Endocrinology and Metabolism

Volume 17(2); April 2002

Review Articles

Stem Cell Plasticity and Medical Applications.: Il Hoan Oh, Anthony D Kang; J Korean Endocr Soc. 2002;17(2):135-142. Published online April 1, 2002

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Abstract PDF: No abstract available.

rhTSH in Thyroid Cancer.: Wonsick Choe; J Korean Endocr Soc. 2002;17(2):143-151. Published online April 1, 2002

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Abstract PDF: No abstract available.

C-reactive Protein and Metabolic Syndrome.: Hyun Chul Lee, Hyeung Jin Kim; J Korean Endocr Soc. 2002;17(2):152-157. Published online April 1, 2002

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Abstract PDF: No abstract available.

Original Articles

Gene Expression of Somatostatin Receptor (Subtype 2 & 5), Gi2 alpha and Pit-1 in GH-secreting Pituitary Adenomas.: Mee sook Ryu, In myung Yang, Cheol young Park, Jeong taek Woo, Sung woon Kim, Jin Woo Kim, Young seoul Kim, Young kil Choi, En hee Kim, Seung joon Park, Kook gi Kim; J Korean Endocr Soc. 2002;17(2):158-169. Published online April 1, 2002

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Abstract PDF: BACKGROUND
Mutation of Gs protein subunit (gsp oncogene), detected in about 30~40% of growth hormone (GH)-secreting pituitary tumors, is associated with an increased long-acting somatostatin analog octreotide sensitivity. However, the mRNA expression of somatostatin receptor (sst) was not changed in the GH-secreting pituitary tumor, regardless of whether they were gsp oncogene positive or negative. This suggests that the expression of genes coding for Gi2 alpha , Pit-1 and the other factors involved in the regulation of secretory activity in somatotrophs is likely to be altered in gsp oncogene positive tumors. We observed the impact of the gsp oncogene on the expression of the genes coding for Gi2 alpha, Pit-1 and sst (2&5) in GH-secreting pituitary tumors. METHODS: The GH response to octreotide was examined in 13 acromegalic patients before transsphenoidal adenomectomy. Genomic DNA and RNA were extracted from fresh frozen tumor tissues. PCR was performed to amplify and sequence the region between codon 184 and 251 that includes exons 8 and 9 of the Gs gene. Sst2, sst5, Gi2 alpha and Pit-1 mRNA levels were measured by semi-quantitative RT-PCR. RESULTS: Sst2 and sst5 mRNA transcripts were detected in all tumors (7 gsp +, 6 gsp-). The amount of sst transcripts varied considerably varied between the tumors. There were no significant differences in sex, age, tumor size, grade or basal GH levels. Pit-1 and sst2 mRNA levels were not different. In contrast, Gi2 alpha mRNA levels were significantly higher in gsp (+) while sst5 mRNA levels were higher in gsp (-). CONCLUSION: These data suggests that gsp oncogene may increase Gi2 alpha levels but decrease sst5 mRNA levels. However, Pit-1 and sst2 mRNA expression may not be affected by gsp oncogene. The increased expression of the Gi2 alpha gene might be an inhibitory compensatory response to the action of gsp oncogene.

Gene Expression of the Somatostatin Receptors, Gi2 alpha and Pit-1 alpha in GH3 Cells Permanently Transfected with a Mutant Gs alpha Gene.: Cheol young Park, In myung Yang, Eun hee Kim, Sook jin Sohn, Mee sook Ryu, Jeong taek Woo, Sung woon Kim, Jin woo Kim, Young seol Kim, Young kil Choi, Seung joon Park; J Korean Endocr Soc. 2002;17(2):170-182. Published online April 1, 2002

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Abstract PDF: BACKGROUND
Cyclic AMP stimulates the expression of the somatostatin (SRIF) receptor (sst1-5) and human growth hormone (GH)-secreting pituitary tumors with the gsp oncogene which increases intracellular cAMP levels, and shows a good inhibitory response of the GH to SRIF. Taken together, we hypothesized that the gsp oncogene may increase the SRIF receptor expression or and factors related to the postreceptor signal transduction of the SRIF, in order to enhance its responsiveness to SRIF. To test this hypothesis, we investigated if the gsp oncogene could increase the sst1, sst2, Gi2 alpha, and pit-1 alpha gene expression in GH3 cells. METHODS: GH3 cells were permanently transfected with the plasmid expressing Gs alpha gene, where the arginine of codon 201 was replaced with histidine. Intracellular cAMP levels and GH concentrations were measured by radioimmunoassays. Gene expressions of the sst1, sst2, Gi2 alpha, and pit-1 alpha were determined by RT-PCR. RESULTS: Intracellular cAMP levels and medium GH release were increased by 1.7 and 2.7-fold in GH3 cells expressing the gsp oncogene, respectively. In GH3 cells expressing the gsp oncogene, the sst1 mRNA levels were decreased, whereas those of the sst2, Gi2 alpha and pit-1 alpha mRNA were increased. A 4-h forskolin (10 M) stimulation remarkably increased the sst1 and sst2 mRNA levels in GH3 cells expressing wild and mutant Gs alpha . However, forskolin did not affect the Gi2 alpha and pit-1 alpha mRNA levels. In contrast, SRIF (1 M, 2 h) decreased the sst2 mRNA levels only in GH3 cells expressing the gsp oncogene. CONCLUSION: These results suggest that higher expressions of sst2, Gi2 alpha, and pit-1 alpha, induced by the gsp oncogene may be a mechanism by which gsp-positive pituitary tumors show a greater response to SRIF. The discrepancy between these and in vivo results should be explored further.

Prevalence of Thyroid Nodules detected by Ultrasonography in Womens Attending Health Check-Ups.: Chang Hoon Yim, Han Jin Oh, Ho Yeon Chung, Ki Ok Han, Hak Chul Jang, Hyun Ku Yoon, In Kwon Han, Byoung Hee Han, Kyung Sang Lee, Byung Jae Cho; J Korean Endocr Soc. 2002;17(2):183-188. Published online April 1, 2002

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Abstract PDF: BACKGROUND
Thyroid nodules are commonly found in clinical practice, and the recent development of thyroid ultrasonography has allowed for the detection of small nodules previously undetectable by routine palpations. Since previous studies on thyroid ultrasonography have been focused on patients with known thyroid disorders, we aimed to determine the prevalence of thyroid nodules in a female population. METHODS: We studied women in the age range 30 to 70 years visiting the health promotion center at Samsung Cheil Hospital for routine health check-ups. After excluding patients with previous thyroid disorders, 1300 women where selected to undergo thyroid ultrasonography for the detection of the presence of thyroid nodules. If nodules were found, their size and numbers were recorded, and these data correlated with the patients age. RESULTS: Of the 1300 subjects, thyroid nodules were detected in 490 (37.7%) with their prevalence (p=0.009), and that of multinodularity of thyroid nodules (p=0.001), increasing with the increasing age of the patients (Age 30 to 39: 30.8%, 40 to 49: 37.0%, 50 to 59: 41.5% and 60 to 69: 65.2%). Among these study subjects, nodules larger than 15 mm in size were detected in 29 and after performing fine needle aspirations on 18 nodules, 17 were found to be benign, with 1 papillary carcinoma, which required a total thyroidectomy. CONCLUSION: The prevalence of thyroid nodules in our female study population was 37.7%, with their prevalence, and that of multinodularity of thyroid nodules, increasing with increased age.

The Postpartum Recurrence of Graves'Disease and its Contributing Factors.: Chang Hoon Yim, Hyun Ah Choi, Seung Suk Han, Hae Sung Kim, Chang Uk Lee, Ho Yeon Chung, Ki Ok Han, Hak Chul Jang, Won Keun Park, Hyun Ku Yoon, In Kwon Han; J Korean Endocr Soc. 2002;17(2):189-196. Published online April 1, 2002

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Abstract PDF: BACKGROUND
Pregnancy affects the course of Graves' Disease (GD), and patients who initially maintain euthyroid function into their middle trimester with minimum doses of antithyroid drugs become exacerbated after delivery. Even patients who are completely cured, requiring no treatment during pregnancy, can relapse after delivery. In this study, we examined the postpartum changes in the thyroid functions of patients with GD, and attempted to determine the factors contributing to these changes. METHODS: The study subjects were recruited from pregnant women visiting our outpatient clinic for routine prenatal evaluations. 45 women previously diagnosed with GD, who had been treated and cured with hyperthyroidism, and were no longer taking any thyroid medications, were evaluated for 1 year post delivery. RESULTS: Among 45 patients, 20 (44.4%) developed thyroid disorders following delivery. Postpartum thyroiditis (PPT) developed in 8 patients (17.8%), and GD developed in 12 (26.0%). The onset of the PPT disease 3.1 +/- 1.4 months following delivery, which was significantly earlier than the 6.7 +/- 2.7 months required for the post delivery onset of GD (p=0.003). The TBII values, measured during the thyrotoxic state in each womaen, were negative in women with PPT and positive in 71.4% of women with GD (p=0.030). The duration of treatment for hyperthyroidism prior or pregnancy, the number of recurrences, and the time interval without treatment, were not associated with the development of postpartum thyroid disorders. Whereas, the mean number of past pregnancies for women who developed PPT was 3.9 +/- 2.1, and was significantly higher than the 2.2+/- 1.7 for women developing no thyroid dysfunctions (p=0.044). In 13 women their initial onset of GD occurred within one year postpartum, 7 (53.8%) having had a recurrence, which was significantly higher than in women whose disease onset occurred unrelated to delivery (5 of 32 women: 15.6%). CONCLUSION: Women with GD developed postpartum thyroid dysfunctions in 44.4% of cases. Women whose initial disease onset occurred within one year postpartum had higher recurrences of GD, and women who developed PPT had a history of higher gravidity compared to the euthyroid women postpartum. Therefore, if women with GD develop postpartum thyroid dysfunctions, the diagnosis should be made, and a treatment modality planned, following careful considerations of the patients' past obstetric history, changes in clinical manifestations and the TBII values.

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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Abstract PDF: 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

Randomized Controlled Trial

Effect of Dexamethasone and 1,25(OH)2D3 on Proliferation and Osteogenic Differentiation of Cultured Human Bone Marrow Stromal Cells.: Hye Soo Kim, Il Woo Lee, Jong Min Lee, Chang Hwan Han, Jin Hyung Sung, Min Young Park, Gil Son Khang, Hai Bang Lee; J Korean Endocr Soc. 2002;17(2):206-217. Published online April 1, 2002

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Abstract PDF: BACKGROUND
It is crucial, in the case of regenerating bone by tissue-engineering technique, that osteoblast progenitors are proliferated and induced to differentiate to osteoblasts sequentially at the proper time. Osteoblasts can be obtained from bone itself or from osteoblast progenitors in bone marrow, even though the amount of human marrow stromal cells in marrow aspirate is usually scanty. These cells, however, have been known demonstrate the potential to easily proliferate and differentiate in osteoblasts, chondroblasts or adipocytes according to different microenvironmental factors. We evaluated the effect of dexamethasone and 1,25(OH)2D3 on the proliferation, differentiation, and mineralization of human marrow stromal cells in vitro. METHODS: We used twelve bone marrow aspirates obtained from different healthy bone marrow donors. Culture plates were randomly divided into the following four experimental groups; group 1 was cultured with control medium only, group 2 with control medium containing 1,25(OH)2D3, group 3 with control medium containing dexamethasone, and group 4 with control medium containing both 1,25(OH)2D3 and dexamethasone. 3H-thymidine uptake, protein content of cell lysates, alkaline phosphatase activities and alkaline phosphatase histochemistries were measured. Alizarin Red-S staining and quantification of dissolved dye were also performed. RESULTS: Combined stimulation of marrow stromal cells with both 1,25(OH)2D3 and dexamethasone was found to be effective to maintain stable long-term culture of the cells and to increased differentiation and mineralization of the cells. Synthesis and mineralization of matrix were highest when the cells were stimulated with 1,25(OH)2D3 alone during the early culture phase. However, 1,25(OH)2D3 shortened the lifespan of the cells. Interestingly, mineralization was higher in female donor cells than in male donor cells when stimulated with dexamethasone alone or with both dexamethasone and 1,25(OH)2D3. Neither 1,25(OH)2D3 nor dexamethasone affected cell proliferation. CONCLUSION: Our results suggest that the synergistic effect of dexamethasone and 1,25(OH)2D3 is important in maintaining long-term culture and differentiation of human marrow stromal cells. It is preferable to administer 1,25(OH)2D3 after the attachment of cultured osteoblasts to biomaterials has been established, since it could shorten cell survival despite the great increase of mineralization at the early culture phase.

Original Articles

Adverse Effects of Antiepileptic Drugs on Bone Mineral Density in Women with Epilepsy.: Yong Won Cho, In Kyu Lee, Seung Ho Hur; J Korean Endocr Soc. 2002;17(2):218-225. Published online April 1, 2002

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Abstract PDF: BACKGROUND
Osteoporosis or osteopenia has been reported in patients taking antiepileptic drugs, but the precise pathophysiological mechanisms of these abnormalities are unclear. The aim of this study was to assess the relationship of antiepileptic drugs on bone mass by analyzing bone mineral density (BMD). METHODS: We compared 62 epileptic women on long-term antiepileptic therapy the same number of age and weight matched healthy control subjects. We measured the serum calcium, phosphorus, protein, alkaline phosphatase and osteocalcin for analyzing factors, that have an influence on bone metabolism and BMD. BMD was measured on the lumbar spine by dual-energy X-ray absorptiometry. RESULTS: The serum level of calcium and osteocalcin were not different between the groups. The serum level of phosphorus and protein were significantly lower in the patient group compared to their controls. The serum level of alkaline phosphatase was significantly higher in the patient group than in their controls. The BMD was significantly lower in the patient group than in their controls. There was a significant correlation between the BMD and the duration of therapy in the patient group. CONCLUSION: The long-term use of antiepileptic drugs leads to a decreased BMD, and the degree of bone mineral density was related to the duration of the therapeutic use of antiepileptics.

The Association between CRP and the Metabolic Syndrome in Korean Adults.: Sin Gon Kim, Dong Lim Kim, Dong Hyun Shin, Nan Hee Kim, Kyung Mook Choi, Sei Hyun Baik, Dong Seop Choi; J Korean Endocr Soc. 2002;17(2):226-235. Published online April 1, 2002

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Abstract PDF: BACKGROUND
Metabolic syndrome (MS) is characterized by insulin resistance accompanied by one or more of the following: obesity, hypertension, impaired glucose tolerance, low HDL cholesterol levels, and/or hypertriglyceridemia. However, the precise underlying pathogenic mechanism of MS is not known. Several recent reports have suggested a positive association between components of MS and markers of the acute-phase response, including C-reactive protein (CRP). These results imply that MS is accompanied by an ongoing inflammatory process. The purpose of our study was to evaluate the association between circulating levels of C-reactive protein, a sensitive systemic marker of inflammation, with components of metabolic syndrome in Korean adults. METHODS: A total of 1,461 subjects aged between 20 and 81 years, who visited the Health Management Center at Korea university between November 2000 and February 2001 were studied. We investigated the correlation between CRP levels and components of MS. The components of MS were categorized, and age-sex adjusted mean values of CRP calculated for the categorized components. The BMI was categorized into 5 classes, and the CRP levels examined according to their BMI class. In addition, subjects with a different number of the MS components were grouped as follows: group 1 for 0 components, group 2 for 1 components, group 3 for 2 components and group 4 for > or = 3 components, and the CRP levels calculated for each group. RESULTS: There were significant positive correlations of CRP levels with age, BMI, TG, systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood glucose (FBS), uric acid, insulin,and homeostasis model assessment IR (HOMAIR). A significant inverse correlation was observed between CRP levels and serum HDL. From the multivariate analysis, age and BMI were significantly correlated with CRP levels. The means of the CRP for the categorized components of MS were significantly higher in the BMI categories: > or =25 for female/27 for male, TG > or =200 mg/dL, fasting plasma glucose > or =126 mg/dL and blood pressure > or =140/90 mmHg, and the CRP levels by BMI class were: 1.19 (BMI <18.5), 1.54 (BMI 18.5~22.9), 1.59 (BMI 23.0~24.9), 1.77 (BMI 25.0~29.9) and 2.07 (BMI >30.0) mg/L. Furthermore, the increase in the CRP levels in relation to the numbers of MS were 1.46 (group 1), 1.70 (group 2), 1.95 (group 3) and 2.11 mg/L (group 4) with statistical significance. CONCLUSION: The above data showed associations between the CRP levels and the different components of MS. This might suggest that MS in Koreans could be accompanied by a systemic inflammation response

Associations of Polymorphisms in Uncoupling Protein 2 and 3-Adrenergic Receptor with Obesity in Korean Adults.: Hyejin Lee, Hyeyoung Park, Youngsun Hong, Yeon Ah Sung; J Korean Endocr Soc. 2002;17(2):236-245. Published online April 1, 2002

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Abstract PDF: BACKGROUND
The genetic and environmental factors involved in the development of obesity and several candidate genes have been suggested to have an influence on energy and fuel metabolism. However, the specific genetic defects responsible for human obesity have not been identified yet. It is likely that a combination of polymorphisms in one or more candidate genes may affect energy metabolism and the development of obesity. We performed this study to determine the role of 45 bp insertion in the uncoupling protein (UCP)2 exon 8 and Trp64Arg polymorphism of beta3-adrenergic receptor ( 3-AR) gene in the regulation of body weight and the pattern of fat distribution. METHODS: In 114 subjects (male: 40, female: 74, mean body mass index: 24.1+/-2.7 kg/m2, 80 subjects with normal glucose tolerance, 34 subjects with impaired glucose tolerance), body fat distribution patterns were assessed by anthropometric measurement, bioelectric impedance analysis and computed tomogram. The genotypes of UCP genes were determined by polymerase chain reaction (PCR), and mutation in 3-AR gene by PCR followed by enzymatic digestion. RESULTS: In UCP2 genes, the frequency of deletion homozygote (DD) was 59.4%, heterozygote (DI) was 3.5% and insertion homozygote (II) was 3.1% Meanwhile, in 3-AR, the frequency of TrpTrp was 67.9%, TrpArg was 29.5% and ArgArg was 2.7%. In the lean group (subjects with a BMI less than 25 kg/m2), the frequencies of insertion allele and Arg64 allele were not significantly different than those among the overweight subjects (BMI > or = 25 kg/m2). There was not significant difference in clinical, biochemical or body fat distribution patterns between the groups according to UCP2 polymorphism. In the case of the polymorphism in 3-AR gene, the subjects with ArgArg homozygotes had lower HDL-cholesterol level (p<0.05). For the individuals over 40 years of age, BMI was greater among those with the deletion homozygotes and Arg64 allele, as compared to other groups according to the combination of UCP2 and 3-AR genotypes (p<0.05). CONCLUSION: These results suggest that genetic variations in UCP2 and 3-AR can synergistically affect metabolic rate and susceptibility to weight gain, thereby and contribute to the change in body weight in later life.

Evaluation of Lung Epithelial Permeability in Patients with Type 2 Diabetes Mellitus using 99mTc-DTPA Aerosol Scintigraphy.: Ji Sung Yoon, Mi Jung Eun, Si Hyung Lee, Jae Hong Kim, Young Hoon Hong, Kyu Chang Won, Ihn Ho Cho, Hyoung Woo Lee; J Korean Endocr Soc. 2002;17(2):246-256. Published online April 1, 2002

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Abstract PDF: BACKGROUND
Diabetes mellitus is often accompanied by complicated microangiopathy, such as, retinopathy, nephropathy, peripheral neuropathy, cardiovascular autonomic neuropathy or macroangiopathy, as well as by coronary artery disease and cerebrovascular disease. However, there have been few reports concerning the pulmonary involvement of diabetes. Recently, capillary basement membrane thickening, nonenzymatic glycosylation of tissue proteins, abnormalities of endothelial cells and increased damage by free radicals were reported as the underlying basis for the reduced lung permeability. 99mTc-DTPA aerosol scintigraphy is a noninvasive, accurate method, which evaluates the permeability of lung epithelial membranes. The clearance rate of 99mTc-DTPA in lungs may correlate inversely with the lung's epithelial permeability. We investigated the relationship between microangiopathies and the lung epithelial permeability in patients with diabetes using 99mTc-DTPA aerosol scintigraphy. METHODS: The study group comprised of 33 patients with type 2 diabetes mellitus, with no clinical evidence of past or present respiratory disease. The patients were divided into two groups in relation to the complications. Group 1: 16 patients with more than one of the complications of retinopathy, nephropathy, cardiovascular autonomic neuropathy and/or peripheral neuropathy, and comprised of 3 males and 13 females, with a mean age of 52.9 +/- 9.6 years. Group 2: 17 patients with no complications, and comprised of 5 males and 12 females with a mean age of 52.8 +/- 11.5 years. Group 3: as a control group, comprised of 11 healthy people: 4 males 4 and 7 females with a mean age of 44.2 +/- 12.5 years. 99m-Tc-DTPA aerosol scintigraphy was performed in the subjects by inhalation of 30 mCi 99mTc-DTPA aerosol and oxygen (9 l/min) using an aero-vent jet nebulizer as the lung delivery system. To evaluate the diabetic complications, CAN (Cardiovascular Autonomic Neuropathy), and NCV (Nerve Conduction Velocity) tests for peripheral neuropathy, fundoscopy for retinopathy and 24 hours urine microalbumin for nephropathy were performed. RESULTS: The mean durations of diabetes in Groups 1 and 2 were 11.1 +/- 4.7 years and 3.8 +/- 2.1 years, respectively (p<0.05). The mean clearance rates of 99mTc-DTPA were found to be 72.1 +/- 19.5min, 52.6 +/- 19.7 min, and 47.1 +/- 10.9 min for Groups 1, 2, and 3, respectively. The mean clearance rate of Group 1 was significantly longer than for Groups 2 and 3 (p<0.05). In other words, the pulmonary epithelial permeability was reduced in diabetic patients with complications compared to the patients without complication and/or the normal controls. Significant positive correlation was found between the pulmonary clearance rate of 99mTc-DTPA, and peripheral neuropathy and cardiovascular autonomic neuropathy (p<0.05). Conclusions: The lungs may be a target organ for diabetes, and impaired pulmonary epithelial permeability seems to be closely related to other diabetic microangiopathies. Therefore, we recommend that 99mTc-DTPA aerosol scintigraphy be used as a technique for assessing lung injury in diabetic patients.

Case Reports

Neonatal Tetany Caused by Hyperparathyroidism Undetected During Pregnancy.: Wan Sub Shim, Hee Baek Park, Bong Soo Cha, Sung Kil Lim, Hyun Chul Lee, Kap Bum Huh; J Korean Endocr Soc. 2002;17(2):257-262. Published online April 1, 2002

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Abstract PDF: Primary hyperparathyroidism is rarely encountered during pregnancy but its prompt diagnosis and treatment if encountered during pregnancy is important because it can carry considerable morbidity not only for the mother but also for the fetus. It tends to remain undiagnosed because 50~80% of the patients are asymptomatic. Even if they do demonstrate symptoms, those are often nonspecific. The other reason for non-diagnosis is masking of hypercalcemia due to the change of calcium homeostasis during pregnancy. Neonatal tetany can be a clue for the presence and diagnosis maternal hyperparathyroidism. The asymptomatic patient who is diagnosed postpartum when her newborn is symptomatic should undergo elective parathyroidectomy to avoid future complication. We experienced a woman with undiagnosed primary hyperparathyroidism during pregnancy whose two children suffered neonatal tetany. We report this case along with a review of literature on primary hyperparathyroidism in pregnancy and calcium homeostasis during pregnancy.

A Case of Anterior Pituitary Agenesis in an Adult Woman.: Tae Sik Jung, Jong Ryeal Hahm, Kang Wan Lee, Jung Hwa Jung, Soo Hee Kim, Jong Ha, Hwal Suk Cho, Sun Il Chung; J Korean Endocr Soc. 2002;17(2):263-268. Published online April 1, 2002

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Abstract PDF: Dear Author, You have used abbreviations that will need to be defined in the main paper, i.e. PIT1, PROP1 and MRI. This is just for your advice. Pituitary agenesis is an uncommon cause of panhypopituitarism. It has been proposed that breech delivery, or birth trauma, is a major factor causing pituitary agenesis. Recent studies have suggested that genetic defects in the PIT1 or PROP1 gene might be involved in the pathogenesis of pituitary agenesis. In this case we report on the diagnosis of a 33-years old female patient with-growth retardation and sexual infantilism. We diagnosed anterior pituitary hormones deficiencies, with the exception of adrenocorticotropic hormone, by a combined pituitary stimulation test. We observed pituitary agenesis using sella MRI. Involvement of the PIT1 or PROP1 genes in this case remains to be determined. Here we report a case of pituitary agenesis found in an adult woman together with a brief review about this disease entity.

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