Endocrinology and Metabolism

Volume 11(2); June 1996

Original Articles

No title in English.: No authors listed No authors listed; J Korean Endocr Soc. 1996;11(2):145-151. Published online November 7, 2019

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Abstract PDF: No abstract available.

Bone and Cytokines.: Hyun Koo Yoon; J Korean Endocr Soc. 1996;11(2):152-155. Published online November 7, 2019

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Abstract PDF: No abstract available.

Effects of Interleukin-6 on mRNA Expression of Alkaline Phosphatase, Osteopontin, Decorin and a1(1)-collagen in Human Bone Marrow Stromal Cells.: Chul Hee Kim, Dong Kwan Kim, Seung Il Park, Kwang Hyun Sohn, Ghi Su Kim; J Korean Endocr Soc. 1996;11(2):156-162. Published online November 7, 2019

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Abstract PDF: Background
Inter1eukin-6(IL-6) is known to be produced by osteoblastic cells and to have impartant role in regulation of bone remodelling, Most previous studies indicated that IL-6 bas a major role in stimulating osteoclastic resorption by increasing recruitment and proliferation of preosteoclasts. But its autocrine effect on osteoblastic cells has not been well established yet. Therefore, we studied the effects of IL-6 on messenger RNA (mRNA) expression of proteins that are characteristic of osteoblastic cells in human bone marrow stromal (osteoprogenitor) cells (hRMSC). Methods: The expression of mRNAs for alkaline phosphatase, al(1)-collagen, osteopontin and decorin were studied by northern blot analysis after 3 7 days' treatrnent with IL-6 in the concenttation range of 101,000 U/ml. Results: The mRNA levels for any of the osteoblastic proteins studied did not change significantly by IL-6 treatment up to the concentration of 1,000 U/ml. Conclusion: These results suggest that IL-6 does not have a significant role in differentiatian or activities of human bone rnarrow stromal.

Clinical Features of Multiple Endocrine Neoplasia Type I in Koreans.: Chul Hee Kim, Ghi Su Kim, Hong Kyu Kim, Joong Yeol Park, Young Kee Shong, Ki Up Lee; J Korean Endocr Soc. 1996;11(2):163-174. Published online November 7, 2019

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Abstract PDF: Background
Multiple endocrine neoplasia type I(MEN I) is a rare, eomplex, and potentially lethal disease. In Korean, only five anecdotal cases were reported as yet. The authors rescently experienced four cases of MEN I, and analysed the clinieal characteristics of MEN I in Koreans. Methods: The authors evaluated nine cases of MEN I, retrospectively. Four cases were analysed by clinical records in patients admitted to Asan Medical Center and five cases were reviewed by previously reported Korean literature from 1986 to 1995. Results: The average age was 39 years(ranged from 33 to 59 years). Eight of the nine patients had hyperparathyroidism documented by elevated serum calcium and PTH level with or without evidence of parathyroid mass. Initial presenting manifestations were symptomatic urinary stone, hypoglycernia due to insulinoma, hypogonadism, acromegaly, or peptic ulcer. Eight of nine patients had pancreatic islet cell tumors, and three of them were be malignant by radiologic and/or pathologic findings. The pancreatic tumors produced various hormones, such as gastrin, insulin, glucagon, or combination of them. Six of the nine cases had pituitary lesion. The most cornmon pituitary tumor was prolactinoma and the remaining was GH or GH and TSH producing tumor. In addition to the major components of MEN I, four had adrenocortical hyperplasia or adenoma and two had carcinoid tumor. There was only one familial case. Conclusion: The clinical charateristics of MEN I in Korean are mostly not different from the previous reports except older age at diagnosis, more comrnon adrenal involvement(44%) and gastrointestinal carcinoid tumor(22%). Although only one case was familial, more cases could be found if careful screening were done for the family members of the MBN I patients. In addition, screening and close follow up for endocrine pancreatic tumors are required for MEN I patients without detectable pancreatic lesion becau~se the malignant potential of pancreatic tumors has beeome an increasing concem for the prognosis of MEN I.

Diagnostic Value of Thallium-201 Scan in The Thyroid Nodule.: Jeong Sik Moon, Kee Hyeon Kim, Chul Sung Park, Jae Haak Lee, Gyeong Heon Jeong, Sun Ho Kim, Jung Kyu Lim, Chin Duk Huh, Hyeng Suk Cho, Jang Shin Son; J Korean Endocr Soc. 1996;11(2):175-181. Published online November 7, 2019

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Abstract PDF: To investigate diagnostic value of Thallium 201(T1-201) thymid scan in differentiating malignant nodule from benign, 135 patients with thyroid nodule were evaluated with Tl-201 thyroid scan, fine needle aspiration(FNA), clinical characteristics and laboratory data. Each had histological diagnosis after thyroidectomy. Tl-201 scan had a sensitivity of 67.3% and a specificity of 66.3% and FNA had sermitivity of 46.9% and specificity of 100% in predicting malignancy. As the size of thyroid nodule and age of patient incteases, diagnostic value of 11-201 thyroid scan was improved. In the thyroid nodules larger then 3cm, sensitivity, specificity and negative predictive value were 100%, 70% and 100%, reqectively. By cornbining Tl-201 throid scan and FNA, sensitivity had 91.8%. From the data we conclude that Tl-201 thyroid scan is valuable with adjuvant diagnostic method in differentiating malignant fmm benign thyroid nodule and treatment planning.

Graves' disease associated with Hashimoto's thyroiditis.: Seong Bin Hong, Myoung Sik Kim, Kwan Woo Lee, Mi Rin Kim, Hyoun Ho In, Kyoung Rae Kim, Young Up Cho, Young Chae Joo; J Korean Endocr Soc. 1996;11(2):182-188. Published online November 7, 2019

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Abstract PDF: Hashimotos thyroiditis and Graves disease have been thought to be the autoirnmune diseases having their distinct and separate clinical and pathologic features. Because of the partial and complete simi1arity in histologic feature, it has been hypothesized that Hashimoto's thyroiditis and Oraves disease may be interrelated. Several patients who had been diagnosed as Graves disease showed features of hypothyroidism, and were proven to have histologie features of Hashimotos thyroiditis in their thyroid tissue. Two meehanisms had been suggested to explain tbis phenomenon. One is that the combined Hashimotos thyroiditis in Graves' disease may become predominant with time, The other is that the amount of TSH receptor blocking antibody may increase in the course of Graves disease. Early recognition of these patients would be impartant to estabilish therapeutic plan. Futhermcee, extensive study of these patients would give more understanding of the mechanism of these diseases. Here we report 5 cases of clinically diagnosed Graves disease with pathologic features of Hashimotos thyroiditis or focal lymphocytic thyroiditis.

Ca Effects on Synthesis and Secretion of Insulin-like Growth Factor(IGF-I) and IGF-Binding Proteins by the Perfased Rat Liver.: Dae Yeol Lee, Chang Won Kang, Jung Soo Kim; J Korean Endocr Soc. 1996;11(2):189-198. Published online November 7, 2019

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Abstract PDF: Background
The insulin-like growth factors, IGF-I and -II, are important metabolic factors involved in cell growth and metabolism. The IGFs are produced in most organs but the liver is believed to be the principal source of circulating IGF-I. It has been demonstrated that calcium in the extracellular fluid has effects on the secretion of various hormones such as parathyroid hormone, insulin and atrial natriuretic peptide in variety of tissues. Methods: In arder to investigate that liver produce IGF-1 and IGFBP-3 and the role of calcium in the regulation of IGF-I and IGFBP-3 secretion and synthesis, the rat liver perfusian model was employed. The liver was perfused with Krebs-Henseleit bicarbonate(KHB) buffer containing 0 or 2.5 mM CaC12 for 2 hours, and 4-ml fractions of perfusates were collected and determined the concentration of IGF-I and IGFBP-3 by using RIA after Sep-pak extraction and Western ligand blot. respectively. To increase or decrease the concentration of intracellular calcium, we also used EGTA, calciurn ionophore A23187 increased IGF-I secretion and synthesis in liver(18.13+0.97 vs 15.78+1.01, p<0.01). However, concentration of glucose was not significantly affected by both calcium(2.07+1.44 vs 2.24+1.74) and BGTA(2.01+1A7 vs 3.11+1.01). Conclusion: Our results demonstrate that liver is a major place far IGF-I and IOFBP-3 production and calcium specifically affects the secretion of IGF-I in the liver perfusion, suggesting that the calcium environment of hepatic cells may influence the secretion of the hepatic IGF-I.

Case Reports

A Case of Pituitary Feedback Adenoma Caused by Primary Hypothyroidism.: Soon Jib Yoo, Sang A Chang, Yoo Bae Ahn, Hyun Sik Son, Kun Ho Yoon, Moo Il Kang, Bong Yun Cha, Kwang Woo Lee, Ho Young Son, Sung Koo Kang, Myung Hee Chung; J Korean Endocr Soc. 1996;11(2):199-206. Published online November 7, 2019

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Abstract PDF: A 14-year-old girl presented with severe headache and grand mal seizure. A magnetic resonance imaging(MRI) of brain showed a pituitary mass(1.0X1.5X1.3cm) incidentally during seizure evaluation. On physical examination, nodular goiter was detected on her anterior neck. The hormone study showed markdly increased basal thyroid stimulating hormone(TSH) level compared to thyroid hormone level, hyperprolactinemia and decreased basal growth hormone level. TSH and prolactin showed exaggerated response to thyrotropin releasing hormone(TRH) and the growth hormone showed delayed and blunted response to insulin-induced hypoglycemia. With the results of thyroid autoantibody and thyroid scan, the diagnosis of Hashimoto's thyroiditis was possible. Thyroid hormone and anticonvulsant drug were started with close observation of clinical status under the impression of pituitary feedback adenoma caused by hypothyroidism. After 3 months replacement therapy of levothyroxine sodium, she achieved euthyroid state with disappearance of headache and nodular goiter. After continuous replacement therapy for 9 months more, the pituitary mass was successfully regressed on follow up MRI with normalization of basal prolactin level. Grand mal seizure was developed after withholding anticonvulsant drug even though continuous admmistration of thyroid hormone. Because of similarity among pituitary adenoma discovered incidentally, careful hormonal study and high index of suspicion should be maintained to achieve correct diagnosis in order to avoid unnecessary pituitary surgery in these patients.

A Case of Thyroid Abscess by Staphylococcus Aureus.: Byeong Sun Kang, So Young Choi, Jeong Ook Eim, Ho Gyreong Chung, Byeong Gun Park, Dong Youl Park, Maeng Youl Chun, Jeong Woo Shin, Sun Il Chung; J Korean Endocr Soc. 1996;11(2):207-213. Published online November 7, 2019

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Abstract PDF: Acute thyroid abscess is an uneommon type of neck infection. We experieneed a case of staphylococcal thyroid abscess in 29 year old man, diagnosed by needle aspira~tion and culture of the aspirate. The patient had complained fever and slowly growing anterior neck swelling. Needle aspiration of the cold nodule prior to broad spectrum antibiotics was performed. After Surgical excision combined with antibiotics, he was discharged with elinical improvement. The laboratory diagnosis and clinical course was summarized and is reported with relevent references.

A Case of Subsequent Papillary Carcinoma of the Thyroid gland and Hashimoto's Thyroiditis.: Sang Woong Han, Yong Seon So, Seok Hwan Kim, Ki Hyun Kwon, Tae Hyeung Kim, Jong Soon Kim, Kwang Hoe Kim, Byung Doo Lee; J Korean Endocr Soc. 1996;11(2):214-220. Published online November 7, 2019

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Abstract PDF: The association of thyroid carcinoma and Hashimotos thyroiditis in same thyroid gland is controversial. Incidence of carcinoma who has Hashimotos thyroiditis has been reported from 0.5 to 22.5 per cent by Crile and by Hirabayashi et al. The reason that there are such great diffarences in the reported incidences of carcinoma in Hashimotos disease is the result of the way the material is reported. The carcinomas of the thyroid which occur in association with Hashirnotos thyroiditis are predominently papillary tumors of lower grade malignancy. Thyroid carcinoma need not be feared in patimts with Hashimotos thymiditis, if one examines the ghmd catefully. When patients with Hashimotos disease are treated with thyroxine, there is little or no tendency for Hashimotos disease propess to clinieally detectable carcinoma of the thymid, and the microcarcinoma does not appear. In this case, single thyroid nodule was detected in Hashiimotos disease patient who was treated with thyroxine. There was no significant volume change of thyroid nodule despite of TSH suppression therapy during six months. Therefore we perforrned FNABC twice, the results were highly suspicious thyroid malignancy and subtotoal thyroidectomy was performed. The final pathologic result was microscopic papillary carcinoma with background Hashlmotos thyroiditis. In conclusion, we experienced a case of subsequent microscopic papillary carcinoma of the thyroid in patient with Hashimotos thyroiditis who was TSH suppression therapy with thyroxine.

A Case of Primary Parathyroid Carcinoma with full-brown Symptom.: Chang Soo Ryu, Deok Ki Kim, Kee Hyun Park, Shi Gyeong Seong, Dong Ho Kim, Sang Min Woo, In Sung Cho; J Korean Endocr Soc. 1996;11(2):221-226. Published online November 7, 2019

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Abstract PDF: Primary hyperparathyroicism is a state of hypersecretion of PTH by the parathyroid. The etiology has not been established. The three possible etiologies of piimary hyperparathyroidism and incidences are adencena(83%), hyperplasia(15%), and carcinoma(1~2%). Parathyroid carcinoma usually presents in the fourth decades. The hallmark preoperative signs are hypercalcemia(serum calcium 15mg/dl). Palpable neck mass and bane and renal disease. Patients may present with multiple signs and syrnptoms, including recurrent nephrolithiasis, peptic ulcers, mental change, less frequently, extensive bone resorption. However, with greater awareness of the disease and wider use of screening tests, including blood calcium determinations, the diagnosis is frequently made in patients who have no symptoms and minimal, if any, signs of the disease ather than hypercalcemia and elevated levels of parathyroid Hormone. An 38-years-old woman was admitted to the hospital due to pain on the left knee joint. We experienced full-brown symptom pertaining to hyperpara- thyroidism. Thus we report a case herein and also discuss clinical anifestation, histologic features and treatment.

A Case of Mediastinal parathyroid adenoma localized by technetium-99m sestamibi scanning.: Bong Yun Cha, Kwang Woo Lee, Ho Young Son, Sung Koo Kang, Ki Ho Song, Sung Hee Lee, Won Hee Han, Hyung Sun Sohn; J Korean Endocr Soc. 1996;11(2):227-232. Published online November 7, 2019

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Abstract PDF: We present a patient with primary hyperparathyroidism in whom preoperative Tc-99m sestarnibi scanning cleary demonstrated mediastinal parathyroid adenoma. After resectian of tumor through median sternotomy, he was restored to the normocalcemia. This case suggests that Tc-99m sestamibi scanning may be a useful method in the preoperative localization of mediastinal parathyroid adenoma.

Nerepinephrine Secreting Pheochromocytoma in the Organ of Zuckerkandl With Epinephrine Granules in Cytoplasm.: Eui Suk Kim, Gang Ryong Lee, Won Seok Lee, Jeong Aa Lee, Jie Jeong Jang, In Cheol Sunwoo, Dae Ha Kim, Gwang Seob Lee; J Korean Endocr Soc. 1996;11(2):233-239. Published online November 7, 2019

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Abstract PDF: Extraadrenal pheochromocytomas developed from the paraganglia other than adrenal medulla are uncommon tumors. Such lesions have been reported that as much as 10% of retroperitoneal paragliomas arise outside the adrenal gland. But their incidence and prognosis are changing partly as a result of progression in developmental mechanism, diagnostic tools and concepts including ultrastructure, immunohistochemistry. The ultrastructure of chromaffine neoplasm from adrenal and extraadrenal tissues has been studied with chrarnaffine granule specificity and type of catecholamine content. With rare exceptions, extraadrenal chrornaffine tumor mainly has high concentration of norepinephrine which is suggested as dict relationship to numoruos electrone dense granular bodies in the cell cytoplasrn. High or intermediate level of epinephrine in tissue is associated with cytoplasmic granular bodies of much less density, Recently we experienced the exception, a case of norepinephrine secreting pheochrom-ocytoma in the organ of Zuckerkandl with epinephrine granules in cytoplasm and this discrepancy probably due to the plasticity - the differences in developmental process and local factors between adrenal medulla and extraadrenal tissues.

Two Cases of hypoglycemia in IDDM patients with insulin antibody.: G A Kim, K W Lee, M R Kim, Y J Kim, J N Jang, S K Bae, B G Son; J Korean Endocr Soc. 1996;11(2):240-246. Published online November 7, 2019

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Abstract PDF: Hirata et al. first described the association of insulin antibodies with hypoglycemia attacks and decreased glucose tolerance in a patient who had not previously received insulin injections. Since that time there have been additional reports in the Japanese literature. Insulin antibodies are present in most of the patients who received insulin for a period of time, usually exceeding six weeks. There were several reports of hypoglycemia in patients with non-insulin-dependent diabetes mellitus who had developed insulin antibody after insulin administration and also in patients with insulin dependent diabetes mellitus. It is well known that either insulin antibody to the lower affinity site or insulin receptor antibody can be a eause of hypoglycemia. Recently, we experienced two cases of hypoglycemia in patient with insulin dependent diabetes rnellitus and non- insulin- dependent diabetes mellitus who had developed insulin antibody after insulin administration. Hereby we present these cases with review of the literature.

Diffuse Nesidioblastosis of the Pancreasin Adult with Persistent Hyperinsulinemic Hypoglycemia.: Seoung Ha Lee, Kean Young Hyoung, Geom Seog Seo, Bong Joo Shin, Chung Gu Cho, Kwang Soo Yang, Kwon Mook Chae, Ki Jung Yun; J Korean Endocr Soc. 1996;11(2):247-253. Published online November 7, 2019

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Abstract PDF: Nesidioblastosis is a term that describes multifocal hyperplasia of all panereatic cell components and is characterized primarily by their disorganization and proliferation throughout the entire panaeas. Adult onset nesidioblastosis is an extremely rare entity associated with hypersecretion of insulin. The authors have recently experieneed a case of nesidioblastosis in an adult. A 41-year old man was admitted due to interrnittenr hypoglycemic symptoms, that had been relieved by carbohydrate ingestion. Hyperinsulinemic hypoglycemia was documented during prolonged fast. Under the presumptive diagnosis of insulinoma, abdominal CT, celiac angiogram and percutaneous transhepatic portal venous sampling were done but we could not find any definitive mass. Eight-five percent of the panacas was removed. Pathologic examination of the resected pancreas revealed irregularly sized islets and scattering of small endocrine cell clusters throughout the acinar tissue and ductuloinsular complex.

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