- A Case of Methimazole-induced Agranulocytosis and Kikuchi's Disease in a Patient with Graves' Disease.
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Seung Eun Lee, Jihyun Ahn, Jaetaek Kim, Yeon Sahng Oh, Yun Jae Chung
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J Korean Endocr Soc. 2008;23(6):420-424. Published online December 1, 2008
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DOI: https://doi.org/10.3803/jkes.2008.23.6.420
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- Methimazole-induced agranulocytosis is a rare, but critical side effect that should be recognized as soon as possible since it may induce a life-threatening condition when it was overlooked. Histiocytic necrotizing lymphadenitis is also called Kikuchi's lymphadenitis, and this is a rare form of lymphadenitis with a self-limited clinical course and this illness is accompanied by cervical lymph node enlargement, fever and malaise. We recently experienced a patient with methimazole-induced agranulocytosis and Graves' disease, and this was accompanied by Kikuchi's disease; the patient presented with sore throat and multiple enlarged cervical lymph nodes. To the best of our knowledge, there is no previous report on methimazole-induced agranulocytosis combined with Kikuchi's disease. Therefore, we report here on this very rare case along with a brief review of the relevant literature.
- Analysis of the Pharmacokinetics of Recombinant Human TSH in Patients with Thyroid Papillary Carcinoma.
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Tae Sik Jung, Hye Seung Jung, Jung Hwa Jung, Yun Jae Chung, Eun Young Oh, Young Ki Min, Myung Shik Lee, Moon Kyu Lee, Kwang Won Kim, Jae Hoon Chung
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J Korean Endocr Soc. 2006;21(3):204-212. Published online June 1, 2006
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DOI: https://doi.org/10.3803/jkes.2006.21.3.204
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- BACKGROUND
Individual variations of the pharmacokinetics of recombinant human TSH (rhTSH) might influence the efficacy of the radioactive iodine (RAI) uptake. We studied to investigate the individual pharmacokinetics of rhTSH and the effect of the anthropometric parameters on the serum TSH levels in patients with thyroid papillary carcinoma. METHODS: We selected 16 patients with conventional rhTSH administration for the preparation of RAI administration between June 2004 and May 2005. We measured serum TSH levels at 24-hour (prior to second rhTSH injection), 48-hour (peak level, prior to RAI administration) and 96-hour (prior to scanning) after the first rhTSH injection. We analyzed the correlation of each TSH levels with age, height, weight, creatinine clearance, body mass index (BMI), and body surface area (BSA). RESULTS: Peak TSH levels were negatively correlated with weight, BMI, and BSA. Among them, weight was an independent parameter by multivariate analysis. Decrement of serum TSH levels from the peak to the level at 96-hour was negatively correlated with weight, BMI, and BSA. It was positively correlated with increment of serum TSH levels from the level at 24-hour to the peak level. Serum TSH level at 96-hour was lower than 25 mU/L in nine of 16 patients. CONCLUSION: Body weight was inversely correlated with peak TSH level after rhTSH administration. rhTSH-stimulated TSH levels might be exaggerated to unwanted levels, and very rapidly degraded in lower-weighted patients. We should make up for the rhTSH regimen considering the individual variations of its pharmacokinetics.
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Citations
Citations to this article as recorded by  - Efficacy of Low-dose and High-dose Radioactive Iodine Ablation With rhTSH in Korean Patients With Differentiated Thyroid Carcinoma
Ji Young Joung, Ji Hun Choi, Yoon Young Cho, Na Kyung Kim, Seo Young Sohn, Sun Wook Kim, Jae Hoon Chung
American Journal of Clinical Oncology.2016; 39(4): 374. CrossRef
- Efficacy of Octreotide LAR in Acromegalic Patients.
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Ji Youn Kim, Jae Hwan Jee, Chan Ho Yoon, Yun Jae Chung, Byung Wan Lee, Gun Yong Cho, Sang Young Kim, Jae Hoon Chung, Yong Ki Min, Myung Shik Lee, Moon Kyu Lee, Kwang Won Kim
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J Korean Endocr Soc. 2005;20(4):344-352. Published online August 1, 2005
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DOI: https://doi.org/10.3803/jkes.2005.20.4.344
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- BACKGROUND
Octreotide(OC)-LAR is a long-acting preparation of octreotide which has been effectively used to suppress GH/IGF-1 hypersecretion in acromegalic patients. The clinical response, biochemical outcomes, and safety of OC-LAR were evaluated in 27 active acromegalic patients. METHOD: 27patients with an active disease status (according to the clinical picture, GH >5microgram/L and elevated age-matched IGF-1), and previously treated with bromocriptine after surgery, comprised the study population. OC-LAR was given(20mg, i.m., every 4 week for 3 injections, then the doses were titrated individually) and the acromegalic symptoms and adverse reactions recorded. The serum levels of GH and IGF-1 were evaluated every 12 week. The acromegalic symptoms including headache, fatigue and arthralgia, improved in all patients. RESULTS: Gastrointestinal side effects were transient and mild. The levels of GH significantly decreased, from 8.9+/-3.5 to 2.9+/-2.2 microgram/L at 12 weeks(P<0.001, vs. baseline), to 2.9+/-2.1microgram/L after 24 weeks(P<0.001) and to 2.5 +/-1.3microgram/L at 48 weeks(P<0.001). The levels of IGF-1 significantly decreased, from 753.7+/-213.6 to 429.7+/-253.4 microgram/L at 12 weeks(P<0.001, vs. at baseline), to 405.7+/-213.3microgram/L at 24 weeks(P <0.001) and to 348.9+/-144.7microgram/L at 48 weeks(P<0.001). The safelevel of GH is less than 2.5microgram/L and normal age-matched IGF-1 levels were achieved in 63 and 52% of the patients, respectively. CONCLUSION: Octreotide-LAR was well tolerated and effective as an adjuvant treatment in lowering the levels of GH and IGF-1 in active acromegalic patients.
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Citations
Citations to this article as recorded by - Letter: Comparison of the Efficacy of Octreotide Long-acting Repeatable and Lanreotide Autogel in Acromegalic Patients (J Korean Endocr Soc 25:37-45, 2010)
Yu-Bae Ahn
Endocrinology and Metabolism.2010; 25(2): 157. CrossRef - The Effect of Octreotide LAR on GH and TSH Co-Secreting Pituitary Adenoma
Nam Keong Kim, Yu Jin Hah, Ho Young Lee, Sang Jin Kim, Mi Kyung Kim, Keun Gyu Park, Ealmaan Kim, Hyukwon Chang, Hye Soon Kim
Endocrinology and Metabolism.2010; 25(4): 378. CrossRef - Comparison of the Efficacy of Octreotide Long-acting Repeatable and Lanreotide Autogel in Acromegalic Patients
Seul young Kim, Dohee Kim
Journal of Korean Endocrine Society.2010; 25(1): 37. CrossRef - Response: Comparison of the Efficacy of Octreotide Long-acting Repeatable and Lanreotide Autogel in Acromegalic Patients (J Korean Endocr Soc 25:37-45, 2010)
Seul Young Kim, Dohee Kim
Endocrinology and Metabolism.2010; 25(2): 159. CrossRef
- Effects of USF-1, USF-2, PTEN and Thyroid Transcription Factors on the Function and Growth in FRTL-5 Cells.
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Yun Jae Chung, eun Sook Kim, Yong Ki Min, Myung Shik Lee, Moon Kyu Lee, Kwang Won Kim, Jae Hoon Chung
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J Korean Endocr Soc. 2004;19(2):127-140. Published online April 1, 2004
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- BACKGROUND
Upstream stimulatory factors (USFs) and PTEN are known to be tumor suppressants. USFs and PAX-8 were reported to be the functional competitors in sodium iodide symporter (NIS) gene expression. We investigated the effects of USF-1, USF-2, PTEN, and thyroid-specific transcription factors (TTF-1, PAX-8) on the function and growth of thyrocytes of FRTL 5 rat thyroid cells. METHODS: Complementary DNAs of the USF-1, USF-2, PTEN, TTF-1 (homeodomain), and PAX-8 were synthesized from RNA extracted from FRTL-5using an RT-PCR kit. Each of them was transiently transfected to the FRTL-5 cells using the lipofectamine after being cloned into the pcDNA3.1 vectors. Stable cell lines, which were transfected by USF-1, PTEN, TTF-1, and PAX-8, were also obtained from the FRTL-5 cells, respectively. Extracellular cAMP concentrations were measured after 24 hours of incubation with varying concentrations of bTSH (0.1~100 mIU/mL). After, [Methyl-3H] thymidine uptake or 5-bromo-2'-deoxyuridine (BrdU) assay was performed. RESULTS: USF-1 and USF-2 significantly increased cAMP levels and decreased thymidine uptake in both transiently and stably transfected cells (p<0.01). PTEN had a tendency to increase both the cAMP levels and BrdU uptake in stable cells, but had a tendency to decrease thymidine uptake in transiently transfected cells. TTF-1 significantly increased the cAMP levels and either thymidine or BrdU uptake in both transiently and stably transfected cells (p<0.05). PAX-8 significantly increased both the cAMP levels and BrdU assay in stable cells, but in transiently transfected cells, it significantly decreased cAMP concentrations (p<0.01). CONCLUSIONS: These results suggested that both the USF-1 and USF-2 play a role in suppressing the growth of thyrocytes but at the same time, they kept the ability to produce cAMP after TSH stimulation. They had opposing effects on TTF-1 and PAX-8 in terms of the proliferation of thyrocytes
- Analysis of Ret Proto-oncogene Mutation in Korean Patients with Medullary Thyroid Carcinomas.
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Hyung Hoon Kim, Hyun Jin Kim, Yun Jae Chung, Yong Ki Min, Myung Shik Lee, Moon Kyu Lee, Kwang Won Kim, Chang Seok Ki, Jong Won Kim, Jae Hoon Chung
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J Korean Endocr Soc. 2003;18(4):360-370. Published online August 1, 2003
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- BACKGROUND
Medullary thyroid carcinomas (MTC) have been reported as hereditary in about 25 ~30% of cases. The identification of germline mutation in RET proto-oncogene is important in the diagnosis of hereditary MTC, and occurs in three forms: MEN 2A, MEN 2B and familial MTC (FMTC). To evaluate the prevalence of the relationship of RET proto-oncogene mutation and genotype-phenotype was studied in Korean patients with MTC. METHODS: Genomic DNA was obtained from 29 patients, with MTC, who underwent a total thyroidectomy, between 1997 and 2003, at the Samsung Medical Center. There were 7 male and 22 female patients, with an average age of 39, ranging from 20 to 60 years. Exon 10, 11, 13, 14 and 16 of the RET proto-oncogene were amplified, with specific primers, using PCR. A sequencing analysis was performed on the PCR product using an automatic sequencing analyzer. RESULTS: Nine of the 29 patients (31%) were identified as having RET mutations. The average age of these 9 patients was 33 years, ranging from 20 to 51, with a female to male ratio of 2. Five patients had MEN 2A and one had FMTC, with the other 3 thought to have non-hereditary (sporadic) MTC. The 4 patients with MEN 2A had RET mutations on codon 634 of exon 11 (2 patients, C634R; 2 patients, C634Y) and the other patient on codon 618 of exon 10 (C618R). One patient with FMTC had a mutation on codon 634 (C634W). Three patients with sporadic MTC had RET mutations on codon 634 (2 patients, C634Y; 1 patient, C634S). However, no genotype- phenotype relationship could be found, due to the limited number of patients. CONCLUSION: Thirty-one percent (9/29) of the patients with MTC had RET proto-oncogene mutations. Three-quarters (9/12) of the Korean patients with MEN 2A, including another 7 patients reported in 3 papers in Korea, had RET mutations on codon 634 of exon 11 (4 patients, C634R; 4 patients, C634Y; 1 patient, C634W), but a quarter (3/12) had mutations on codon 618 of exon 10 (2 patients, C618R; 1 patient, C618S). Although no relations could be found between the genotypes and phenotypes, extensive prospective studies will be required to verify this.
- Clinical and Hormonal Analysis of Five New Cases and Eight Previously Reported Cases of Isolated ACTCH Deficiency in Korea.
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Eun Young Oh, Byoung Joon Kim, Yun Jae Chung, Dong Joon Kim, Jong Ryul Hahm, Jae Hoon Chung, Yong Ki Min, Myung Shik Lee, Moon Kyu Lee, Kwang Won Kim
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J Korean Endocr Soc. 1999;14(3):568-577. Published online January 1, 2001
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- Isolated ACTH deficiency is an uncommon disorder, which is defined by low cortisol production with low or normal plasma ACTH levels and no other pituitary abnormalities. We report five new cases of this disorder, and summarize the clinical and hormonal features of 8 previously reported cases in Korea plus 5 new cases. 1) The clinical manifestations of isolated ACTH deficiency are variable, non-specific and similar to those seen in adrenocortical insufficiency of any cause, the age of patients ranged from 21 to 66 years old with an average age of 46 years, and the male to female ratio was 10:3. 2) Hyponatremia and hypoglycemia were commmon laboratory findings, so the presence of unexplained hyponatremia or hypoglycemia should always warrant consideration of the diagnosis of isolated ACTH deficiency. 3) 3 of 13 patients accompanied by empty sella suggesting selective destruction of pituitary ACTH producing cells. 4) ACTH response to exogenous CRH or vasopressin was not elicited in all tested cases, suggesting pituitary disorders. 5) Most patients showed dramatic response with oral predinisone. In conclusion, when there are unexplained general weakness, fatigue, weight loss, nausea, vomiting, hypoglycemia, or hyponatremia, isolated ACTH deficiency should be excluded. Immunologic and pathologic studies, and hormonal evolution with glucocorticoid treatment are needed to understand the pathogenesis of isolated ACTH deficiency.
- A Case of Acromegaly with Graves' Disease.
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Jae Hoon Chung, Kwang Won Kim, Byoung Joon Kim, Sung Hoon Kim, Myung Sik Lee, Moon Gyu Lee, Yong Ki Min, Jong Hyun Kim, Eun Young Oh, Yun Jae Chung, Sang Soo Bae
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J Korean Endocr Soc. 1998;13(3):432-438. Published online January 1, 2001
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- Goiter is present in 25-50% of patients with acromegaly, which probably results from IGF- I stimulation of thyroid cell growth. These goiters are usually non-toxic but there have been well documented cases of co-existent hyperthyroidism and acromegaly. Graves disease with acromegaly has been rarely reported compared with the other type of hyperthyroidism due to increased tumoral secretion of TSH. We experienced a 44-year-old woman who presented with Graves disease and acromegaly. Basal serum GH and IGF-I concentrations were 10.8 pg/L and 571.82 ng/mL, respectively (reference value: (5 mg/L and 130-354 ng/mL, respectively). GH was not suppressed less than 2 pg/L during oral glucose loading test. GH was stimulated by TRH. Postcontrast sellar MRI demonstrated ovoid-shaped low signal intensity nodule measuring O.8 cm in diameter in left side of pituitary gland. Thyroid scan(131I) showed enlarged thyroid with increased radioiodine uptake (61.3%). Histologic examination showed acidophilic adenoma. GH and prolactin were positive on immunohistochemical staining. GH was suppressed less than 2.26 mg/L by oral glucose loading following operation. The patient has been followed with antithyroid drug(PTU) medication after operation(TSA).
- A Case of Cushing's Disease due to Large Pituitary Adenoma Treated by Surgery in Combination with Radiotherapy.
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Jae Hoon Chung, Kwang Won Kim, Myung Sik Lee, Moon Gyu Lee, Yong Ki Min, Jong Hyun Kim, Eun Young Oh, Yun Jae Chung, Jung Ho Park
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J Korean Endocr Soc. 1998;13(3):417-422. Published online January 1, 2001
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- Large pituitary adenomas causing Cushings disease are uncommon, and usually present with mild manifestations of Cushings syndrome. Large adenomas may have rapid growth and quickly reach a size large enough to become clinically apparent. These tumors are more frequently invasive than microadenomas, their widespread extensions make radical surgical removal difficult and the ultimate clinical course malignant. We report a case of 37 year-old women presenting amenorrhea, weight gain, and moon face. Sellar magnetic resonance imaging(MRI) demonstrated a large lobulating tumor measuring 3.5cm in diameter, arising from sella turcica, extending up to suprasellar area and invading the cavernous sinuses. Transfrontal adenectomy was performed to remove a mass, but residual mass was remained after surgery. Subsequent external brain radiotherapy(total dose 5400cGy) was performed. Histology revealed an adrenocorticotrophin(ACTH) secreting pituitary adenoma. After treatment, her menstration was started, body weight was reduced, and moon face was disappeared.
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