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Volume 13(2); June 1998
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Original Articles
Recent Advance in Medical Treatment of Erectile Dysfunction.
Dong Soo Ryu, Jun Kyu Suh
J Korean Endocr Soc. 1998;13(2):137-144.   Published online January 1, 2001
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No abstract available.
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Thyroid Tumor and Oncogene.
Moo Il Kang
J Korean Endocr Soc. 1998;13(2):145-149.   Published online January 1, 2001
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No abstract available.
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Effect of ICV Corticosterone on hypothalamic NPY mRNA Expression in food-restricted, Adrenalectomized Rats.
Yeo Joo Kim, Mi Rim Kim, Moon Seok Nam, Yong Sung Kim
J Korean Endocr Soc. 1998;13(2):150-155.   Published online January 1, 2001
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BACKGROUND
Adrenalectomy does impair the expression of hypothalamic NPY gene in the rat and replacement of glucocorticoid by intracerebroventricular(ICV) route resulted in a normalization of refeeding hyperphagia and weight gain in adrenalectomized(ADX), food-deprived rats. The purpose of this study was to assess the direct effect of CNS glucocorticoid on hypothalamic NPY gene expression which occurs following food deprivation in ADX rats. METHODS: Adult male Wistar rats were fitted with ICV cannulae and restricted the food intake for 14 days. Adrenalectomy and sham operation were done on the 10th day and single ICV corticosterone acetate(100ug/2uL) was given in one ADX group(ADX+CORT, n=9) and vehicle (2uL) was given in another ADX group(ADX+VEH, n=9) and sham rats(SHAM+VEH, n=7). After experiment, we measured NPY mRNA on arcuate nucleus by in situ hybridization. RESULTS: The rate of weight loss of ADX rats closely parallded that of sham-operated rats. Plasma glucose and insulin levels were not significantly different in three groups. Hybridization density on the ARC in ADX+VEH rats(0.42+/-0.02uCi/g: p<0.05) was significantly reduced compared to that in sham controls(0.68+/-0. 11uCi/g). ICV corticosterone injection increased the hybridization density in ADX+CORT rats(0.53+/-0.04uCi/g) compared to vehicle alone, although this did not reach that of controls. NPY gene expression was 40% in ADX+VEH rats and 62% in ADX+CORT rats compared to control rats. CONCLUSIONS: These results are consistent with the hypothesis that CNS glucocorticoid deficiency appears to be responsible for the impairment of refeeding hyperphagia in ADX rats and the effect of CNS glucocorticoid deficiency is a manifestation of impaired activation of hypothalamic NPY gene expression in the ARC.
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Outcome of Surgery and Radiotherapy in Acromegaly.
Chan Soo Shin, Chang Hoon Yim, Hee Won Jung, Dae Hee Han, Do Joon Park, Hee Jin Kim, Yun Yong Lee, Kyung Soo Park, Il Han Kim, Sung Yeon Kim, Hong Gyu Lee
J Korean Endocr Soc. 1998;13(2):156-166.   Published online January 1, 2001
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BACKGROUND
The primary goal of therapy for acmmegaly is to reduce excess growth hormone (GH) secretion through surgical excision of pituitary adenoma and, in patients with large tumors, to debulk tumor mass and decompress adjacent structures. For the patients in whom surgery is contraindicated or has failed, radiotherapy should be considered. However, there was no analysis of the outcome folIowing the treatment of acromegly in Korea. METHODS: We retrospectively reviewed 128 patients who underwent surgical excision or radiotherapy for acromegaly and followed at our hospital between January 1980 and July 1997 to investigate the outcome of surgny and radiotherapy for acromegaly and to analyze preoperative and preradiotherapeutic parameters that predict a successful outcome of therapy. RESULTS: Pituitary adenomectomy was underwent to the 113 patients with acromegaly, then 33.6% of them showed basa1 GH levels below 5 ug/L and basal GH levels were dropped below 2.5 ug/L in 22.1% of the 113 patients. Postoperative basal GH levels were significantly correlated with preoperative tumor size(r=0.54, p<0.05) and preoperative GH levels(r=0.44, p<0.05). A successful outcome of surgery was influenced by preoperative tumor size, preoperative GH level and extrasellar extension. Multivariate analysis indicated that preoperative tumor size was an independent significant factor affecting the postoperative outcome(OR=2.19, p<0.05). After radiotherapy, the median years of decrease GH<10ug/L and <5ug/L were 3.7 and 7.8, respectively and GH levels of <5ug/L occurred in 35 percent of the patients at 5 years and in 56 percent at 10 yeats. The outcome of radiotherapy depends on the GH levels in preradiotherapy. CONCLUSION: The most reliable prognostic preoperative parameter of successful outcome of surgery was preoperative tumor size and the rate of fall in serum GH after radiotherapy is comparable to the preradiotherapy GH levels in our study, so that early diagnosis and proper treatment can improve the outcome of therapy in the patients with acromegaly. In the cases of large GH-secreting pituitary adenoma, it is required a combination of surgery and radiotherapy to achieve maximal suppresssion of GH levels before radiotherapy.
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Usefulness of Immunoglobulin Fraction Precipitated with Polyethylene Glycol in Assay for TSH Receptor Antibodies using Chinese Hamster Overy Cells Expressing Human TSH Receptors.
Won Bae Kim, Hyun Kyung Chung, Chang Soon Koh, Chang Hoon Yim, Do Joon Park, Bo Yeon Cho, Hong Gyu Lee
J Korean Endocr Soc. 1998;13(2):167-180.   Published online January 1, 2001
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BACKGROUND
Graves' disease and primary myxedema are thought to be caused by the action of TSH receptor autoantibodies(thyroid stimulating antibody; TSAb & thyroid stimulation blocking antibody; TSBAb). Thus, detection of these antibodies is crucial in diagnosis and in follow up of those patients. Recently, a sensitive method using human TSH receptor transfected Chinese Hamster Ovary(CHO) cells has been developed. However, the complexity of IgG purification procedure is considered as a limitation for its clinical application as a routine test. The aim of this study is to determine whether polyethylene glycol(PEG)-precipitated immunogiobuIin fraction could substitute for purified IgG. METHODS: We developed optimal conditions for TSAb and TSBAb assays using crude, PEG precipitated immunoglobulin fraction; and evaluated the correlation of TSAb and TSBAb activities between thase measured using crude immunoglobulin fraction and purified IgG to clarify the usefulness of PEG-precipitated immunoglobulin fraction. TSH receptor expressing wild type CHO cells were used in TSAb and CHO cells expressing chimeric TSH receptor(Mc2; 90-165 amino acid residues were substituted by those of rat LH/CG receptar) were used in TSBAb assay to minimize the possible disturbing effects of TSAb in serum. RESULTS: The optimal serum amount for TSAb and TSBAb assay using PEG-precipitated immunoglobulin fraction were 250mL serum equivalent/well and 50mL serum equivalent/well, respectively. The optimal incubation time for both assays were 2 homs, and aptimal ccrncentration of bTSH for TSBAb assay was 0.1U/L. TSAb activities measured with PEG-precipitated immunoglobulin were significantly correlated with those measured with purified IgG in 26 patients with Graves diseases(r=0.93, p<0.001). Although TSBAb activities measured using PEG-precipitated imrnunoglobulin were conelated with those measured using purified IgG in 20 patients with primary myxedema(r=0.86, p<0.001), the positive rate in TSBAb assay using PEG-precipitated immunoglobulin was lower than that of usmg purified IgG(20% v.s. 65%) because of negative conversion of TSBAb activities in samples with weakly positive TSBAb activities measured using purified IgG. CONCLUSION: PEG-precipitated immunoglobulin fraction could be used instead of purified IgG in TSAb assay using hTSHR-tranasfected wild type CHO cells with equal sensitivity and specificity. This simple and practical TSAb assay using PEG-precipitated immunoglobulin in hTSHR-transfected CHO cells would be useful in clinica1 practiee.
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Expression of Human Sodium Iodide Symporter mRNA in Papillary Thyroid Carcinoma.
Hong Kyu Kim, Il Min Ahn, Young Il Kim, Eun Sook Kim, Hyun Soo Park, Ki Young Park, Seok Jun Hong
J Korean Endocr Soc. 1998;13(2):181-188.   Published online January 1, 2001
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BACKGROUND
The sodium iodide symporter(NIS) is a plasma membrane protein which is respoasibIe for iodide transport into thyroid cell. The cDNA sequence of NIS has recently been cloned from rat and human. Intrinsic ability and its differences in iodide accumulation have been exploited as a useful tool for diagnosis and therapy of thyroid diseases. It is also known that some differentiated thyroid cancers do not take up radioactive iodine at therapeutic dose. METHODS: To understand the expression and regulation of NIS in thyroid tumars, we measured the expressons of human NIS(hNIS), TSH-receptor(R), and thyroglohulin(Tg) mRNAs from papillary thyroid carcinoma(PTC) tissues by reverse transcriptase-polymerase chain reaction (RT-PCR) and RNase protection assay(RPA). RESULT: By RT-PCR analysis, 87% of PTC expressed hNIS mRNA, but the degree of expression were variable. Interestingly, 32% of PTC showed significant level of hNIS expression even though pre-operative technetium thyroid scan of all thyroid tumors were cold but the level was lower than normal control tissues. All of PTC showed the expressions of Tg and TSH-R mRNAs and there was a correlation between hNIS mRNA and TSH-R mRNA(Rsq 0.35, p=0.01). By RPA, the expression of hNIS and TSH-R in normal control tissue were detected with 20microgram and 40microgram of total RNA respectively, but the higher concentrations(> or =60microgram for hNIS and > or =40microgram for TSH-R) were required to detect in PTC, showing that tbe expression of hNIS in FTC was lower than TSH-R expression. CONCLUSION: PTC tends to lose hNIS mRNA expression earlier than TSH-R mRNA and the measurement of hNIS mRNA in PTC may be useful as an indicator of the therapeutic response to radioactive iodine.
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Prevalence of Gsa, ras, p53 Mutations and ret/PTC Rearrangement in Differentiated Thyroid Tumors of Korean Population.
Il Min Ahn, Young Il Kim, Hyun Soo Park, Ki Young Park, Seok Jun Hong, Eun Joo Lee, Kyung Yub Gong
J Korean Endocr Soc. 1998;13(2):189-197.   Published online January 1, 2001
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BACKGROUND
In thyroid tumor, ras, Gsa, p53 mutation and ret/FfC rearrangement have been reported with variable prevalences in different geographic regions. We studied the prevalences of these mutations and reammgement in thyroid tumors of Korean population. METHODS: Eleven cases of adenamatous goiter, 8 cases of follicular adenoma, 5 cases of foliicular carcinoma, 37 cases of papillary carcinoma were included in this study. To find mutations and rearrangement, RT-PCR, SSCP, and/or direct sequencing, after subcloning if necessary, were used. RESULTS: We could not find any rearrangment for ret/PTC-l, -2, -3 and mutations of Gsa. For ras oncogene, K and H-ras mutations were not found, but N-ras mutations, point mutation of CAA to CGA in codon 61, were detected in 1 follicular adenoma(12.5%, 1/8) and 1 follicular carcinoma(33%, 1/3). And p53 mutations were detected only in 1 case of papillary carcinoma (3%, 1/31: exon 8, codon 266 GGA-GAA). CONCLUSION: ret/PTC rearrangement, Gsa, ras and p53 mutations are relatively rare in differentiated thyroid neoplasms of Korean population, which may reflect the genetic and environmental differences from those countries with high prevalence.
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Assessment of Bone Age: A comparison of the Greulich Pyle Method to the Tanner Whitehouse Method.
Se Young Kim, Se Won Yang
J Korean Endocr Soc. 1998;13(2):198-204.   Published online January 1, 2001
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BACKGROUND
Bone age measurements have clinical significance in estimation of growth status and prediction of final adult height. Mostly used methods of bone age measurements are Tanner Whitehouse method(TW2) and Greulich-Pyle method(OP). TW2 is known to be more accurate method in determining the bone age, compared to GP. But GP is being used more widely despite some shortcomings, because TW2 is time consuming and need special training. In this study, we observed the correlation between GP and TW2 to evaluate which bone age among three portions of hand and wrist[metacarpals and phalanges(GP1), carpal bones(GP2), distai radius and ulna (GP3)], measured by GP, was more correlated with the bone age, measured by TW2. METHODS: Left hand/wrist radiographs were taken from 100 prepubertal children with normal growth. These radiogrphs were reviewed by two pediatric endocrinologists independently. Bone ages using TW2 were measured at first, and then GP1, GP2, and GP3 were measured. These bone ages had been compared with TW2, using SAS computer program. RESULTS: The mean chronological age of 100 children was 10.0+/-2.5 years(5 years to 14.7 years range, 63 males and 37 females). The bone age by TW2 was 9.0+/- 2.6 years(2.3 to 13.6 years). The bone age by GP1, GP2, and GP3 were 8.8+/-2.5 years, 8.7+/-2.9 years, and 8.3+/-2.8 years, respectively. Bone ages by TW2 were significantly closer to the chronological age than those by GP. The Pea~rson correlation coefficients of GP1, GP2, and GP3 in eomparison to TW2 were 0,87(p=0.0001), 0.94(p=0.0001), and 0.91(p=0.0001), respectively, There are significant correlatkm between bone ages by TW2 and GP. Bone ages by GP2 and GP3 were statistically significantly different from those by TW2(P<0.01). Bone ages by GP1 has no statistical difference with that by TW2(P=0.64). CONCLUSION: TW2 method is more accurate than GP method in determining the bone age, but it needs time-consuming and laborious efforts. We suggest that the use of GP method for the metacarpals and phalanges can result in a considerable saving of time with no significant loss of accuracy and reproducibility.
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Relationship of Dehydroepiandrosterone Sulfate, Sex Hormone Binding Globulin and Carotid Atherosclerosis in Women.
Young Sun Hong, Yeon Ah Sung, Nan Ho Kyung, Jee Young Oh, Hye Young Choi
J Korean Endocr Soc. 1998;13(2):205-215.   Published online January 1, 2001
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BACKGROUND
Cardiovascular disease is the major cause of morbidity and mortality. It is well known that androgen and sex hormone-binding globulin(SHBG) in women were associated with risk factors for cardiovascular disease such as obesity, central fat accumulation and atherogenic lipid profile. High resolution B-mode ultrasonography can visualize directly both luminal and vessel wall characteristics, and ultrasonic measurement of carotid intima-medial thickness(IMT) can be used to investigate the atherosclerosis of coronary, cerebral and peripheral arteries. The aim of this study was to evaluate the relationship between the serum dehydroepiandrosterone sulfate(DHEA-S) and SHBG, and body fat distribution pattern, cardiovascular risk factor and carotid atherosclerosis in women. METHODS: Blood pressure, fasting serum glucose, insulin, lipid profile, SHBG and DHEA-S were measured. Body fat distribution pattern was assessed by waist to hip ratio, waist to thigh ratio and subscapular to triceps skin fold thickness ratio, faf mass measured by bioelectric impedance analyzer, subcutaneous fat area, visceral fat area, and visceral to subcutaneous fat area ratio(VSR) at the level of umbilicus using the computed tomography. The IMT of the carotid artery was measured by high resolution B mode ultrasound as a marker of atherosclerosis. RESULTS: 1) There was no significant difference of age-adjusted values of carotid IMT among subjects with NGT(0.426+/-0.09mm), IGT(0.46+/-10.09mm) and NIDDM(0.453+/-0.11mm). 2) In postrnenopausal women, carotid IMT was greater(0.484+/-0.11mm, p=0.05) than premenopausal women(0.426+/-0.08mm), but it was not significant after age adjustment. Serum SHBG and DHEA-S levels in postmenopausal women were significantly lower(p<0.05) than premenopausal women, but they were not significant after age adjustment. 3) Carotid IMT was significantly correlated with age(r=0.37, p<0.01), fasting serum glucose (r=0.32, p<0.01), total cholesterol(r= 0.25, p<0.05), LDL-cholesterol(r=0.26, p<0.05), visceral fat area(r=0.35, p<0.01) and VSR(r=0.31, p<0.05). 4) By the stepwise multiple regression analysis, carotid IMT was positively and significantly associated with age(p<0.01) and serum DHEA-S concentration(p<0.05) in dent of age, body mass index, waist to hip ratio, fasting serum glucose. CONCLUSION: Carotid IMT was associated with age and serum DHEA-S concentration in women without cardiovascular disease. Therefore, serum DHEA-S may be one of risk factors for cardiovascular disease in women. However, we could not conclude its cause-result relationship because of cross sectional nature of our study, and prospective study will be needed.
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Serum Immunoreactive-Leptin Concentrations and its Relation to Adiposity and Other biochemical Parameters in Korean Males.
Sung Kil Lim, Bong Soo Cha, Young Duk Song, Hyun Chul Lee, Kap Bum Huh, Eun Sook Kim, Sang Kyu Na, Jae Ho Shin, Kyung Rae Kim, Soo Yeon Nam
J Korean Endocr Soc. 1998;13(2):216-223.   Published online January 1, 2001
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BACKGROUND
Leptin, the product of obese(ob) gene, is thought to be a lipostatic hormone that contributes to body weight regulation through modulating food intake and energy expenditure. Animals with leptin deficiency are obese and lose body weight when they are given leptin. However little is known about the physiologic actions of leptin in humans. Plasma leptin concentrations are shown to be elevated in obese humans. So far, the factors that regulate plasma leptin concentrations remain to be identified. This work is undertaken, therefore, to examine the basal leptin concentrations in lean and obese korean males, and relation between leptin concentrations, body fat and other biochemical pararneters. METHODS: We measured the height, weight, waist/ hip ratio, fasting blood glucose, insulin, total cholesterol, triglyceride, free fatty acid and leptin concentrations in 45 obese and 45 normalweight males without medical and surgical problems. RESULTS: Means of percent IBW were 136.3+/-10.3%(mean+/-SD) and 97.2+/-6.5% in obese and control group respectively. Pasting blood sugar, free fatty acid, total cholesterol concentrations were not different between obese and control group. But the insulin and triglyceride concentrations were higher in obese group than those in control group(p< 0.05). Also, the mean leptin concentrstion was higher in obese group than that in control group(5.8+/-3.5 vs 3.0+/-2.1). The leptin concentrations were not correlated with fasting blood sugar, free fatty acid, total cholesterol levels, triglyceride, insulin or age, but correlated with WHR(r2=0.203), BMI and percent IBW. CONCLUSIONS: These findings suggest that the leptin coneentrations are positively correlated with adiposity. The mean serum leptin concentrations in korean obese males were lower than those reported in other studies, probably because the subjects of this study were only males and had lower fat amount compared to other studies, and the change of body weight and calorie intake before study was not considered.
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Primary Aldosteronism Due to Aldosterone Producing Adenama in the Presence of Contralateral Nonfunctioning Adenama.
Ho Young Son, Eun Ah Kim, Jin Il Kwon, Young Joon Kim, Won Ho Chung, Kyung Rim Choi, Sang Jin Choi, Hye Young Park, Moon Ho Kang
J Korean Endocr Soc. 1998;13(2):223-229.   Published online January 1, 2001
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Primary aldosteronism is in most cases due either to a unilateral adrenal adenama or to a bilateral hyperplasia of the adrenal cortex. But, a few of bilateral adrena1 tumors in primary aldosteronism also have been reported. In these cases, it is important to differentiate the bilateral aldosterone producing adenomas from the unilateral aldosteronoma in the presence of a contralateral nonhmctioning adenoma for marking a treatment plan. We report a case of primary aldosteronism due to a unilateral aldosteronoma in the presence of a contralateral nonfunctioning adenoma. Abdominal CT sean revealed bilateral adrenal tumors, of which the functioning one was successfully localized using adrenal scintigraphy and selective adrenal venous sampling.
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Small Medullary Thyroid Cancer Dectected by Genetic Mutation Screening in Men IIa Family.
Jae Hoon Chung, Kwang Won Kim, Ji Eun Kim, Byoung Joon Kim, Sung Hoon Kim, Kyung Ah Kim, Myung Sik Lee, Moon Gyu Lee
J Korean Endocr Soc. 1998;13(2):230-239.   Published online January 1, 2001
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Multiple endocrine neoplasia (MEN) Ila is an inherited disease characterized by the development of medullary thyroid carcinoma, pheochromocytoma and hyperparathyroidism. It has been shown to be associated with germ-line mutatians in the RET proto-oncogene. Presymptomatic screening of medullary thyroid carcinoma in MEN IIa families enables the early diagnosis of this tumor with its significant morbidity, We describe a 19-year-old woman fmm a MEN IIa family who was founded by DNA analysis to be a gene carrier of MEN IIa and then was diagnosed, using a pentagastrin stimulation test, as having presymptomatie medullary thyroid carcinoma She underwent thyroidectomy and histologic examination confirmed medullary thyroid carcinoma. It is cancluded that direct genetic analysis for mutations in the RET proto-oncogene should be the diagnstlc test of choice for identifying family members at risk for MEN IIa and thyroidectomy on the basis of genetic analysis is a rational course of action.
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Case Reports
A Case of SIADH Related to Drug-indeced Generalized Maculopapular Rash.
Soon Jib Yoo, Kwang Woo Lee, Ho Young Son, Sung Koo Kang, Bong Yeon Cha, Ho Jin Song, Joo Yeon Choi, Jin No Park, Dong Huh
J Korean Endocr Soc. 1998;13(2):240-246.   Published online January 1, 2001
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Syndrome of inappropriate antidiutetic hormone(SIADH) secretion is the most common cause of hyponatremia in clinical medicine. Before diagnosis of the SIADH is made, other causes for a decreased diluting capacity and nonosmotic stimuli for AVP release need to be rule out. Disorders associated with SIADH can be divided into 4 major etiologic groups: malignancies, pulmonary diseases, central nervous disorders, and drugs. A 45-year-old woman was admitted due to maculopapular skin eruption and fever after taking medications for fever and myalgia. Generalized tonic clonic seizure was developed nine days later, and laboratory results showed marked hyponatremia. During the evaluation, treatment, and subsequent follow-up, the diagnosis of SIADH was confirmed, but the definitive cause was obscure. With fluid restriction, sodium replacement and demeclocycline therapy, she recovered completely 6 months later. We suggest that the SIADH might be related to drug-induced generalized maculopapular rash via menmgitis-like reaction in CSF as one of systemic adverse side effects to drugs rather than direct effect of related drugs.
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A Case of Wernicke's Encephalopathy Caused by Hyperemesis Gravidarum Complicated with Thyroid Storm and Abnormal Liver Function.
Sang In Choi, Chul Soo Lim, Chi Young Moon, Hong Sun Baek
J Korean Endocr Soc. 1998;13(2):247-251.   Published online January 1, 2001
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A 27-year-old woman developed Wemicke's encephalopathy in the 16th week of her first pregnaney. She had thyroid storm and abnormal liver function. Her thyrotoxic symptom and abncemal liver function was recovered after medication of antithyroid drug, steroid, hepatotonic drug and administration of thiamine(fursulthiamin), but the fetus was lost, Thereafter her thyroid function returned to normal and euthyroid state was maintained without medication of antithyroid drug, but her neurological defect was remained. We suggest that severe hyperemesis gravidarum is a possible risk factor of the thyroid storm and Wemicke's encephalopathy in patients with hyperthyroidism, and consider the check of the thyroid function. The need for parenteral thiamine supplementation and medication of antithyroid drug is warranted in patients with severe hyperemesis gravidarum which lasts longer than 3 weeks and abnormal thyroid function.
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A Case of Ocular Myasthenia Associated with Graves's disease.
Hong Nam Kim, Keum Jin Ban, Seok Shi, Shin Han, Soo Jin Yoon, So Yeon Kim, Byoung Ik Park, Kwon Jun Lee
J Korean Endocr Soc. 1998;13(2):252-257.   Published online January 1, 2001
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The occurrences of thyrotoxicosis in patients with myasthenia gravis have been reported before the knowledge of the pathogenesis of the two disease. Thytotoxicosis is known to occur in 3 to 6 percent of patients with myasthenia gravis and myasthenia gravis occurs in only a fraction of 1 percent of the thyrotoxic populatian. Myasthenia gravis is currently considered as a systemic autoimmune disorder of acetylcholine receptor and often presented with other autoimmune diseases such as SLE, Rheumatoid arthritis. We experienced a 18-year-old woman who presented with graves disease and isolated ocular myasthenia gravis. Chest CT didnot reveal enlarged thymus. The usual treatement of myasthenia gravis associated with thymtoxicosis consists of medical control of the thyrotoxicosis, then thymectomy and later subtotal thyroidectomy. Her ptosis and thyrotoxicosis have improved after the medicatian of anticholinesterase and propylthiourecil. A case of ocular myasthenia gravis with Gravesdisease was experienced, so we reported the case with a brief review of literature.
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