- One Family of Familial Combined hyperlipidemia Associated with Various Metabolic Abnormalities.
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Kwan Woo Lee, Sung Kyu Lee, Yun Suk Chung, Hyun Man Kim, Yoon Jung Kim, Eun Kyung Hong, Bong Nam Chae, Ji Won Park
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J Korean Endocr Soc. 1999;14(2):418-424. Published online January 1, 2001
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- Familial combined hyperlipidemia is one af the manogenic disorders frequently found in humans and is seen in 0.5~2% of the general populatian, accounting for at least 10% of persons with pemature atlmmcletusis. The distinguishing feature of familial combined hyperlipidemia, in camparison with other single-gene abnarmalities of lipoprotein metabolism, is that not all affected members have the same plasma lipid phenotype; some individuals have an elevation of cholesterol concentration alane(type IIa lipoprotein pattern), while some athers have an elevation of triglyceride concentration alone(type IV pattem), and still others have elevations of both values(type IIb pattem). In any one persan, the lipid phenotype can change as a result of dietary or drug treatment. Familial combined hyperlipidemia should be suspected in those subjects with moderate hypertriglyceridemia and/or moderate hypercholestaolemia (lipoprotein types IIa, Ilb, IV), especially when premature coronary heart disease is evident in the family histary. Low plasma HDL-cholesterol, obesity, insulin resistance and hyperuricemia are often . Family members affected by familial combined hyperlipidemia should be identified and be treated, since tbe condition is associated with premature caronary heart diasease. We have found one family of familial combined hyperlipidemia with one member(case 1) associated with insulin resistance, hyperuricemia and gout, and another member(case 2) associated with diabetes mellitus and infertiTity.
- A Case of Methimazole Induced Agranulocytosis Complicated with Deep Neck Abscess.
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Kwan Woo Lee, Sung Kyu Lee, Yun Suk Chung, Hyun Man Kim, Yoon Jung Kim, Eun Kyung Hong, Bong Nam Chae, Jin Ho Lee, Chang Young Ha, Joon Sung Park
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J Korean Endocr Soc. 1998;13(4):617-621. Published online January 1, 2001
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- The thiourea derivatives, propylthiouracil and methimazole are in widespread use for the treatment of hyperthyroidism. The untoward side effects of these drugs are not infrequent and agranulocytosis is the most serious side effect them. We observed one case of methimazole induced agranulocytosis complicated by deep neck abscess. A 54-year-old woman was admitted because of fever, chilling and sore throat for 1 week. The symptom was developed after receiving methimazole 30mg daily day due to hyperthyroidism during last 3 months. Physical examination revealed hyperemic, enlarged tonsils and tender swelling of the right lower neck The peripheral blood total leukoeyte count was 1,500/mm' (absolute neutrophil count, ANC 9) and a peripheral blood smear revealed few neutrophil. The patient was administered G-CSF 2 mg/kg daily, and on the fifth day of hospitalization, fever subsided and ANC increased to 3,431. On the 11th day, fever developed again and the tenderness and swelling in both lower neck area were aggrevated. Computed tomography of the neck was performed, and revealed a large deep neck abscess. After pus aspiration and antibiotics therapy, the neck abscess was disappeared.
- Antibody-dependent Cell-mediated Cytotoxitity as a Prognostic Indicator in the Medical Treatment of Graves' Disease.
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Kwan Woo Lee, Young Goo Shin, Hye Rim Ro, Sung Kyu Lee, Yun Suk Chung, Hyun Man Kim, Yoon Jung Kim, Eun Kyung Hong, Bong Nam Chae
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J Korean Endocr Soc. 1998;13(4):554-562. Published online January 1, 2001
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- BACKGROUND
The several forms of treatment of Graves disease-thyroidectomy, antithyroid drugs and radioiodide therapy-are in wide use now. But which therapy is best is a matter of debate. Some authors reported that in patients who underwent thyroidectomy, higher titers of serum antimicrosomal antibody were associated with 1) higher formation rates of germinal centers, 2) more lymphocyte infiltration in the thyroid tissue, 3) higher incidence of hypothyroidism, and 4) lower incidence of recurrence. We were interested in the relationship of thyroid autoantibody titers, ADCC(antibody-dependent cell-mediated cytotoxicity) activity and the clinical response to antithyroid medication. METHODS: We measured ADCC activities from patients in Graves disease(n-48), Hashimoto thyroiditis(n=17) and normal control(n=9). The patients of Graves disease were followed up for more than 1 year, and they were grouped into A(n=17, well responsed group to antithyroid medication) and B(n=31, poorly responsed group). We examined ADCC activities of patients' sera by chromium release assay. RESULTS: 1) Mean age of patients with Graves disease was 34.4210.4 years and 15 patients were male(31%). 2) Results of thyroid function tests of the Graves' patients were T 585.9 +/- 255.3 ng/dL, T4 21.3 +/- 12.2 mg/dL, TSH 0.11 +/- 0.06mIU/mL. Concentrations of antimicrosomal antibody, antithyroglobulin antibody and thyrotropin binding inhibitory immunoglobulin were 1279.1 +/- 1486.7 IU/mL, 488.1 +/- 751.1 IU/mL, and 38.5 +/- 33.4U/L respectively. 3) There was no significant difference between levels of thyroid hormones or concentrations of thyroid autoantibodies and ADCC activities in graves patients. 4) The ADCC activity of the Graves patient group(24.49%) was significantly higher than that of the normal control group(3.76%), and significantly lower than that of the Hashimotos thyroiditis group(36.34%). 5) There was no significant difference in ADCC activity between group A(18.24 +/- 13.44%) and B(27.91 +20.02%). CONCLUSION: From this results, we suggested that ADCC activity seems to be no value as a prognostic factor in predicting the response to antithyroid drugs in Graves disease patients. But, further studies, larger number of patients and long-term follow up, are needed.
- Impaired Glucose Tolerance Associated with Klinefalter Syndrome.
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Kwan Woo Lee, Choong Keun Cha, Chul Uhm, Oh Young Kwon, Sung Kyu Lee, Yun Suk Chung, Hyun Man Kim, Yoon Jung Kim, Eun Kyung Hong, Bong Nam Chae
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J Korean Endocr Soc. 1998;13(3):495-500. Published online January 1, 2001
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- Klinefelter syndrome is one of the most common forms of primary hypogonadism and infertility in males. It is a clinical syndrome consisting of gynecomastia, azoospermia, and increased urinary excretion of follicle-stimulating hormone. Fequency of diabetes mellitus, emphysema, asthma, breast cancer increase in Klinefelter syndrome. We report a 16-year-old male patient with impaired glucose tolerance in association with Klinefelter syndrome, which was confirmed by chromosome analysis. The mechanism of impaired glucose tolerance in this patient was peripheral insulin resistance which clarified by euglycemic hyperinsulinemic clamp test.
- A Case with Multifocal Langerhans Cell Granulomatosis Involving the Thyroid Gland.
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Kwan Woo Lee, Chul Kwon Chung, Sung Chul Hwang, Hyun Hee Yim, So Yun Park, Sung Kyu Lee, Yun Suk Chung, Hyun Man Kim, Yoon Jung Kim, Eun Kyung Hong, Bong Nam Chae
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J Korean Endocr Soc. 1998;13(3):466-472. Published online January 1, 2001
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- Langerhans cell granulomatosis(LCG), previously termed 'Histiocytosis-X', is one of the rare disease. LCG is characterized by proliferation of Langerhans cells in a unifocal or multifocal pattern. And LCG may be manifested in a variety of way, ranging from a spontaneously regressing solitary lesion to a multisystem life-threatening disorder. This disease usually involves the bone, lung, skin and lymph node. The most common endocrinologic abnormalities in LCG are diabetes insipidus and growth hormone deficiency. LCG involving the thyroid gland is extremely rare and only a small numbers of cases have been reported worldwide. A 41-year-old diabetic female visited the hospital due to the neck swelling for 3 months and she also complained of polyuria, polydipsia and easy fatigue. LCG involving multiple organs included thyroid gland was diagnosed by high-resolution CT of lung, by characteristic histological findings of the thyroid lesion and by the immunohistochemical staining for S-100 protein and OKT 6(CD la). She is followed at OPD without any medication.
- Three Cases of Primary Hypothyroidism with Down Syndrome in Adult.
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Kwan Woo Lee, Young Goo Shin, Sung Keun Lee, Sung Kyu Lee, Yun Suk Chung, Hyun Man Kim
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J Korean Endocr Soc. 1998;13(3):453-458. Published online January 1, 2001
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- Down syndrome is perhaps the most common genetic condition associated with mental retardation. In cytogenetic examination, trisomy 21 is in 95% of Down syndrome, and the others are mosaicism, translocation or deletion. There are many associated diseases with Down syndrome such as, thyroid function abnormality, congenital heart disease, intestinal blockage, and so on. Hypothyroidism appeared in 15% before adolescent in Down syndrome patients. In Korea, there were several reports of Down syndrome with hypothyroidism in childhood but not in adulthood. And we had three cases of hypothyroidism with Down syndrome in adulthood. Cytogenetic examination revealed trisomy 21 in the 2 cases and 1 case of mosaicism. Antithyroid antibody was positive in one case. None of these cases was admitted due to symptoms of hypothyroidism. It is very difficult to make the diagnosis of hypothyroidism in Down syndrome because of similarity in symptoms between Down syndrome and hypothyroidism. Thus, periodic thyroid function test should be made in Down syndrome, and this could be a part of improving quality of life in Down syndrome.
- Two Cases with Squamous Cell Carcinoma of the Thyroid Gland.
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Kwan Woo Lee, So Yun Park, Sung Kyu Lee, Yun Suk Chung, Hyun Man Kim, Yun Mi JIn, Yoon Jung Kim, Eun Kyung Hong, Bong Nam Chae, Ho Young Lim
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J Korean Endocr Soc. 1998;13(3):446-452. Published online January 1, 2001
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- Primary squamous cell carcinoma of the thyroid is rare, presenting much less than one percent of all primary thyroid malignancies. Most cases have been reported in elderly patients with a history of goiter. It is necessary to differentiate between primary squamous cell carcinoma and secondary involvement from other sites. Secondary involvement of the thyroid may be more amenable to palliation or cure. The treatment of choice in primary squamous cell carcinoma is radical surgery in resectable cases, but the squamous cell carcinoma behaves aggressively and carries a uniformly poor prognosis regardless of the treatment. We had an experience of a primary squamous cell carcinoma of the thyroid in two elderly patients. These patients presented a typical feature of a primary squamous cell carcinoma of the thyroid, which has been rarely reported in Korea.
- A Case of Surgically Treated Insulinoma in Pregnancy.
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Kwan Woo Lee, Euy Young Soh, Young Goo Shin, Sung Keun Lee, So Yun Park, Sung Kyu Lee, Yun Suk Chung, Hyun Man Kim, Kyung Joo Hwang, Yun Mi JIn
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J Korean Endocr Soc. 1998;13(2):288-294. Published online January 1, 2001
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- Insuliin secreting tumor is 70% prevalent disease in female and predoadnant in forth and sixth deeade. The incidence of insulinoma is one case per 250,000 patient-years. Insulinoma in pregnancy was extremely rare, and the prevalence was not reported. The diagnosis of an insulinoma is depend on demonstration of hypoglycemia with high insulin and C-peptide levels. Immunoreactive insulin/plasma glucose ratio0.3 in particular support the diagnosis of an insulinoma. Fetal complication would be developed because of hypoglycemia. In approximately half of the cases reported, surgical exploration was done during pregrancy, the remainder were treated after delivery. Insulinoma poses serious diagnostic and therapeutic problems when she is pregnant. We experienced a case of insulinoma in pregnancy that represented Whipples triad and was treated by surgical intervention.
- A Case of non-islet Cell Tumor Hypoglycemia Due to Gepatoma-increased serum subfraction of big insulin-like growth factor II.
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Kwan Woo Lee, Hyun Soo Kim, Yun Suk Chung, Hyun Man Kim, Myung Ho Yoon, Joon Ho Ko, Hyo Chul Kim, Young Soo Kim, Sung Won Cho
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J Korean Endocr Soc. 1997;12(4):667-671. Published online January 1, 2001
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- Hypoglycemia due to non-islet cell tumor is usually associated with hypersecretion of big insulin-like growth factor II (IGF-II). This big IGF-II cannot form ternary IGF complex, and is biologically more active in peripheral tissue, inducing increased glucose utilization and hypoglycemia. A 57-year-old man developed severe hypoglycemia due to hepatocellular carcinoma. To control hypoglycemia, the patient required continuous glucose infusion. The circulating levels of cortisol and free T4 were in the normal range. The plasma levels of insulin, C-peptide, IGF-I, IGF binding protein-3 (IGFBP-3), and total IGF-II levels were decreased. Radioimmunoassay of IGF-II revealed that big IGF-II immunoreactivity markedly increased compared to that of normal control. In this patient, it was strongly suggested that big IGF-II might be a cause of severe intractable hypoglycemia.
- A Case of Thymic Carcinoid Tumor Associated with Ectopic ACTH Syndrome.
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Kwan Woo Lee, Young Goo Shin, Sung Keun Lee, Sung Kyu Lee, Yun Suk Chung, Hyun Man Kim, Yo Han Cho, Kwang Hyun Ko, Jung Sun Kim, Chul Shim
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J Korean Endocr Soc. 1997;12(4):647-654. Published online January 1, 2001
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- The syndrome of ectopic production of ACTH by non-pituitary neoplasm occurs with various types of tumors. ACTH-producing thymic carcinoid tumor is rare and has not been reported in Korea. We have experienced a 36-year-old male patient with ACTH-producing thymic carcinoid tumor, presenting symptoms of generalized weakness and weight gain. Clinical presentation, radiologic and hormonal evaluation, and pathologic examination were compatible with ACTH-producing thymic carcinoid tumor. The immunohistochemical staining of the thymic carcinoid tumor showed positivity for ACTH. Primary and metastatic tumor and both adrenal glands were resected. Radiation therapy and chemotherapy were performed. The prognosis of this patient is thought to be poor.
- Four Cases of Newly Developing Goiter During Lithium Carbonate Therapy.
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Kwan Woo Lee, Young Goo Shin, Sung Keun Lee, Sung Kyu Lee, Yun Suk Chung, Hyun Man Kim
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J Korean Endocr Soc. 1997;12(4):621-626. Published online January 1, 2001
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- Since 1949, lithium has been widely used for treatment of manic depressive disorder. It has also been used for agranulocytosis after anticaneer chemotherapy and partially for hyperthyroidism. But it is well known that the long term administration of this drug is associated wih various antithyroid effects such as hypothyroidism, simple goiter, nodules and even thyrotoxicosis. Although the exact mechanism for leading hypothyroidism or goiter is still unknown, the incidence of lithium-induced hypothyroidism is 1-37% during lithium atment. We had an experience of newly developing goiter with or without hypothyroidism during lithium treatment in 4 MDP patients. Among our patients, the duration of lithium administration was from 0.7 months to 11 years, and the development of thyroid abnormality was impossible to predict. They were treated with thyroxine while lithium was discontinued causing favorable outcome. We suggest that routine thyroid function test include thyroid autoimmune antibody screening in patients planning to undergo lithium treatment.
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