidence of excessive adrenal steroid hormone in approximately 60% of cases, in which rapidly progressing Cushing's syndrome with or without virilization is the most frequent presentation. Some patients experience an increase or a decline in cortisol production through the progression of their ACC. We report on an unusual case of a cortisol-producing ACC, and the patient presented with a decline in cortisol production, followed by an increase in cortisol production, through the progression of the tumor. A 65-year-old woman who manifested with facial edema and weight gain was diagnosed with Cushing's syndrome, caused by cortisol producing ACC. The patient was treated with adrenalectomy. However, 8 months later, a metastatic hepatic tumor of recurred ACC was detected. At that time, the hormonal evaluation revealed that the liver mass did not produce any hormones. The patient was treated with metastatectomy. Four months later, a relapsed tumor was detected. Increased cortisol production was observed at that time. We speculate there was a change in the clonal dominance within the ACC and this change might cause such a difference. This is the first case report of ACC that showed variable hormone production during progression.
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A case of Paraganglioma Arising in the Transverse Mesocolon.
Hong Il Kim, Bo kyung Koo, You Jin Lee, Jin Taek Kim, Young Min Cho, Kuhn Uk Lee, Seong Yeon Kim
J Korean Endocr Soc. 2005;20(5):496-501.   Published online October 1, 2005
DOI: https://doi.org/10.3803/jkes.2005.20.5.496
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  • 1 Crossref
AbstractAbstract PDF
Herein, a case of a solitary primary paraganglioma arising in the mesentery, found in a hypertensive 70-year-old woman, who presented with nausea and postprandial abdominal discomfort, is reported. Ultrasonography and computed tomography showed a hypervascular mass abutting the second portion of the duodenum. An exploratory laparotomy revealed a 5.5 x 5.3 x 5cm sized mass in the mesentery of the transverse colon, which was histologically proven to be a paraganglioma. No intraoperative hemodynamic changes developed, and the postoperative course was uneventful. To our knowledge, this is the first case of a paraganglioma arising in the mesentery reported in Korea. Considering the unusual locations and the associated operative risk, it is necessary to rule out the possibility of a functioning paraganglioma in the preoperative differential diagnosis of an abdominal mass.

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  • Mesenteric Lesions with Similar or Distinctive Appearances on CT
    Hwajin Cha, Jiyoung Hwang, Seong Sook Hong, Eun Ji Lee, Hyun-joo Kim, Yun-Woo Chang
    Journal of the Korean Society of Radiology.2019; 80(6): 1091.     CrossRef
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The Effects on Visceral Fat and Cardiovascular Risk Factors of Testosterone Replacement in Secondary Hypogonadal Men.
Eui Sil Hong, Sung Yeon Kim, Young Ju Choi, Sang Wan Kim, Chan Soo Shin, Kyong Soo Park, Hak Chul Jang, Seong Yeon Kim, Bo Youn Cho, Hong Kyu Lee
J Korean Endocr Soc. 2005;20(3):252-260.   Published online June 1, 2005
DOI: https://doi.org/10.3803/jkes.2005.20.3.252
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  • 4 Crossref
AbstractAbstract PDF
BACKGROUND
Increased body fat, abdominal obesity and insulin resistance are important clinical features in hypogonadal men. Several studies have demonstrated that a low testosterone concentration in men is associated with coronary heart disease, visceral obesity and insulin resistance. In this study, the effects of testosterone replacement therapy on the abdominal visceral fat and cardiovascular risk factors in hypogonadal men were investigated. METHODS: We selected 26 men with secondary hypogonadism (mean serum testosterone+/-SD 0.39+/- 0.57ng/mL), who were then treated with testosterone for 12 months. We measured the body composition, including the abdominal visceral fat area by abdominal CT at the L4 level, both before and 12 months after treatment, and the lipid profile, fasting plasma insulin, HOMA-IR and the serum homocysteine, CRP and IL-6 before and 6, 12 months after treatment. RESULTS: With respect to the body composition, the lean body mass had significantly increased 12 months after treatment(P= 0.002), but there were no significant changes in the body fat mass and abdominal visceral fat area. There was a trend toward a decreased fasting plasma insulin and HOMA-IR, but this did not reach statistical significance. The total cholesterol had decreased significantly at 12 months(P=0.04) and the HDL cholesterol decreased significantly over the course of study(P=0.02). There were no significant changes in the serum homocysteine, CRP and IL-6 after treatment. CONCLUSIONS: After 12 months testosterone replacement therapy in the 26 men with hypogonadism, the lean body mass had increased significantly, but there was no significant change on the abdominal visceral fat during the treatment period. Testosterone replacement had deleterious effect on HDL cholesterol, but not significant effects on insulin resistance and the serum homocysteine, CRP and IL-6. These results suggest that testosterone replacement therapy may have a few adverse effects on cardiovascular diseases in hypogonadal men. However, it will be necessary to examine the long-term effects of testosterone replacement on the incidence of cardiovascular events as well as the cardiovascular risk factors in men with hypogonadism

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  • The Association of Level of Testosterone and Parameters of Obesity
    Chong Hwa Kim
    The Korean Journal of Obesity.2015; 24(1): 28.     CrossRef
  • The Relationship between Various Obesity Indices and Level of Male Hormone according to Different Age Groups
    Yoo-Jung Lee, Hyeon-Ju Kim, Mi-Hee Kong
    The Korean Journal of Obesity.2014; 23(4): 245.     CrossRef
  • Androgen Receptor Gene CAG Repeat Polymorphism and Effect of Testosterone Therapy in Hypogonadal Men in Korea
    Min Joo Kim, Jin Taek Kim, Sun Wook Cho, Sang Wan Kim, Chan Soo Shin, Kyong Soo Park, Seong Yeon Kim
    Endocrinology and Metabolism.2011; 26(3): 225.     CrossRef
  • Effects of Androgen on the Cardiovascular System in the Aging Male
    Jin Wook Kim, Je Jong Kim, Du Geon Moon
    Korean Journal of Andrology.2011; 29(1): 10.     CrossRef
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The Clinical Characteristics of Macroprolactinemia.
Young Ju Choi, Jun Goo Kang, Sung Yeon Kim, Eui Sil Hong, Sang Wan Kim, Chan Soo Shin, Seong Yeon Kim, Bo Youn Cho, Hong Kyu Lee
J Korean Endocr Soc. 2005;20(3):216-223.   Published online June 1, 2005
DOI: https://doi.org/10.3803/jkes.2005.20.3.216
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AbstractAbstract PDF
BACKGROUND
Prolactin has been identified by gel chromatography to exist is three different forms in human serum; monomeric prolactin(molecular mass 23kDa), big prolactin (molecular mass 50~60 kDa) and big big prolactin, otherwise known as macroprolactin(molecular mass 150~170kDa). The predominance of macroprolactinemia has long been known in idiopathic hyperprolactinemic patients with maintained fertility. In recent reports, 24% of microprolactinoma patients showed no menstrual disturbances, which was suggestive of macroprolactinemia. The purpose of this study was to evaluate: (1) the frequency of macroprolactinemia among idiopathic hyperprolactinemia and prolactinoma patients, (2) the difference in the clinical characteristics between hyperprolactinemia, with and without macroprolactinemia, among idiopathic hyperprolactinemia and prolactinoma patients, and (3) the follow-up prolactin level using the bromocriptine response. METHODS: We retrospectively analyzed the clinical characteristics and prolactin levels in 43 idiopathic hyperprolactinemia and 51 prolactinoma patients with a poor bromocriptine response. Macroprolactinemia was identified by the prolactin recovery of < 40% using the polyethylene glycol(PEG) precipitation test. RESULTS: (1) Of the 43 idiopathic hyperprolactinemia and 51 prolactinoma patients, 17(39.5%) and 9(17.6%), respectively, were macroprolactinemic(P<0.05). (2) Among the idiopathic hyperprolactinemia patients, galactorrhea combined with amenorrhea was significantly less frequent (P<0.05), with the 1- and 2-year follow-up prolactin levels being significantly higher in those with macroprolactinemia than monomeric prolactinemia(P<0.05). (3) Among the prolactinoma patients, amenorrhea was significantly less frequent(P<0.05), but asymptomatic cases were more frequent in those with macroprolactinemia than monomeric prolactinemia(P <0.05). The 1- and 2-year follow-up prolactin levels were significantly higher in those with macroprolactinemia than monomeric prolactinemia(P<0.05). CONCLUSION: The screening of macroprolactinemia should be considered in idiopathic hyperprolactinemia and prolactinoma patients with a poor bromocriptine response
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A Case of Primary Reninism Manifested by Hypertension with Hypokalemia.
Hyung Jin Choi, Eui Sil Hong, Young Min Cho, Do Joon Park, Chan Soo Shin, Kyong Soo Park, Seong Yeon Kim, Bo Youn Cho, Hong Kyu Lee
J Korean Endocr Soc. 2005;20(2):168-173.   Published online April 1, 2005
DOI: https://doi.org/10.3803/jkes.2005.20.2.168
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AbstractAbstract PDF
Primary reninism is a rare cause of hypertension manifesting along with hypokalemia. A high level of plasma renin activity and a high level of serum aldosterone are the whole markers of primary reninism. Upon making the diagnosis of primary reninism, other more common causes of aldosteronism must be differentiated, such as renovascular hypertension and primary aldosteronism. Primary reninism is commonly caused by juxtaglomerular cell tumor, which is one of the curable causes of hypertension, and this can be successfully treated by conservative surgery. We report here on a case of primary reninism that was caused by juxtaglomerular cell tumor that developed in a 22-year-old female patient. She was recently diagnosed with hypertension and hypokalemia. She had markedly elevated plasma renin activity and an increased serum aldosterone concentration. Computed tomography revealed a mass located in the right kidney and selective renal vein sampling suggested that the mass was secreting an excess of renin. Right nephrectomy was done and her hypertension with hypokalemia was successfully treated. We report here a case of primary reninism that presented with juxtaglomerular cell tumor along with a review of the literature

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  • Reninoma: a rare cause of curable hypertension
    Ji Hye Kim, Ji Hyun Kim, Myung Hyun Cho, Eujin Park, Hye Sun Hyun, Yo Han Ahn, Hee Gyung Kang, Kyung Chul Moon, Il-Soo Ha, Hae Il Cheong
    Korean Journal of Pediatrics.2019; 62(4): 144.     CrossRef
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High-Dose Hook Effect in Patients with Macroprolactinoma.
Sung Yeon Kim, Chul Gu Park, Young Ju Choi, Eui Sil Hong, Sang Wan Kim, Chan Soo Shin, Hak Chul Jang, Seong Yeon Kim, Bo Youn Cho, Hong Kyu Lee
J Korean Endocr Soc. 2005;20(2):148-153.   Published online April 1, 2005
DOI: https://doi.org/10.3803/jkes.2005.20.2.148
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AbstractAbstract PDF
BACKGROUND
Large amounts of antigen may produce false low values on immunoradiometric assays due to the so-called high-dose hook effect. The physicians' awareness of the possibility of the "high-dose hook effect" will prevent preoperative misdiagnosis. The study was designed to identify the frequency and clinical features of patients with pituitary macroadenomas in whom a high-dose PRL hook effect was documented. METHODS: Our retrospective study involved 42 patients with non-functioning pituitary adenomas (tumor diameter >30mm) who underwent transsphenoidal microsurgery from between Jan 1999 to Aug 2004, and 6 patients with non-functioning pituitary adenoma(tumor diameter>30mm) were selected for prospective study from Sep 2003 to Feb 2004. Our retrospective study also involved 13 patients with macroprolactinoma for the comparison of the clinical features. RESULTS: 1) The presence of a high-dose hook effect was retrospectively suggested when the PRL levels increased in 4 out of the 42 patients with non- functioning adenomas(tumor diameter >30mm) after surgery. Post-operative immunohistochemical staining of their pituitary specimens revealed the tumors to be prolactinoma. 2) Prospectively, dilution testing of the specimens obtained before surgery was done in the 6 patients, and one patient presented with a case of the hook effect. The patient's prolactin level was measured at 53.1ng/mL before dilution and this was increased up to 22,600ng/mL upon the 1:1000 dilution. 3) Conclusively, the hook effect was seen in 5 of the 48 patients(10.4%) with non-functioning pituitary adenoma(tumor diameter >30mm) 4) Compared with other 2 patient groups(the macroprolactinoma(N=13) group, and the non-functioning pituitary tumor(N=43) group), the high-dose PRL hook effect is more likely to be observed in male patients with large pituitary tumors. CONCLUSION: In order to avoid the high-dose hook effect, PRL should be assayed at 1:100~1:200 or even higher dilutions of serum from all patients(and especially the male patients) with large pituitary tumors

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  • Multiple Endocrine Neoplasia Type 1 Presenting with an Invasive Giant Prolactinoma
    Jinhoon Cha, Jin Seo Kim, Jung Suk Han, Yeon Won Park, Min Joo Kim, Yun Hyi Ku, Hong Il Kim
    The Korean Journal of Medicine.2016; 91(3): 300.     CrossRef
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A Case of Protein-losing Enteropathy with an Abnormal Cortisol Response to ACTH Stimulation.
Hong Il Kim, Bo Kyeong Koo, You Jin Lee, Eun Jung Lee, Soo Heon Kwak, Sun Wook Cho, Hyung Jin Choi, Young Min Cho, Seong Yeon Kim
J Korean Endocr Soc. 2005;20(1):90-95.   Published online February 1, 2005
DOI: https://doi.org/10.3803/jkes.2005.20.1.90
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AbstractAbstract PDF
We hereby report a case of a 62-year-old male patient who was misdiagnosed with adrenal insufficiency during the course of protein-losing enteropathy caused by superior mesenteric arterial thrombosis. The patient was suspected to have adrenal insufficiency due to hyponatremia and severe weakness. The cortisol responses to the initial challenge of 250microgram ACTH were inadequate (maximum serum cortisol level after ACTH challenge was 10.9microgram/dL), while the serum albumin concentration was 1.9g/dL. Subsequently, intravenous steroid therapy was given to the patient. However, after bowel resection, the serum albumin level increased to 3.4g/dL and the cortisol response to the follow-up rapid ACTH stimulation was completely normal. Accordingly, we discontinued steroid replacement and discharged the patient without any problem. In conclusion, measuring total serum cortisol in a patient with hypo-pro-teinemia may lead to misdiagnosis of adrenal insufficiency. In such cases, caution should be exercised in interpreting the results in terms of total serum cortisol level or measurement of serum free cortisol levels should be considered.
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The Efficacy of MIBG Scan as a Diagnostic and Docalization Test for Pheochromocytoma.
Cheol Ku Park, Kyeong Won Kim, Do Hee Kim, Jae Hyeon Kim, Jun Gu Kang, San Wan Kim, Young Min Cho, Do Joon Park, Chan Soo Shin, Kyong Soo Park, Bo Youn Cho, Hong Kyu Lee, Seong Yeon Kim
J Korean Endocr Soc. 2005;20(1):21-28.   Published online February 1, 2005
DOI: https://doi.org/10.3803/jkes.2005.20.1.21
  • 1,535 View
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AbstractAbstract PDF
BACKGROUND
Computed tomography(CT) is currently considered as the initial imaging procedure of choice for the localization of pheochromocytomas in most of the cases. 131I-or 123I-Metaiodobenzylguanidine scintigraphy(MIBG scan) was proven to be a highly specific tool for the detection of adrenal and extra-adrenal pheochromocytomas, but was less sensitive than CT. The present study is aimed to evaluate the usefulness of a MIBG scan in diagnosis and localization of pheochromocytoma when compared to CT. METHODS: We retrospectively evaluated 27 patients who underwent a MIBG scan for a pheochromocytoma at the Seoul National University Hospital from the year 2000 and 2002. According to the pathological and clinical findings, in 16 the patients pheochromocytoma was confirmed to be positive and the rest 11 of the patients were excluded from the study. RESULTS: Pheochromocytomas was identified in 16 patients. Eleven of them were localized in adrenal gland and 5 were extra-adrenal lesions. The sensitivity to MIBG scan in adrenal lesions and extra-adrenal lesions, was 72%(8/11) and 40%(2/5) respectively. In our study, the overall sensitivity to MIBG scan was 62%(10/16), and overall specificity was 90.9%(10/11). By CT four were identified to have equivocal biochemical abnormalities, but were definite and extraadrenal tumors by MIBG scan showed abnormal uptakes in two of them. CONCLUSION: The MIBG scan was especially useful in 2 of the 27 patients but we had no experienced about the additional benefits of a MIBG scan in the other 25 cases. Our results reveal that a MIBG scan should be performed carefully for the diagnosis and localization of a pheochromocytoma, while considering cost and time of operation.
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Diagnostic Value of 24-hours Urinary Total Metanephrine As a Screening Test of Patients with Suspected Pheochromocytoma.
Sang Wan Kim, Kyung Won Kim, Do Joon Park, Chan Soo Shin, Kyung Soo Park, Seong Yeon Kim, Bo Youn Cho, Hong Kyu Lee
J Korean Endocr Soc. 2005;20(1):12-20.   Published online February 1, 2005
DOI: https://doi.org/10.3803/jkes.2005.20.1.12
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BACKGROUND
A pheochromocytoma is a rare cause of secondary hypertension. Its diagnosis is important as the hypertension is usually curable by resection of the tumor, whereas the condition is potentially lethal if undetected. Biochemical confirmation of excessive catecholamine production is a prerequisite to a definitive diagnosis. Various studies from other countries have indicated that measuring of the urinary metanephrine, using a specific procedure, is the single most reliable screening test for all patients suspected of having a pheochromocytoma. However, the diagnostic value of urinary metanephrine has never been reported in Korea. We investigated the diagnostic value of 24-hours urinary metanephrine in patients with a suspected pheochromocytoma. METHODS: This was a retrospective evaluation study, which included 95 patients with sustained hypertension and paroxysmal symptoms, and 38 patients with asymptomatic adrenal incidentaloma at Seoul National University Hospital, between July 2000 and October 2002. We performed the 24- hour urinary total metanephrine test on all patients. The diagnosis of a pheochromocytoma was applied only when confirmed by pathological analysis of a resected specimen. The possibility of a pheochromocytoma was ruled out when all biochemical tests were normal, which were performed at least in duplicate, or there was no evidence of a mass in abdominal radiological studies or histological verification. We determined the upper reference limit for urinary metanephrine as 1.3mg/day and calculated the sensitivity and specificity of the 24-hour urinary metanephrine test. RESULTS: Seventeen patients were diagnosed with a pheochromocytoma. The total metanephrine measurement had sensitivities and specificities of 82.4 and 73.3% in all the patients, 90.9 and 66.7% in patients with hypertension and paroxysmal symptoms, and 66.7 and 90.6% in patients with adrenal incidentaloma, respectively. CONCLUSION: The urinary total metanephrine measurement had relatively lower sensitivities and specificities than in other countries(sensitivity: 83~100%, specificity: 80~98%). The sensitivity of urinary metanephrine was relatively high in patients with hypertension and paroxysmal symptoms, and the specificity was high in patients with an adrenal incidentaloma. We suggest that normetanephrine and metanephrine should be separately measured, and a reasonable upper reference limit be used. It may also be necessary to measure urinary metanephrine together with urinary catecholamine or VMA to improve the diagnostic value of the urinary metanephrine test.
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Renin-Angiotensin-Aldsterone System and Cardiovascular Diseases.
Seong Yeon Kim
J Korean Endocr Soc. 2004;19(6):551-572.   Published online December 1, 2004
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No abstract available.
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Relationship between Adiponectin, Leptin and Body Fat in Men with Hypogonadism Before and After Testosterone Treatment.
Sang Wan Kim, Joon Ku Kang, Do Joon Park, Chan Soo Shin, Kyung Soo Park, Seong Yeon Kim, Bo Youn Cho, Hong Kyu Lee
J Korean Endocr Soc. 2004;19(5):473-484.   Published online October 1, 2004
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BACKGROUND
Testosterone replacement therapy in men with hypogonadism improves sexual function, decreases body fat, and increases the mass and function of lean muscle. These beneficial effects of testosterone replacement therapy are accompanied by slight lowering of the high density lipoprotein (HDL) cholesterol levels, increase in the hematocrit/hemoglobin ratio and size of the prostate gland. It is presently unknown whether the effect of testosterone on body fat could also reduce the risk of atherosclerotic disease associated with obesity. We investigated the relationship between body fat and blood leptin and adiponectin levels to elucidate the effect of testosterone on body fat metabolism, as well as the effect of testosterone on lipid and bone metabolism. METHODS: We selected 28 men, who were hypogonadal (mean serum testosterone+/-SD, 22.3+/-35.3 ng/dL) due to an organic disease, and them with oral testosterone (testosterone undecanoate) for 12 months. We measured the body composition, serum leptin, plasma adiponectin, biochemical bone markers, bone mineral density, prostate-specific antigen, and serum lipids before and 3, 6 and 12 months after treatment. We analyzed the relationship between body fat and blood leptin and adiponectin levels. RESULTS: The mean serum testosterone concentration reached the subnormal range after 6 months of treatment, which remained for the duration of treatment. The fat mass decreased and muscle mass increased, not within the first 6 months, but principally within 12 months (p<0.05). Although the decrease in the serum leptin level was not statistically significant, there were positive correlations between the leptin level and fat mass before and after 6 months of treatment (p<0.05). The plasma adiponectin did not increase or correlate with body fat parameters. The bone mineral densities of the lumbar spine (L2-L4) and femoral neck did not increased, but the serum osteocalcin and urine N-telopeptide were significantly decreased (p<0.05 and <0.01, respectively). The HDL-cholesterol decreased, principally within the first 6 months (p<0.01), but the total and LDL cholesterols, and the triglycerides remained unchanged during the course of treatment. There was also no change in prostate-specific antigen. CONCLUSION: Twelve months of oral testosterone replacement in men with hypogonadism improved body composition and bone metabolism, but demonstrated subnormal serum testosterone levels, had no effect on the leptin and adiponectin levels and decrease in HDL-cholesterol levels. It will be necessary to examine the long-term effects of testosterone replacement on the incidence of cardiovascular events as well as cardiovascular risk factors in men with hypogonadism
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The Aging-related Change of Responses to TSH in Thyroid Cells.
Young Joo Park, Tae Yong Kim, Ji Eun Kim, Young Cheol Kim, In Kyeong Chung, Chan Soo Shin, Do Joon Park, Kyoung Soo Park, Seong Yeon Kim, Sang Chul Park, Hong Kyu Lee, Bo Youn Cho
J Korean Endocr Soc. 2004;19(2):141-151.   Published online April 1, 2004
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BACKGROUND
To understand the mechanism of aging-related changes of the thyroid, the differentiated functions and growth of thyroid cells in response to TSH were investigated using aged or young thyrocytes. METHODS: FRTL-5 cells, with less than 10 or more than 45 passages, were used. After treatment with 1 U/L TSH or 1-100 mM NaI, the cAMP generation, iodide uptake, cellular proliferation or the expression of NIS mRNA or protein were measured. Sprague-Dawley rats were sacrificed at 5 and 16 weeks and 23 months, and their thyroids used for Northern blot analysis or immunohistochemistry of NIS. RESULTS: There were no differences in cAMP generation, iodide uptake, the proportions of G1/M or S phase, or intracellular DNA contents between the young and aged cells at basel levels. After TSH stimulation, these were increased in dose-dependent manners, with larger increments in the young cells. The changes in the NIS mRNA expression were similar in both the young and aged cells, but to a greater extent in the young cells. A similar phenomenon was observed in rat. However, the amount or intracellular distribution of NIS protein was not different. There was also no difference in the function or expression of NIS after treatment with a high dose of iodide. CONCLUSION: The aging-related decrease in the generation of cAMP might be thought of as one of the mechanisms of the decrement of iodide uptake or cellular proliferation with aging. The decreased expression of NIS mRNA seems to be the most important mechanism for the decreased iodide uptake capacity
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Diagnostic Value of 1microgram Rapid ACTH Stimulation Test According to the Timing of Sampling of Serum Cortisol in Patients with Suspected Central Adrenal Insufficiency.
Sang Wan Kim, Young Min Cho, Do Joon Park, Chan Soo Shin, Kyung Soo Park, Seong Yeon Kim, Bo Youn Cho, Hong Kyu Lee
J Korean Endocr Soc. 2004;19(1):33-41.   Published online February 1, 2004
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BACKGROUND
Traditional testing of the hypothalamic-pituitary-adrenal axis function has essentially relied upon the insulin tolerance test or the metyrapone test(both tests are not only uncomfortable, but are also dangerous). The standard ACTH stimulation test uses an extremely supra-physiologic amount(250f microgram) of ACTH to evaluate a physiological response, which may result in a false normal response. The 1microgram rapid ACTH stimulation test is more physiological and more sensitive than the standard test, but there exist much controversy about when the serum cortisol should be measured or what the most appropriate cut-off point is for normality or whether the 1microgram ACTH commercial solution is needed. The aims of this study were to investigate 1) whether 1microgram of ACTH is an appropriate amount to stimulate the adrenal gland of patients that have suspected central adrenal insufficiency compared with insulin tolerance test(ITT) and 2) the diagnostic value of the 1microgram rapid ACTH stimulation test according to timing of sampling of serum cortisol. METHODS: In order to evaluate the dose-response relationship between ACTH and cortisol, we performed the ITT in 77 patients with suspected central adrenal insufficiency with serial measurements of serum cortisol and plasma ACTH. We drew the blood samples in 10 min intervals between 10 and 60 min after the administration of 1microgram ACTH in 39 patients with central adrenal insufficiency and in 38 pituitary control patients with pituitary. ITT was used to confirm the diseases for the patients of central adrenal insufficiency, but for pituitary control patients, the ITT indicated normality in the patients. Also, all subjects underwent the 250microgram rapid ACTH stimulation test, and we compared the diagnostic value of the 1microgram ACTH stimulation test with the 250microgram test. RESULTS: 1) The plasma ACTH level after the 1microgram ACTH stimulation test, even if it was be assumed as approximately 300pg/mL, was expected to be sufficient enough to stimulate the adrenal cortex normally(serum cortisol levels >18microgram/dL) compared to the plasma ACTH level in the ITT. 2) The sensitivity and specificity of the 1microgram rapid ACTH stimulation test was highest with 92.3% and 84.2%, respectively, when serum cortisol levels were measured at 20, 30, and 40 min after the ACTH injection. The 1microgram rapid ACTH stimulation test was more sensitive than the 250microgram ACTH test(sensitivity: 92.3%, specificity: 71.8%). CONCLUSION: The 1microgram rapid ACTH stimulation test was more sensitive test in patients with suspected central adrenal insufficiency, and blood samples for cortisol levels should be drawn at 20, 30, and 40 min after ACTH administration.
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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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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.
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Crosstalk Between cAMP and Phosphoinositide System in Signal Transduction Pathways Through TSH Receptor.
Byung Sool Moon, Young Joo Park, Seong Yeon Kim, Bo Youn Cho, Hong Kyu Lee, Do Joon Park
J Korean Endocr Soc. 2003;18(4):404-413.   Published online August 1, 2003
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BACKGROUND
TSH stimulates both the adenyl cyclase and phospholipase C (PLC) pathways by binding to a single cell surface receptor that is coupled to G protein, and we examined crosstalk between these two signaling pathways. METHODS: FRTL-5 rat thyroid cells were grown in 6H medium, then incubated with 5H medium before the stimulation. Then cells were incubated for 24 hours with 5H mix containing 1 mCi/L myo-(2-N-3H) inositol. After pretreatment of 100 microM Rp-cAMP, 100 microM forskolin, 50 nM staurosporine, or 100 nM PMA (phorbol-12-myristate-13-acetate), TSH were added in different experiments. After 30 min at 37 degrees C, cells were disrupted and IP formation was determined. RESULTS: Stimulation with 100 microU/mL TSH resulted in a 1.65 fold increase in IP generation. In pursuing the possibility that the two post-receptor events might be linked in some way, we examined the effect of exogenously administrated Rp-cAMP, protein kinase A antagonist, and forskolin, a direct stimulant of protein kinase A, on IP generation achieved at a dose of 100 microU/mL TSH. The pretreatment of 100 M Rp-cAMP at a concentration sufficient to inhibit protein kinase A enhanced TSH-induced IP production. This effect of Rp-cAMP was dose-dependent. Forskolin attenuatedTSH-stimulated increases in phosphatidylinositide turnover. PMA, a protein kinase C (PKC) activator and staurosporine, a PKC inhibitor did not affect TSH-induced IP generation. CONCLUSION: These data suggested that activation of adenylate cyclase/cAMP post-receptor signalling casacde, which results in the protien kinase A activation, has an inhibitory effect on IP turnover activated by TSH.
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Interaction of Pituitary Adenylate Cyclase-Activating Polypeptide and Angiotensin II on Aldosterone Production in Human Adrenocortical H295R Cells.
Seong Yeon Kim, Sang Wan Kim, Young Min Cho, Do Joon Park, Chan Soo Shin, Kyung Soo Park, Bo Youn Cho, Hong Kye Lee
J Korean Endocr Soc. 2003;18(3):272-282.   Published online June 1, 2003
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BACKGROUND
Evidence is accumulating that aldosterone secretion can be regulated in a paracrine and/or an autocrine manner by several neuropeptides locally released within the adrenal gland. Among neuropeptides, pituitary adenylate cyclase-activating polypeptide (PACAP) is present in high concentration in the human adrenal gland. The purpose of this study was to investigate the action of PACAP and the interaction between PACAP and angiotensin II (AII), the main physiologic aldosterone secretagogue, in aldosterone production in human H295R adrenocortical cells. METHODS: H295R cells were incubated with increasing concentrations of PACAP (10(-11)M~10(-7)M) in the absence or presence of 10(-7)M AII. Aldosterone concentration in the supernatant was determined by RIA. Intracellular cAMP content was measured by RIA and total inositol phosphate (IP) production by anion exchange chromatography. Gene expression of CYP11B2 was studied by RT-PCR. RESULTS: In H295R cells, PACAP stimulated aldosterone production in a dose-dependent manner. Incubation of H295R cells with PACAP in the presence of AII significantly increased aldosterone production, compared with that of PACAP alone. PACAP dose-dependently increased cAMP production, but 10(-7)M AII had no effect on either basal or PACAP-stimulated cAMP production. Total IP production was not affected by PACAP, but was increased by 10(-7)M AII; an increase that was not further increased by addition of PACAP. RT-PCR analysis of H295R cells which were exposed to 10-7M PACAP or 10(-7)M AII showed an increase in CYP11B2 transcript signal. Induction of CYP11B2 mRNA expression in response to treatment with both PACAP and AII was significantly more than that resulting from using PACAP alone. CONCLUSION: The present study demonstrates that PACAP exerts a direct stimulatory effect on aldosterone production through induction of CYP11B2 mRNA expression by adenylate cyclase activation as the main intracellular signal pathway in H295R cells. Furthermore, there may be some additive effects between PACAP and AII on aldosterone production.
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A Case of Syndrome of Resistance to Thyroid Hormone Associated with Mutation(M313T) in Thyroid Hormone Receptor Beta Gene.
Jae Kyung Hwang, Kyung Won Kim, Tae Yong Kim, Sang Wan Kim, Young Joo Park, Do Joon Park, Seong Yeon Kim, Hong Kyu Lee, Bo Youn Cho
J Korean Endocr Soc. 2003;18(2):206-213.   Published online April 1, 2003
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Syndrome of resistance to thyroid hormone(RTH) is inherited by an autosomal dominant trait, and characterized by elevated thyroid hormone levels with reduced responsiveness of the pituitary and peripheral tissues to thyroid hormone action. All of the reported RTH patients have various mutations in the ligand-binding domain coding region of the thyroid hormone receptor beta gene. A 21-year-old man visited our hospital complaining of fatigue. He had mild thyroid goiter and intermittent palpitation. Thyroid function test showed elevated total T3, free T4, and TSH levels. Levels of TSH free a-subunit and basal pituitary hormones, except prolactin, were normal. MRI of the sellar region showed no abnormal finding. TSH response to TRH stimulation was normal, and TSH values to TRH stimulation after T3 suppression revealed partial response. Sequeuce analysis of the thyroid hormone receptor beta gene confirmed a heterozygous missense mutation in exon 9; and the amino acid alteration was a substitution of a threonine(ACG) for a methionine(ATG) at codon313. Sequeuce analysis of the parents showed no mutation.We report the first case of a man with RTH caused by a de novo mutation(M313T) in TRbeta gene, confirmed by sequeuce analysis.
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A Case of Multiple Endocrine Neoplasia Type 2B associated with a M918T Mutation in RET Proto-Oncogene.
Tae Yong Kim, Jae Kyung Hwang, Min Kyong Moon, Young Joo Park, Do Joon Park, Seong Yeon Kim, Hong Kyu Lee, Yo Kyu Yoon, Bo Youn Cho
J Korean Endocr Soc. 2003;18(1):85-93.   Published online February 1, 2003
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A multiple endocrine neoplasia type 2B(MEN2B) is the most distinct and aggressive form of the MEN type 2 variants. We report a case of a 24-years-old woman with MEN2B. The patient had previously undergone a Duhamel's operation due to a megacolon at 6 years old, minor surgery to remove small tumors on the lip at 8 years old, and a bilateral osteotomy of the femur, due to coxa valga, at 15 years old. She underwent a total thyroidectomy and neck dissection, due to a growing thyroid nodule, despite thyroxine treatment, at 19 years old. The pathology revealed a medullary thyroid carcinoma. There was no history of MEN 2B in her family. She had prominent lips, multiple oral mucosal masses, and marfanoid habitus. During the subsequent follow-up, a positron emission tomogram was taken due to a persistently high level of serum calcitonin, despite repeated neck dissections, which revealed a mass in the right adrenal gland. Adrenomedullary function tests showed high levels of urinary catecholamine metabolites, and a genetic analysis of the peripheral leukocyte showed a codon 918 mutation (Met918Thr) at exon 16 of the RET proto-oncogene. The patient underwent a right adrenalectomy and the pathology revealed a pheoch-romocytoma.
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Regulatory Mechanism of p66 Shc Expression by TSH in FRTL-5 Cells.
Young Joo Park, Eun Shin Park, Tae Yong Kim, Yun Yong Lee, Seon Hwa Lee, Do Joon Park, Chan Soo Shin, Kyoung Soo Park, Seong Yeon Kim, Hong Kyu Lee, Bo Youn Cho
J Korean Endocr Soc. 2003;18(1):45-55.   Published online February 1, 2003
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BACKGROUND
Thyroid goiters are very common, however, the mechanism of development is not fully understood. A TSH receptor has been known to activate two different signaling pathways the cAMP/protein kinase A(PKA) and phospholipase C(PLC)/protein kinase C(PKC) systems. However, both systems are limited in the degree to which they explain the discrepancy between a goiter and TSH receptor activation. It has recently been reported that the expression of p66 Shc was increased by TSH stimulation in thyrocytes, suggesting that the p66 Shc molecule may play a critical role in the transition of the TSH-induced growth signals. METHODS AND RESULTS: In this study, we examined the expression of p66 Shc by stimulation of TSH, and the regulatory mechanisms of the TSH-induced expression of the p66 Shc in FRTL-5 cells. In FRTL-5 cells, TSH could increase the expression of the p66 Shc, and the this expression was decreased to basal levels after the removal of TSH. The TSH-induced p66 Shc expression was competitively inhibited by TSH receptor blocking antibodies. The increments of the expression of the p66 Shc protein caused by TSH were both time and concentration dependent, and it was same in the mRNA levels. Cholera toxin increased the expression of the p66 Shc, while pertussis toxin did not. The activators of the cAMP/PKA pathway (8-bromo-cAMP and forskolin) also stimulated the expression of p66 Shc, and the PKA inhibitor H89 decreased the expression, while the inhibition of the PKC pathway by GF109203X, or PMA, affected the expression of p66 Shc very little. CONCLUSION: Our data suggests that p66 Shc may play an important role in regulating the growth of thyrocytes. The TSH receptor - Gs protein - adenylate cyclase - cAMP - PKA pathway mainly mediates the TSH effects on the expression of p66 Shc molecules.
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Vitamin D Receptor Gene 3' End Polymorphisms in Patients with Graves' Disease in Koreans.
Jae Kyung Hwang, Kyung Won Kim, Tae Yong Kim, Hui Su Lee, Young Joo Park, Chan Soo Shin, Do Joon Park, Kyong Soo Park, Byung Doo Rhee, Seong Yeon Kim, Hong Kyu Lee, Bo Youn Cho
J Korean Endocr Soc. 2003;18(1):12-23.   Published online February 1, 2003
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BACKGROUND
The aim of this study was to evaluate the association of vitamin D receptor (VDR) gene polymorphisms with Graves' disease in Koreans. We also investigated the association of VDR gene polymorphisms with the clinical characteristics and titers of TSH receptor antibodies in patients with Graves' disease. SUBJECTS AND METHODS: The VDR gene polymorphisms were evaluated in 117 patients with Graves' disease and 156 normal controls. The polymorphisms were represented according to restriction fragment length polymorphism; Aa(ApaI), Bb(BsmI) and Tt(TaqI), with the capital letters signifying the absence, and small letters the presence of restriction sites. RESULTS: The distribution of the ApaI polymorphism genotype was: AA(17.1%), Aa(50.4%) and aa(32.5%). The BsmI polymorphism genotype distribution was: BB(7.1%), Bb(35.4%) and bb(57.5%); and the TaqI polymorphism genotype distribution was: TT(92.6%), Tt(6.2) and tt(1.2%). No significant differences in either genotypic or allelic distributions were observed, between the patients with Graves' disease and the normal controls, associated with the VDR gene polymorphisms. No significant differences were observed with age, sex, size of goiter or the presence of ophthalmopathy, in patients with Graves' disease associated with the VDR gene polymorphisms. However, the titers of the TBII were significantly higher in the aa than the Aa genotype, and were also higher in the group without the A allele than in groups with(aa 55.9+/-18.3 vs. Aa 43.2+/-23.4, p<0.05; aa 55.9+/-18.3 vs. AA and Aa 42.9+/-23.5, p<0.05). Thyroid stimulating antibodies measured with a CHO cell transfected with a wild type of human TSH receptor, were also higher in patients without the A allele than in those with(aa 620+/-829 vs. AA and Aa 353+/-306, p<0.05). The titers of the anti-thyroglobulin antibodies were significantly higher in the groups not containing the B allele than in the group that did(bb 50.9+/-42.8 vs. BB and Bb 31.9+/-38.9, p<0.05). The serum alkaline phosphatase activities were higher in the group having the b allele than in the group that did not(Bb and bb 139+/-68 vs. BB 82.2+/-15.5, p<0.05). CONCLUSIONS: The VDR gene 3' end polymorphism was not associated with susceptibility to Graves' disease in Koreans. The studies of other polymorphism sites of the VDR gene might be required to elucidate the association of VDR gene polymorphisms with Graves' disease in Koreans.
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A Case of Acute Suppurative Thyroiditis as a Complication of Acupuncture in Patient with a Benign Thyroid Nodule.
Tae Yong Kim, Han Mo Yang, Jae Kyung Hwang, Young Min Cho, Young Joo Park, Do Joon Park, Seong Yeon Kim, Hong Kyu Lee, Bo Youn Cho
J Korean Endocr Soc. 2002;17(4):576-582.   Published online August 1, 2002
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Acute suppurative thyroiditis is an uncommon disease, and usually affects patients with preexisting thyroid gland pathology. Penetrating injury could provide an acquired channel for the infection to spread into the relatively infection-resistant thyroid gland. We describe the first case of acute suppurative thyroiditis, as a complication of acupuncture, in a patient with a benign thyroid nodule. A 54-year-old male received acupuncture on his neck for the treatment of a previously diagnosed thyroid nodule. Four days after the acupuncture, the patient was admitted due to severe pain of the anterior neck and odynophagia. Fever and tenderness over the thyroid gland were observed. Burkholderia cepacia was isolated from a culture dish of aspirate of the thyroid gland. A neck computed tomography scan showed an abscess in the thyroid gland. Antibiotic treatment, and repeated drainage of the abscess, ameliorated the symptoms of infection. Two weeks after admission, the patient was discharged without sequela. Acupuncture should be considered as a kind of penetrating injury, which may induce acute suppurative thyroiditis.
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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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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
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Hypertensive Complications in Patients with Primary Aldosteronism.
Seong Hee Kwon, Yeong Min Cho, Heoung Kyu Park, Do Jun Park, Chan Soo Shin, Kyong Soo Park, Seong Yeon Kim, Bo Yeon Cho, Hong Kyu Lee
J Korean Endocr Soc. 2002;17(1):95-103.   Published online February 1, 2002
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BACKGROUND
Primary aldosteronism (PA) is believed to be a benign form of secondary hypertension due to the low incidence of hypertensive complications. Recently, several studies have shown that hypertensive complications were common in patients with PA. Therefore, we investigated hypertensive complications in 46 PA patients. METHEODS: Clinical and laboratory features of 46 46 patients were retrospectively analyzed. Hypertensive complications of this group were left ventricular hypertrophy, cerebrovascular accidents, hypertensive nephropathy and hypertensive retinopathy. RESULTS: Hypertensive complications were found in 30 (65.2%) of the 46 patients. The incidence of severe hypertension (higher than or equal to 110 mmHg in diastolic blood pressure) was 17.6%. Left ventricular hypertrophy was found in 26 (56.7%) of the 46 patients. Cerebrovascular accidents were found in 6 patients, and hypertensive nephropathy in 4 patients. The incidence of severe hypertensive retinopathy (higher than or equal to grade 3 in the Keith-Wagener Barker classification) was 17.6%. Of the 35 PA patients who underwent surgical treatment hypertension was found in 18 (51.4%). CONCLUSION: These results indicate that hypertensive complications are common in patients with PA, suggesting that early detection, treatment and close follow-up are necessary in PA.
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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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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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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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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
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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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BACKGROUND
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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The Changes of Expression of Thyroid Specific Antigens in Aging.
Young Joo Park, Eun Shin Park, Tae Yong Kim, Sang Wan Kim, Hyeong Kyu Park, Do Joon Park, Won Bae Kim, Chan Soo Shin, Kyoung Soo Park, Seong Yeon Kim, Sang Chul Park, Hong Kyu Lee, Bo Youn Cho
J Korean Endocr Soc. 2001;16(4-5):457-466.   Published online October 1, 2001
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BACKGROUND
With the prevalence of serum antithyroglobulin(anti-TG) and antithyroperoxidase(anti-TPO) autoantibodies increasing with age, it has been suggested that changes of thyroid autoimmunity with aging are associated with endemic iodine intake. To understand the mechanism of aging-related increases of thyroid autoimmune response, we investigated the expression of thyroid specific autoantigens of aged phenotype, and compared them with those of young phenotype both in vivo and in vitro. METHODS: Sprague-Dawley rats were sacrificed at 5, 10 and 16 weeks(young), and at 23 months(aged). Their FRTL-5 thyroid cells were harvested at cell passages less than 10(fresh) or more than 30 (aged). The expression of thyroid autoantigens, sodium-iodide symporter(NIS), TSH receptor (TSHR), TG and TPO, were examined by northern blot analysis. To evaluate the effects of iodide, 1mM of NaI was added to the medium for 24 hours, and following incubation the expressions of MHC class I and class II were also examined. RESULTS: The expressions of TPO were markedly increased in the aged rats, and those of TG were moderately. However, NIS and TSHR showed no differences in their expression levels between aged rats and young rats. In vitro, there were no differences in the expressions of TG or TPO, nor of NIS or TSHR, between aged cells and fresh cells. Neither did Iodide exhibit any influence on the expression of MHC molecules in aged cells or fresh cells. CONCLUSION: The expression levels of TPO and TG were increased in aged rats, which may partially explain the mechanism of increasing thyroid autoimmunity with age.
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Early Detection of Medullary Thyroid Cancer by Screening of the RET Proto-oncogene Germ Line Point Mutation in Family Members Affected with Hereditary Medullary Thyroid Cancer .
Sun Wook Kim, Tae Yong Kim, Young Joo Park, Won Bae Kim, Chan Soo Shin, Do Joon Park, Kyoung Soo Park, Seong Yeon Kim, Bo Youn Cho, Hong Kyu Lee
J Korean Endocr Soc. 2001;16(1):54-64.   Published online February 1, 2001
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BACKGROUND
Conventional biochemical screening for family members with hereditary medullary thyroid cancer (MTC) is associated with problems of sensitivity and, specificity and it frequently detects gene carriers only after disease progression. Molecular genetic screening tests that detect germ-line point mutations of the RET proto-oncogene has changed our approach to hereditary MTC. In this study we screened members of a large Korean family that had a history of hereditary MTC by a molecular genetic method and propose a therapeutic approach in managing the disorder. METHODS: Using DNA acquired from peripheral blood leukocytes of the index patient, we performed PCR and direct sequencing of exon 10 of the RET proto-oncogene. PCR-RFLP using an Mbo II restriction enzyme was performed on family members who were at risk of MTC according to the family pedigree. Basal serum calcitonin level was determined in family members who had a point mutation of the RET proto-oncogene and a pentagastrin stimulation test was performed in 3 members. RESULTS: Genetic analysis in the index case revealed a mutation in exon 10, codon 618 of the RET proto-oncogene (TGC to AGC). Out of 28 members who were at risk of MTC, 24 members participated in the screening test. 9 members tested positive for a mutation in the same chromosomal location as the index patient by PCR-RFLP. Basal serum calcitonins were above 100 pg/mL in 2 members. 3 members who had a RET point muatation but a normal basal serum calcitonin level participated in the pentagastrin stimulation test and the results were negative in all members. We found a small medullary thyroid carcinoma that had a diameter of 0.2 cm in a 16 years old boy according to a negative pentagastrin stimulation test and who had received a prophylactic total thyroidectomy. He had no evidence of a lymph node metastasis. CONCLUSION: We detected a germ-line mutation of the RET proto-oncogene in codon 618 of Exon 10 by a molecular genetic method in a family with a hereditary MTC and found 9 members that had a negative history of MTC but had a RET point mutation. There was a very small MTC found in a 16 years old boy who had a normal pentagastrin stimulation test result. Therefore, It is recommended that a prophylactic total thyroidectomy be performed as well as in members that have a mutation of the RET proto-oncogene because MTC can metastasize early in its disease course.'
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IL-10 Plasmid DNA Delivery in NOD Mice for the Prevention of Autoimmune Pancreatic Beta Cell Destruction.
Jae Joon Koh, Kyung Soo Ko, Jong Sang Park, Won Bae Kim, Kyong Soo Park, Seong Yeon Kim, Hong Kyu Lee, San Goo Shin, Sung Wan Kim
J Korean Endocr Soc. 2000;15(2):262-271.   Published online January 1, 2001
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BACKGROUND
Recently, we have reported that biodegradable poly [-(4-aminobutyl)-L-glycolic acid] (PAGA) can condense and protect plasmid DNA from DNase I. In this study, we investigated whether the systemic administration of pCAGGS mouse IL-10 (mIL-10) expression plasmid complexed with PAGA can reduce the development of insulitis in non-obese diabetic (NOD) mice. METHODS: PAGA/mIL-10 plasmid complexes were stable for more than 60 minutes, but the naked DNA was destroyed within 10 minutes by DNase I. The PAGA/DNA complexes were injected into the tail vein of 3 week-old NOD mice. RESULTS: Serum mIL-10 level peaked at 5 days after injection, could be detected for more than 7 weeks. The prevalence of severe insulitis at 12 week-old NOD mice was markedly reduced by the intravenous injection of PAGA/DNA complex (15.7%) compared to that of naked DNA injection (34.5%) and non-treated controls (90.9%). In conclusion, systemic administration of pCAGGS mIL-10 plasmid/PAGA complexes can reduce the severity of insulitis in NOD mice. CONCLUSION: The study presents the PAGA/DNA complex has the potential for the application of the prevention of autoimmune diabetes mellitus.
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The Correlation of Plasma Homocysteine and Mitochondrial DNA Content in Peripheral Blood in Healthy Women.
Soo Lim, Won Shik Shin, Kyong Soo Park, Seong Yeon Kim, Jong Ho Lee, Mi Ja Yim, Ji Hyun Song, Hong Kyu Lee
J Korean Endocr Soc. 2000;15(2):248-261.   Published online January 1, 2001
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BACKGROUND
Hyperhomocysteinemia is an independent risk factor for cardiovascular diseases. Previous reports showed that homocysteine damages mitochondrial gene expression, function and structure. In recent years, homocysteine and mitochondrial DNA (mtDNA) content are reported to relate with insulin resistance. The aim of this study is to investigate the correlation of plasma homocysteine level and mitochondrial DNA content in peripheral blood. METHODS: The mtDNA content, homocysteine and insulin resistance parameters were measured in healthy women (n=60). Plasma homocysteine level was measured by ion-exchange chromatography method and the mtDNA content in peripheral blood was measured by real time PCR method using ABI Prism 7700 machine. RESULTS: Significant correlation was found between homocysteine and mtDNA content (r=-0.507, p<0.05). Homocysteine was correlated with age (r=0.397), cholesterol (r=0.327), LDL-cholesterol (r=0.318), apolipoprotein B (r=0.387), HbA1c (r=0.274) positively and folate (r=-0.262), apolipoprotein A1 (r=-0.293), VO2max (r=-0.332) negatively. Mitochondrial DNA content was correlated with age (r=-0.535), BMI (r=-0.397), cholesterol (r=-0.340), LDL-cholesterol (r=-0.319), apolipoprotein B (r=-0.367) negatively and apolipoprotein A1 (r=0.346), lactate (r=0.307), VO2max (r=0.308) positively. All correlations were statistically significant(p<0.05). CONCLUSION: In this study, plasma homocysteine level was related with mitochondrial DNA content negatively and these two factors are estimated to be concerned with insulin resistance.
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Changes of Biochemical Bone Markers and Bone Mineral Density after Hormone Replacement Therapy in Korean Women.
Kyong Soo Park, Do Joon Park, Seong Yeon Kim, Bo Youn Cho, Hong Kyu Lee, Jae Hyeon Kim, Jeong Goo Kim
J Korean Endocr Soc. 2000;15(2):226-236.   Published online January 1, 2001
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BACKGROUND
Biochemical bone markers have been suggested to reflect postmenopausal high bone turnover. These markers could be useful in following response to hormone replacement therapy (HRT). But we have few studies about the sequential changes of biochemical bone markers and bone mass after HRT in Korean women, and it is unclear whether women with early menopause have different response to HRT from women with normal menopause. The aims of the present study were to see the sequential changes of biochemical bone markers and bone mass after HRT in Korean women, to examine whether a single baseline biochemical bone marker or a change in biochemical bone marker could predict subsequent bone mass, and to determine the difference of response to HRT between women with early menopause and women with normal menopause. METHODS: Postmenopausal women (n=21) were divided with into three groups according to their age at menopause (AAM): the first group with AAM < or = 43 years (early menopause group, n=7), the second group with 43 years < or = AAM < or = 50 years (n=4), and the third group with AAM > or = 50 years (normal menopause group, n=10). For the HRT, conjugated estrogen (0.625mg per day) and continuous or cyclic medroxyprogesterone (2.5-10mg per day) were administered. Bone mineral density (BMD) was measured at baseline and 12 months and biochemical bone markers were measured at baseline and 3, 6, and 12 months during HRT. RESULTS: Deoxypyridinoline, type 1 collagen N-telopeptide, bone alkaline phosphatase, and osteocalcin were significantly decreased at 3 months, and mean percent changes from baseline of bone resorption markers were larger than those of bone formation markers. At 12 months, BMD was significantly increased at lumbar spine and Ward's triangle. But BMD was not significantly increased at femur neck and femur trochanter. Two baseline bone markers (bone alkaline phosphatase and type 1 collagen N-telopeptide) correlated with changes of BMD but any changes of bone markers at 3, 6 months didn't correlate with changes of BMD. In early menopause group, changes of bone markers and BMD were larger than those in normal menopause group, but the difference between the two groups was not significant. CONCLUSION: All four bone markers showed significant reduction at 3 months, but bone resorption markers were decreased more markedly and rapidly, and some baseline bone markers can predict the change of BMD after HRT. The difference of response to HRT between early menopause group and normal menopause group was not significant.
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Case of Sheehan's Syndrome Misdiagnosed as Pituitary Apoplexy due to Pituitary Adenoma.
Sun Hee Park, Do Joon Park, Kyoung Soo Park, Seong Yeon Kim, Bo Youn Cho, Hong Kyu Lee
J Korean Endocr Soc. 2000;15(1):107-112.   Published online January 1, 2001
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Postpartum ischemic necrosis of the pituitary gland, known as Sheehan's syndrome, is well-established clinical entity. The recent progress in radiological imaging allows an easy and noninvasive study of the pituitary area in the patients while still alive. An empty or partially empty sella is a constant feature of Sheehan's syndrome in the later phase. We report a case of nonhemorrhagic postpartum pituitary infarction documented in the acute phase with clinical, endocrine, and sequential magnetic resonance (MR) imaging studies.
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Bone Turnover and Bone Mineral Density in Acromegaly.
Sun Wook Kim, Hee Jin Kim, Seon Hwa Lee, Won Bae Kim, Do Joon Park, Chan Soo Shin, Kyong Soo Park, Seong Yeon Kim, Bo Youn Cho, Hong Kyu Lee
J Korean Endocr Soc. 1999;14(4):688-697.   Published online January 1, 2001
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BACKGROUND
Abnormalities of calcium homeostasis and bone remodelling were known in acromegaly, but controversy concerning the influence of chronically elevated serum growth hormone (GH)/insulin like growth factor-I (IGF-I) concentrations on bone metabolism has been existed. In this study, we assess the effect of chronically elevated serum GH/IGF-I levels on bone metabolism and bone mineral density (BMD) in patients with acromegaly and compare the markers of bone metabolism and BMD of active acromegaly according to gonadal function. METHODS: We measured biochemical markers of bone turnover and BMD in 50 acromegalic patients (41 active disease, 9 inactive disease) and 41 control subjects. RESULTS: Active acromegalic patients had significantly higher serum oteocalcin levels (13.8+/-7.7 versus 6.8+/-4.7, 6.0+/--3.4 ng/mL, p<0.05) and urinary type I cross-linked N-telopeptide (101.7+/-64.2 versus 49.3+/-33.3, 56.1+/-39.4 nM BCM/mM Cr, p<0.05) compared with inactive acromegaly and control subjects. Serum IGF-I levels correlated positively with serum osteocalcin levels(r=0.69, p<0.05) and urinary type I cross-linked N-telopeptide (r=0.44, p<0.05). In the female patients with active acromegaly, BMD (T-score) was elevated in the femoral neck(1.00+/-0.14 versus 0.89+/-0.12,p<0.05) and trochanter (0.88+/-0.15 versus 0.77+/-0.11, p<0.05), whereas BMD of lumbar spine(1.13+/- 0.17 versus 1.17+/-0.17, p>0.05) and femoral Ward's triangle (0.78+/-0.16 versus 0.77+0.13, p>0.05) were not different from those of control subjects. In the patients with active acromegaly, serum osteocalcin levels (16.4+/-8.8 versus 14.9+/-10.1 ng/mL, p>0.05) as well as urinary type I cross-linked N-telopeptide (104.8+/-68.1 versus 122.0+/-80.3 nM BCM/mM Cr, p>0.05) were not different according to gonadal function. Also, femoral and spinal BMD were not different according to the gonadal function. CONCLUSION: GH/IGF-I excess increase bone turnover and might achieve a positive bone balance at each remodelling cycle. Markers of bone turnover and BMD of skeletal bone were not influenced by gonadal function in the patients with active acromegaly.
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Clinical Features Associated with an Increased Risk of Malignancy in Indeterminate Group by Find Needle Aspiration of Thyroid Nodules.
Seon Hwa Lee, Sun Wook Kim, Do Joon Park, Won Bae Kim, Seong Yeon Kim, Bo Youn Cho, Hong Kyu Lee, Chang Soon Koh
J Korean Endocr Soc. 1999;14(3):505-513.   Published online January 1, 2001
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BACKGROUND
The recommended management of patients who have cytologic diagnosis of indeterminate group by fine fine needle aspiration (FNA) in thyroid nodules is controversial. Our objective was to identify the incidence of malignancy through thyroidectomy in indeterminate group and clinical features associated with an increased risk of malignancy that might guide future practice. METHODS: We retrospectively reviewed the medical records of 222 patients who had cytologic diagnosis of indeterminate group by FNA in thyroid nodules at Seoul National University Hospital from Jan. 1990 to Aug. 1998. Patients characteristics and clinical features were compared between benign and malignant nodules classified as pathologic findings through thyroidectomy. RESULTS: The frequency of indeterminate group was 6% (222/3981) among patients underwent thyroid FNA. The frequency of malignant nodules was 47.4% (64/135) among 135 patients underwent thyroidectomy. Among clinical features, rapid increase in size (7.0% vs 20.3%, p=0.024), local symptoms such as dysphagia, hoarseness, pain (1.4% vs 15.6%, p=0.003), fixation (4.4% vs 35.7%, p<0.001), hard consistency(15.7% vs 59.7%, p<0.001) and irregular surface(6.3% vs 25.6%, p=0.001) were significantly more common in malignant nodules than in benign nodules. However, clinical features such as mean age of patients, male sex, presence of past history of benign thyroid disease, family history of benign thyroid disease, solitary nodule, presence of cervical lymph nodes, mean size of nodules and cold nodules by thyroid scan in malignant nodules were not significantly different from that in benign nodules. Among clinical features that were significantly more common in malignant nodules, fixation(p=0.042) and presence of local symptoms (p=0.043) were significantly independent risk factors predictive of malignancy. CONCLUSION: Its better to recommend thyroidectomy in patients with clinical features such as presence of local symptoms, fixed nodule and hard nodule in indeterminate group, in otherwise to decide treatment with repeated FNAs when clinical features such as patients symptoms and physical examinations of nodule change through regular follow-up.
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Diagnosis of Cushing's Disease by Inferior Petrosal Sinus Sampling (IPSS): Evidence of False Negative Results.
Seon Hwa Lee, Hyeon Jeong Jeon, Sun Hee Park, Sun Wook Kim, Do Joon Park, Kyong Soo Park, Seong Yeon Kim, Bo Youn Cho, Hong Kyu Lee
J Korean Endocr Soc. 1999;14(3):483-492.   Published online January 1, 2001
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BACKGROUND
While inferior petrosal sinus sampling (IPSS) correctly diagnoses pituitary dependent Cushings syndrome if a significant ratio of plasma ACTH between the IPS and the peripheral blood is demonstrated, little has been said about the significance of a negative ratio in Cushings disease (e.g. false negative result). We evaluated the results of IPSS with Cushings disease, and compared them with imaging findings through transsphenoidal surgery. METHODS: 29 patients with Cushings disease underwent transsphenoidal examination of the pituitary gland from 1989 to 1998 at Seoul National University Hospital were evaluated. We compared the results of IPSS and imaging findings with sellar CT or dynamic MRI. The ratio of the ACTH concentrations at the IPS and in the peripheral blood (IPS:P ratio) and the ratio of the ACTH concentrations between the IPSs (interpetrosal ratio) were calculated before and after CRH infusion. RESULTS: With IPSS the diagnosis of Cushings disease was possible in 90% (26/29), and 3 cases in whom IPSS did not show significant IPS:P ACTH ratio were confirmed to be Cushings disease through hemihypophysectomy of lesion suspected by sellar dynamic MRI and achieved remission after operation (e.g. false negative result of diagnosis for Cushings disease by IPSS). However, accurate localization of microadenoma was achieved in only 59% (17/29). Imaging study detected microadenoma in 76% (22/29) and correctly localized in 66% (19/29). Both IPSS and imaging study precisely localized the pituitary microadenoma in 10 (34.5%) cases of 29 cases and a discrepancy between two studies existed in 7 (24.1%) cases in which the imaging study correctly localized microadenoma in 6 cases and IPSS in 1 case. CONCLUSION: Only when a significant IPS:P ACTH ratio is present can Cushings disease be established by IPSS. The absence of a significant IPS:P ACTH ratio does not necessarily imply ectopic secretion of ACfH, nor does it exclude Cushings disease. The results of lateralization by IPSS do not remove the need for transsphenoidal examination of the sella turcica because false negative result can be. IPSS and radiologic study should be complementary used in diagnosis of Cushings disease and localization of microadenoma, as IPSS can be used when sellar imaging study failed to visualize the lesion and hemihypophysectomy of suspected lesion by imaging study can be considered when IPSS did not show significant ratio of ACTH.
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Medical Treatment of Acromegaly.
Seong Yeon Kim
J Korean Endocr Soc. 1999;14(3):453-457.   Published online January 1, 2001
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No abstract available.
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The Diagnostic Value of a Low Dose (1ug) Rapid ACTH Stimulation Test to Assess the Adrenocortical Function.
In Kyung Jung, Jae Seok Jeon, Young Joo Park, Chan Soo Shin, Kyoung Soo Park, Seong Yeon Kim, Hong Kyu Lee, Hee Jin Kim, Jae Hyeon Kim
J Korean Endocr Soc. 1997;12(3):433-442.   Published online January 1, 2001
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BACKGROUND
Insulin induced hypoglycemia has been used to assess the adrenocortical function, but may be hazardous. The standard rapid ACTH stimulation test has been advocated as a substitute but is sometimes insensitive. In this study, low dose (1ug) rapid ACTH stimulation test was compared to insulin induced hypoglycemia and standard dose (250ug) rapid ACTH stimulation. METHODS: 27 patients (14 men and 13 women) with pituitary disease and definite adrenocortical dysfunction (14 patients were confirmed by insulin induced hypoglycemia) and 23 controls (pituitary control: 3 men and 7 women, confirmed by insulin induced hypoglycemia, normal control: 8 men and 5 women) were studied. All subjects underwent rapid ACTH stimulation test with 2 different level of stimulation (1 and 250ug). Serum cortisol levels were measured at 0, 30 and 60 min after each dose of ACTH injection. A normal response was defined as a peak cortisol value of 497nrnol/L (18ug/dL) or above, RESULTS: During rapid ACTH stimulation study in controls, the peak serum cortisol level was significantly lower (690+-25lnmol/L (25.0+-9.1ug/dL) vs. 933+-257nmol/L (33.8+-9.3ug/dL); p< 0.01) and the peak appeared earlier (30min. vs. 60min) after the administration of low dose ACTH than after standard dose. However, the serum cortisol level at 30min was not different. In patient group, each serum cortisol level at 30min and 60min had no difference between low and standard dose (p>0.1). None of these 27 patients showed normal response to low dose stimulation, but 2 of 27 did to standard dose. In controls, 19 of 23 showed normal response to low dose, and all of 23 did to standard dose (sensitivity 100% vs 92.5%, specificity 82.5% vs 100%). The results of low and high dose stimulation test agreed with those of insulin induced hypoglycemia (Kendalls g= 0.50 vs 0.92, p<0.01 vs 0.001). CONCLUSIONS: The results of a low dose (1ug) rapid ACTH stimulation test showed good correlation with those of the standard dose (250ug) rapid ACTH stimulation test and insulin induced hypoglycemia. Thus it may be used in screening for the diagnosis of adrenal insufficiency.
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Glucose metabolism in chronic hepatitis B infection-acute insulin response and glucose disappearance rate to intravenous glucose.
Chan Soo Shin, Kyoung Soo Park, Seong Yeon Kim, Hong Kyu Lee, Chang Soon Koh, Young Bae Kim
J Korean Endocr Soc. 1997;12(2):275-282.   Published online January 1, 2001
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BACKGROUND
Glucose intolerance and diabetes mellitus are frequently observed in chronic liver disease. However, the causal relationships between these two are difficult to prove. Chronic hepatitis B infection, which is prevalent in Korea, is thought to be a good model to study the natural history of abnormal glucose metabolism in chronic liver disease because many patients with chronic hepatitis B infection eventually progress to liver cirrhosis. METHODS: In order to evaluate glucose metabolism in chronic hepatitis B infection, we did intravenous glucose tolerance test in patients with chronic hepatitis B and age, sex and body mass index matched controls and compared the first phase insulin response and glucose disappearance rates between 2 groups. RESULTS: Patients with chronic hepatitis B showed lower glucose disappearance rate and higher plasma insulin and C-peptide area (0-10min after iv glucose) than controls. Patients with decreased glucose disappearance rate had higher AST level and decreased plasma C-peptide area (0-10min). CONCLUSION: Most of the patients with chronic hepatits B infection is associated with insulin resistance and compensatory increase in the first phase insulin secretion. Inadequate insulin secretion may contribute to decreased glucose disappearance rate in these patients.
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The Localization of Microadenoma with Sella Imaging Study and Inferior Petrosal Sinus Sampling in Cushing's Disease.
Jae Seok Jeon, Sang Jeon Choi, Chan Soo Shin, Kyoung Soo Park, Seong Yeon Kim, Bo Youn Cho, Hong Kyu Lee, Chang Soon Koh, Hee Won Jung, Dae Hee Han, Moon Hee Han, Kee Hyun Chang
J Korean Endocr Soc. 1996;11(4):492-499.   Published online November 7, 2019
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Background
Inferior petrosal sinus sampling(IPSS) is known to be useful for the differential diagnosis of ACTH-dependent Cushings syndrome and for the preoperative lateralization of pituitary microadenoma. We tried to analyze the relative value of IPSS in localization of microadenoma as compared with sella imaging study including computerized tomogram(CT) or magnet resonance imaging(MRI) in Cushings disease. Methods: We reviewed the clinical records of 21 patients with Cushings disease who underwent IPSS and the radiologic study such as sella CT or sella MRI preoperatively followed by transsphenoidal microsurgery. By pathologic examination including immunohistochemistry and postoperative clinical and biochemical evaluation we confirmed the diagnosis of Cushings disease due to pituitary microadenoma in all 21 cases. Results: Sella CT or sella MRI detected microadenoma in 57.1% of cases( =12/21), while recently available dynamic MRI did so in 7 out of S cases. With IPSS the diagnosis of Cushings disease was possible in 90.5% of cases(= 19/21), but accurate lateralization of microadenoma was achieved in only 63.2% of cases( =12/19). IPSS precisely localized the pituitary microadenoma in 6 out of 9 cases whose lesion were not detected by the radiologic study. Of 7 cases in which IPSS failed to localize microadenoma, the radiologic study detected the lesion in 6 cases. Of 5 cases in which IPSS and the radiologic study showed a discrepancy in location of microadenoma, the radiologic study correctly localizaed the lesion in 4 cases and IPSS did so in one case. Conclusion: IPSS is not more reliable than sella imaging study for preoperative localization of microadenoma in Cushings disease. However it might have a complementary role, especially when sella imaging study failed to visualize the lesion.
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The Incidence of Thyroid Autoantibody in Subacute Thyroiditis and the Clinical Characteristics of Greeping Thyroiditis.
Jae Seok Jeon, Won Bae Kim, Hae Young Park, Young Joo Park, Hyun Kyung Chung, Sang Jeon Choi, Chan Soo Shin, Kyoung Soo Park, Seong Yeon Kim, Bo Youn Cho, Hong Kyu Lee, Chang Soon Koh
J Korean Endocr Soc. 1996;11(4):438-446.   Published online November 7, 2019
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Background
Subacute thyroiditis is a spontaneously resolving inflammatory disorder of thyroid gland, usually associated with painful goiter and short-lived thyrotoxicosis. Although its etiology is yet to be established, much evidence suggests viral infections and genetic factors play important roles. Usually, both lobes of thyroid gland are involved simultaneously, but in some patients one lobe is involved first and the other later(creeping thyroiditis), Thyroid autoantibodies which might appear probably due to inflammatory release of thyroid antigens, are found in a variable number of patients with subacute thyroiditis. However there have been few detailed reports on their incidence in Korean patients with subacute thyroiditis. So, we were to see the elinical characteristics of patients with subacute thyroiditis with special regards to the incidence of thyroid autoantibodies and to the incidence and characteristics of creeping thyroiditis, Methods: We reviewed the clinical records of 85 patients with subacute thyroiditis(7 men and 78 wornen, meam age of 43+9 years) who had visited the thyroid clinic in Seoul National University Hospital between 1986 and 1994. Results: At initial visit, the incidenees of thyroid autoantibodies were as follows: anti- microsomal antibody 7.8%, anti-thyroglobulin antibody 22.1%, and thyratropin binding inhibitor inununglobulin 6.3%. During the follow-up period, thyroid autoantibodies appeared most frequently between the first and the second month after initial visit. Compared to those with non-creeping thyroiditis, the patients with creeping thyroiditis(21.4%) had nonspecific systemic sy~rnptoms more frequently(89% vs. 42%, p<0.05). They required steroid therapy more ftequently(89% vs. 52%, p <0.05), and needed longer duration of treatment(9.3+6.2weeks vs, 4.7+3.7weeks, p<0.05). The incidence of abnormalities in liver function and the incidence of thyroid autoantibodies were higher in non-creeping thyroiditis group. Conclusion: In accordance with previous reports, thyroid autoantibodies were detected in only a small portion of Korean patients with subacute thyroiditis. Rather different clinical manifestations and different incidences of thyroid autoantibodies between ereeping group and non-creeping group suggest differences in the pathogenetic mechanisms between those two groups. However, there is need for further study to validate such observation and to elucidate the mechanisms.
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A Clinical Study on Hypopitutiarism: Significance of Combined Pituitary Stimulation Test.
Bo Youn Cho, Hong Gyu Lee, Chang Soon Koh, Hyung Kyu Park, Sook Kyung Kim, Chan Soo Shin, Seong Yeon Kim, Jae Seok Chun, Kyung Soo Park, Hyeon Kyu Kim, Sun Wook Kim
J Korean Endocr Soc. 1996;11(3):268-276.   Published online November 7, 2019
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Background
Hypopituitarism can be caused by various diseases. Its clinical manifestations vary, depending on the extent and severity of the pituitary hormone deficiency. And some patients may initially present with SIADH-like features. Combined pituitary stimulation test has been used for the diagnosis of hypopituitarism and subsequent hormone replacement therapy. However, the test is laborious, expensive and uncomfortable to the patients, So we performed this study to know whether combined pituitary stimulation test can be replaced with clinical features and simple basal hormone concentrations. Methods: Fifty-four patients who were diagnosed as hypopituitarism by combined pituitary stimulation test were included in this study. Clinical features and basal hormone data were compared with the results of combined pituitary stimulation test for the evaluation of pituitary-gonadal, pituitary-thyroid, and pituitary-adrenal axes, using X2 test. Results: 1) In pituitary-gonadal axis, the evaluation of clinical features and basal gonad hormone concentrations were significantly consistent with stimulation test(p<0.05), 2) In pituitary-thyroid axis, the evaluation of basal thyroid hormone concentrations were more helpful than stimulation test though results of the two tests were not consistent. 3) In pituitary-adrenal axis, all patients whose basal cortisol concentrations were low showed inadequate responses to stimulation test. However, stimulation test revealed adrenal insufficiency in some patients with normal basal cortisol concentrations. 4) 9 patients who presented with SIADH-like features were older than the others and had all corticotropin deficiency. Conclusion: In patients with suspected hypopituitarism, the evaluation of clinical features and basal hormone concentrations can be sufficient for the diagnosis of hypopituitarism and hormone replacement therapy. However, stimulation test is necessary to investigate adrenal function in patients with normal basal cortisol concentrations. And hypopituitarism should be considered in old patients who present with SIADH-like features.
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A Case of Symptomatic Severe Hypercalcemia as Initial Manifestation of Hyperthyroidism.
Hye Young Park, Won Bae Kim, Hyeon Kyu Kim, Chan Soo Shin, Seong Yeon Kim, Bo Youn Cho, Hong Gyu Lee, Chang Soon Koh
J Korean Endocr Soc. 1996;11(1):124-126.   Published online November 7, 2019
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No abstract available.
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Clinical Characteristics of Graves' Disease Patients with Undetectable Thyrotropin Binding Inhibitor Immunoglubulin (TB2).
Bo Youn Cho, Won Bae Kim, Hong Gyu Lee, Chang Soon Koh, Seong Yeon Kim, Seok In Lee, Jae Seok Chun, Kyung Soo Park
J Korean Endocr Soc. 1996;11(1):68-74.   Published online November 7, 2019
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Background
Graves disease is an autoimmune disease caused by TSH receptor antibodies. Thyrotropin binding inhibitor immunoglobulins(TBII) are detected in most Graves patients, but some patients have no TBII activities in their sera. It is unknown whether the clinical features of TBII-positive patients are different from those of TBII-negative patients. Methods: To evaluate the prevalence of TBII-negative Graves' patients and its clinical differences from TBII-positive patients, we examined TBII by radioreceptor assay in 686 consecutive untreated Graves patients. We found 84 TBII-negative patients(15 men and 69 women, mean age ±EM: 40.9±.4 years) and compared their clinical characteristics with 87 TBII-positive patients (22 men and 65 women, mean age±EM: 39.9±.5 years) who were selected randomly from the same patients group. Results: In this study, TBII was undetectable in 12.2% of patients with Graves' disease(84 of 686). TBII-negative group had a less weight loss than TBII-positive group. However, there was no significant differences in age, sex ratio, prevalence of ophthalmopathy, duration of illness and positive rate of family history for thyroid diseases between TBII-negative and -positive groups. Serum total T or T levels were not different from each other, but T3-uptake was significantly higher in TBII-positive group than that in TBII-negative group, suggesting that the free hormone levels in TBII-negative group might be lower. The thyroid uptake of 99mTcO4 was significantly higher in TBII positive group than that in TBII-negative group. Thyroid autoantibodies, including antimicrosomal and antithyroglobulin antibodies were detected in almost all patients but there were no differences in titers and positive rate between TBII-negative and -positive groups. Conclusion: Although TBII-negative Graves patients showed less weight loss and low 99mTc04 thyroidal uptake compare to TBII-positive patients, the clinical and immunological characteristics of TBII-negative patients are not different from TBII-positive one.
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Changes in Serum Lipids and Apolipoproteins Levels According to the Thyroxine Treatment in The Patients with Subclinical Hypothyroidism.
Hye Young Park, Bo Youn Cho, Won Bae Kim, Hong Gyu Lee, Chang Soon Koh, Geon Sang Park, Hyung Kyu Park, Sook Kyung Kim, Chan Soo Shin, Seong Yeon Kim
J Korean Endocr Soc. 1996;11(1):41-51.   Published online November 7, 2019
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Background
Subclinical hypothyroidism(SCH) is a common biochemical abnormality which can be found in routine screening tests of thyroid function. We are increasingly faced with the question of whether its an indication for thyroxine replacement therapy. The effect of thyroxine replacement on lipid profile in SCH has aroused a great interest because of an association of overt hypothyroidism(OVH) with hyperlipidemia and increased risk of coronary artery disease. Method: We prospectively evaluated the changes in lipids and apoproteins before and after thyroxine replacement therapy in 23 patients with SCH and in 37 patients with OVH. We measured serum total cholesterol and triglyceride using autoanalyzer, high density lipoprotein(HDL) chole-sterol by dextran sulfate method, Apo A1 and Apo B by immunonephelometric assay. Results: Thyroxine replacement therapy significantly decreased total cholesterol, low density lipoprotein(LDL) cholesterol and apo B levels, but did not affect the level of triglyceride, HDL cholesterol or apo AI in patients with OVH. In SCH, thyroxine replacement therapy with the doses to normalize serum TSH concentrations also decreased significantly the level of cholesterol and LDL cholesterol albeit apo B levels did not change. Moreover, in most of patients with OVH (11 of 12) and in all of patients with SCH(5 of 5) who had had hyperchlesterolemia before treatment, thyroxine replament normalized their cholesterol and LDL cholesterol levels. Conclusion: In regard to the beneficial changes in blood lipid levels, patients with SCH should be treated, especially in cases who have other risk factors for the development of atherosclerosis. If thyroxine replacement only will reduce the incidence of coronary artery disease in SCH remains to be elucidated by long-term prospective studies.
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A Study on the Urinary Iodine Excretion in Normal subjects and Patients with Thyroid disease.
Seong Yeon Kim, Bo Youn Cho, Hong Kyu Lee, Seok In Lee, Woon Bae Kim, Hye Young Park, Chang Soon Koh
J Korean Endocr Soc. 1995;10(4):386-394.   Published online November 7, 2019
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An adequate supply of dietary iodine is essential for the synthesis of the thyroid hormons. The measurement of dietary iodine intake is important for the clinical assessment of thyroid disease, especially in areas where iodine intake is excessive or deficient.To evaluate dietary iodine intake in Korean and its effects on thyroid function, we measured urinary iodine excretion with morning urine by electrode method in 184 normal subjects, 96 postpartum women and 181 patients with thyroid disease from October 1994 to February 1995. The results were as follows;1) In normal control, the mean value of urinary iodine excretion was 3.8+-2.7mg/L (range 0.1-15.0mg/L). However, there was no sex and age differences in the urinary iodine excretion.2) In postpartum women, the urinary iodine excretion was 9.0+-10.8mg/L who were not taken high iodine diet(Miyok-Guk), the mean value was statistically higher than normal control(p<0.01) and significant increased the urinary iodine excretion after eating of high iodine diet(p<0.01).3) In volunteer, there were increase of urinary iodine excretion more than 10 folds after high iodine diet and medication.4) The urinary iodine excretion in patients with thyroid diseases was not different from normal control, and there were no significant differences of urinary iodine excretion among the patient groups. The urinary iodine excretion in the acute stage of patients with subactue thyroiditis or painless thyroiditis was significantly increased compared to the recovery stage. However, it was not significantly different from that of normal control.In conclusion, urinary iodine excretion in Korean population is very high comparing to the reported data in Western population but similar with Japanese. The urinary iodine excretion is significant increase( more than 10-folds of basal level) after high iodine diet or high iodine containing medication in postpartum women or healthy persons. As a clue of destruction induced thyrotoxicosis, the urinary iodine excretion measurement is not valid in area where iodine intake is excessive like Korea.
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Relationship between Blood Pressure and Insulin Level or Red Cell Membrane Na+ Transport in Acromegaly.
Seong Yeon Kim, Hyun Kyu Kim, Kyung Soo Park, Bo Youn Cho, Hong Kyu Lee, Chang Soon Koh
J Korean Endocr Soc. 1995;10(1):35-44.   Published online November 6, 2019
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To test the hypothesis that hyperinsulinemia and/or abnormalities of red cell membrane Na^+ transport are concerned in the pathogenesis of hypertension, we investigated the relationship between blood pressure, insulin level and red cell membrane Na^+ transport in patients with acromegaly which is frequently associated with hypertension, hyperinsulinemia and abnormalities of red cell membrane Na^+ transport.The results were as follows;1) BMI and both systolic and diastolic blood pressure were significantly higher in patients with acromegaly than in control subjects.2) Fasting glucose and insulin levels were higher, and both serum glucose and insulin responses after a 75g glucose load were significantly increased in patients with acromegaly as compared with control subjects.3) Vmax of Na^+-Li^+ countertransport were significantly higher in patients with acromegaly than in control subjects while red cell Na^+ concentration and Vmax of Na^+, K^+ ATPase were similar in the two groups.4) In multiple stepwise regression analysis, age was directly correlated with both systolic and diastolic blood pressure in acromegaly. On the other hand both insulin level and red cell membrane Na^+ transport showed little correlation with either systolic or diastolic pressure. 5) Prevalence of hypertension in acromegaly was 39%(9 out of 23) and only age except for blood pressure was significantly higher in hypertensive acromegalic patients than in normotensive acromegalic patients while GH level, insulin levels and red cell membrane Na^+ transport were similar in the two groupsThese results suggest that hyperinsulinemia or abnormalities of red cell membrane Na^+ transport are not causally related to hypertension in patients with acromegaly.
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Changes in Thyrotropin Receptor Blocking Antibody after Antithyroid drug Administration to Patients with Atrophic Autoimmune Thyroiditis (Primary Myxedema).
Seong Yeon Kim, Bo Youn Cho, Hong Kyu Lee, Jae Hoon Chung, Chang Soon Koh, Chan Soo Shin, Won Bae Kim
J Korean Endocr Soc. 1994;10(3):229-241.   Published online November 6, 2019
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It is well Known that antithyroid drug treatment of Graves' disease suppresses excessive thyroid hormone synthesis and causes a parallel decrease in serum thyroid autoantibody levels including thyroid stimulating antibodies(TSAb) in most patients suggesting the immunosuppressive or immunomodulating effects of antithyroid drugs. In the context of view that thyrotropin receptor blocking antibody may play an important pathogenetic role at least in some patients with primary myxedema(chronic atrophic autoimmune thyroiditis), antithyroid drug treatment in these patients might be beneficial to disease course. To evaluate the effect of antithyroid drug on the thyrotropin receptor blocking antibody levels, we serially measured thyrotropin-binding inhibitor immunoglobulins(TBII) and thyroid stimulation blocking antibodies(TSBAb) using FRTL-5 cells, antimicrosomal- and antithyroglobulin antibody activities in 7 patients with primary myedema who have blocking TSH receptor antibodies during 6 months of methimazole(MMI, 40mg/day) administration. TBII and TSBAb activities did not change after MMI, but one of them showed stepwise decrease and disappearance of TBII and TSBAb activities. Antimicrosomal- and antithyroglobulin antibody activities decreased significantly after 3 months of MMI administration in those patients. These results suggest a minimal effect of antithyroid drug treatment on the level of thyrotropin receptor blocking antibodies. Persistence of thyrotropin receptor blocking antibodies despite of the decrease in antimicrosomal and antithyroglobulin antibodies might suggest that blocking TSH receptor antibodies of primary myxedema is produced mainly in extrathyroidal tissue in contrast to the thyroid stimulating antibodies of Graves' disease. One patient, whose blocking antibody have disappeared after MMI treatment, is under observation to see if she will remain in remission of hypothyroidism.
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A Case of Thyrotropin - Secreting Pituitary Adenoma.
Seong Yeon Kim, Bo Youn Cho, Hong Kyu Lee, Chang Soon Koh, Woon Bae Kim, Hye Young Park, Jin Sung Kim
J Korean Endocr Soc. 1994;10(2):153-160.   Published online November 6, 2019
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thyrotropin-secreting(TSH) pituitary adenoma is extremely rare condition causing hyperthyroidism by uncontrolled secretion of thyrotropin. Among total pituitary adenomas, less than 1 percent are thyrotropin-secreting type, and only about 150 cases have been reported till now. However, increasing numbers of cases are being found due to the availability of ultra-sensitive TSH assay. We report here a patient with thyrotropin-secreting pituitay adenoma secreting TSH with production of lutenizing hormone(LH), follicle stimulating hormone(FSH), growth hormone(GH), prolactin(PRL) and free alpha-subunit.A 21-years old man visited thyroid clinic because of palpitation and dyspnea on exertion. He had diffuse goiter and features of mild thyrotoxicosis, and his thyroid function test showed increased T3, T4 and normal TSH. Serum free alpha-subunit concentration was 7420.5pg/ml(24.7mIU/ml) and the molar ratio of free alpha-subunit to TSH was 15.9. Basal pituitary hormone levels except TSH and the response to combined pituitary stimulation test were normal. A large sellar mass extending into frontal lobe was found on sellar MRI, so it was removed surgically leaving residual tumor mass due to the extensive nature of tumor. In immunohistochemical study the tumor tissue was stained with antibodies to TSH, LH, FSH, GH and PRL. His hyperthyroidism and goiter disappeared after partial removal of tumor. Somatostatin analogue(octreotide acetate) were given continuously via subcutaneous route(150 ug/day) using infusion pump to reduce the size of residual tumor. After 4 months of octreotide infusion, the size of tumor decreased slightly, and he is under treatment without any side effect.
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A Case of Thyroid Anaplastic Cancer with Intestinal Metastasis.
Seong Yeon Kim, Kyung Soo Park, Bo Youn Cho, Hong Kyu Lee, Chang Soon Koh, Jae Seok Jeon, Min Seon Kim, Won Bae Kim
J Korean Endocr Soc. 1994;9(4):375-379.   Published online November 6, 2019
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Thyroid anaplastic cancer is one of the most malignant neoplasms encountered in human. These tumors usually present as rapidly enlarging neck mass in old patients who may or may not have had a previously recognized goiter. The distant metastases of anaplastic cancer eventually occur in about 50% patients, mostly in the lung and bone and are an important prognostic factor, substantially reducing survival time.A 66-year old man visited out hospital because of rapidly growing anterior neck mass and hoarseness. He was diagnosed as thyroid anaplastic cancer with lymph node and lung metastasis and received combined chemotherapy and radiation therapy. On the 8th hospital day, severe abdominal pain developed and exploratory laparotomy was conducted. During operation, two intestinal mass were discovered, one of which was perforated. The microscopic examinations showed that undifferentiated malignant cells were infiltrated in the wall of small bowel. We report this case because we first experienced thyroid anaplastic cancer with intestinal metastasis.
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Insulin Resistance, Body Fat Distribution, and Sex Hormones in Healthy Men and Premenopausal Women.
Seong Yeon Kim, Kyung Soo Park, Bo Youn Cho, Hong Kyu Lee, Chan Soo Shin, Chang Soon Koh, Tae Geun Oh, Woon Bae Kim
J Korean Endocr Soc. 1994;9(4):366-374.   Published online November 6, 2019
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It is well known that obesity central obesity is associated with insulin resistance and some studies reported that sex hormones were associated with insulin resistance. Recently, low levels of sex-hormone binding globulin(SHBG), an indirect index of androgenicity, have been observed to predict the development of non-insulin dependent diabetes mellitus(NIDDM) in women and SHBG has been proposed as a marker for insulin resistance. In contrast to findings in women, decreased SHBG did not predict the occurrence of NIDDM in men, so it is suggested that sex hormones may have a different role for insulin resistance between men and women. To investigate the difference of the associations among the body fat distribution, sex hormone and insulin sensitivity index in men and women, we measured body-mass index(BMI) and waist to hip circumference ratio(WHR) and concentrations serum SHBG, total testosterone, free testosterone, and dehydroepiandrosterone sulfate(DHEA-S) concentrations in 29 healthy adults(men:19, women:10) who showed normal glucose tolerance. Insulin sensitivity index(M/I) was measured by euglycemic hyperinsulinemic clamp. There were no differences in age, BMI, fasting plasma glucose, insulin and free fatty acid levels between men and women. WHR of men is higher than that of women(0.82+-0.01 vs. 0.73+-0.01, p=0.002). Insulin sensitivity index(M/I) is similar in men and women(7.80+-0.71 mg/kg/min/uU/ml X 100 vs. 9.74+-0.89 mg/kg/min/uU/ml X 100, p=0.196).In Pearson's correlation, M/I was significantly correlated with BMI(r=-0.69, p<0.01) and WHR(r=-0.68, p<0.01) in men and DHEA-S(r=-0.68, p<0.05) and SHBG(r=0.61, p=0.056) concentrations in women.In multiple regression analysis, M/I had the most significant association with BMI(R^2=0.484, beta=-0.696, p<0.001) in men and DHEA-S(R^2=0.471, beta=-0.686, p<0.05) concentration in women.Conclusively, we found that sex hormones were significantly associated with insulin resistance and the effects of sex hormones on insulin resistance may be different in men and women.
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Effect of Antiliyolytic Agents on Glueose Metabolism in Thyrotoxic Patients.
Seong Yeon Kim, Kyung Soo Park, Bo Youn Cho, Hong Kyu Lee, Chan Soo Shin, Chang Soon Koh, Hun Ki Min, Tae Geun Oh, Chul Hee Kim, Moon Kyu Lee, Jong Ho Ahn, Kee Up Lee
J Korean Endocr Soc. 1994;9(4):325-331.   Published online November 6, 2019
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Decreased glucose tolerance is often found in patients with thyrotoxicosis but the pathogenetic mechanisms are poorly understood. Since the concentrations of free fatty acid are usually elevated due to increased lipolysis in thyrotoxicosis, the preferential oxidation of the free fatty acids may explain the decreased glucose tolerance in hyperthyroidism. The aim of this study was to investigate whether lowering plasma free fatty acid(FFA) by acipimox, a long-acting antilipolytic agent, could affect glucose metabolism in thyrotoxicosis. We performed intravenous glucose tolerance test with acipimox or placebo in 6 untreated thyrotoxicmen and 6 age-and body mass index(BMI)-matched controls. The following results were obtained.1) The basal plasma FFA concentration in thyrotoxic patients were significantly higher than those in controls(997.0+-303.4 uEq/L vs. 290.5+-169.1 uEq/L; p<0.01). 2) Plasma FFA concentrations decreased rapidly with acipimox ingestion in both controls and thyrotoxic patients.3) Plasma glucose concentrations were significantly lower with acipimox ingestion than with placebo in thyrotoxic patients from 17min after intravenous glucose load and to the end of the study.4) Plasma insulin concentrations in thyrotoxic patients with acipimox ingestion were higher at 5, 7 min after iv glucose load.5) In thyrotoxic patients, glucose disappearance rate(K_glucose) in acipimox treatment was significantly higher than that in placebo treatment(2.44+-0.84 vs. 1.58+-0.37;p<0.05). 6) K_glucose values were inversely correlated with basal FFA concentrations(r=-0.58, p<0.05). In summary, in thyrotoxic patients with elevated plasma FFA levels, acipimox lowered plasma FFA, which in turn improved glucose tolerance.
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A Clinical study on the diagnesis and Treatment of Cushing's Disease - The significance of bilateral inferior petrosal sinus sampling -.
Seong Yeon Kim, Kyung Soo Park, Bo Youn Cho, Hong Kyu Lee, Jae Seok Jeon, Hyeong Kyu Park, Chang Soon Koh, Hun Ki Min, Heu Won Jeong, Dae Hee Han, Moon Hee Han, Kee Hyun Jang
J Korean Endocr Soc. 1994;9(2):115-120.   Published online November 6, 2019
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Bilateral inferior petrosal sinus sampling(IPSS) is known to be useful for the differential diagnosis of ACTH-dependent Cushing's syndrome and for the preoperative localization of pituitary microadenomas.To evaluate the usefulness of IPSS, we performed the procedure in the 17 cases of ACTH-dependent Cushing's syndrome including 2 cases of macroadenomas, 6 of them with CRH stimulation test. A inferior petrosal sinus-to-peripheral ACTH ratio of 2:1 or greater(3:1 after CRH stimulation) indicates a pituitary source of ACTH hypersecretion, and a ratio of the ACTH level in one inferior petrosal sinus to the ACTH level in the other of 1:4 or greater lateralizes the microadenomas to that half of the pituitary gland.With these criteria, we diagnosed Cushing's disease in 15 of 17 cases of ACTH-dependent Cushing's syndrome, and localized the lesion in 8 of 13 cases of microadenoma.In conclusion, IPSS with CRH stimulation has high diagnostic accuracy in the differential diagnosis of ACTH-dependent Cushing's syndrome, but still has the limitations on the localization of microadenoma.
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Activation of phosphatidylinositol 4, 5-biphosphate(PIP2) cascade by thyroid stimulating antibody.
Jae Hoon Chung, Bo Youn Cho, Jae Seok Jeon, Kyong Soo Park, Seong Yeon Kim, Hong Kyu Lee, Chang Soon Koh
J Korean Endocr Soc. 1993;8(4):422-431.   Published online January 1, 2001
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No abstract available.
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Preoperative treatment of acromegaly with long-acting somatostatin analog octreotide.
Seok In Lee, Hyun Kyu Kim, Kyung Soo Ko, Kyong Soo Park, Seong Yeon Kim, Bo Youn Cho, Hong Kyu Lee, Chang Soon Koh, Hun Ki Min, Hyun Jip Kim, Heu Won Jeong, Dae Hee Han
J Korean Endocr Soc. 1993;8(1):35-41.   Published online January 1, 2001
  • 1,066 View
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No abstract available.
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Combined estrogen-progesterone(Divina@) treatment in postmenopausal women with special reference to serum lipoprotein patterns.
Min Seon Kim, Tae Geun Oh, Kyung Soo Ko, Kyong Soo Park, Seong Yeon Kim, Hong Kyu Lee, Chang Soon Koh, Hun Ki Min, Hak Chul Jang, Yong Ki Min, In Kwon Han
J Korean Endocr Soc. 1992;7(3):267-272.   Published online January 1, 2001
  • 999 View
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No abstract available.
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Effect of prolactin on aldosterone secretion in humans.
Yun Ah Sung, Seong Yeon Kim, Bo Youn Cho, Hong Kyu Lee, Chang Soon Koh, Hun Ki Min, Seung Keun Oh
J Korean Endocr Soc. 1992;7(2):136-142.   Published online January 1, 2001
  • 998 View
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AbstractAbstract PDF
No abstract available.
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Clinical features of autonomously functioning thyroid nodules.
Min Ho Shong, Jun Key Chung, Seong Yeon Kim, Myung Chul Lee, Bo Youn Cho, Hong Kyu Lee, Chang Soon Koh, Hun Ki Min
J Korean Endocr Soc. 1992;7(2):115-120.   Published online January 1, 2001
  • 1,132 View
  • 17 Download
AbstractAbstract PDF
No abstract available.
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Parathyroid imaging: comparison of technetium-thallium subtraction scan, ultrasonography and computed tomography.
Yong Soo Park, Suk In Lee, Seong Yeon Kim, Myung Chul Lee, Bo Youn Cho, Hong Kyu Lee, Chang Soon Koh, Hun Ki Min, Sung Keun Oh, Chai Hyung Park, Myung Shik Lee
J Korean Endocr Soc. 1992;7(1):52-60.   Published online January 1, 2001
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No abstract available.
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Amiodarone-induced thyrotoxicosis.
Min Ho Shong, Ka Hee Yi, Seong Yeon Kim, Bo Youn Cho, Hong Kyu Lee, Chang Soon Koh, Hun Ki Min
J Korean Endocr Soc. 1991;6(3):276-279.   Published online January 1, 2001
  • 1,063 View
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No abstract available.
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Changes in diurnal variation of thyrotropin secretion in nonthyroid- al illness and its mechanism.
Bo Youn Cho, Min Ho Shong, Ka Hee Yi, Jae Joon Koh, Kyung Soo Ko, Kyoung Soo Park, Seong Yeon Kim, Hong Kyu Lee, Chang Soon Koh, Hun Ki Min
J Korean Endocr Soc. 1991;6(2):133-140.   Published online January 1, 2001
  • 918 View
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AbstractAbstract PDF
No abstract available.
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Changes of blood pressure and RBC membrane Na+ transport in thyroid disease.
Won Bae Kim, Kyung Soo Ko, Suk In Lee, Seong Yeon Kim, Bo Yeon Cho, Hong Kyu Lee, Chang Soon Koh, Hun Ki Min
J Korean Endocr Soc. 1991;6(1):25-37.   Published online January 1, 2001
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AbstractAbstract PDF
No abstract available.
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Endocrinol Metab : Endocrinology and Metabolism