It has been long proposed that the osteocyte network continually compares present mechanical strains to usual levels of strain, and triggers signals to osteoclasts or osteoblasts resulting in bone loss or gain, as needed. Whereas physiological levels of mechanical stimulation maintain bone mass, too low or too high levels of strain induce bone resorption. One mechanism by which osteocytes may trigger bone resorption is by undergoing apoptosis. Either low or high levels of mechanical loading lead to increased prevalence of osteocyte apoptosis, which temporally precedes and is spatially associated with osteoclast recruitment and the subsequent increase in bone resorption[1,2]. A cause and effect relationship between osteocyte death and bone resorption has been demonstrated using a transgenic mouse model of inducible osteocyte ablation in which osteocyte apoptosis was sufficient to trigger osteoclast recruitment[3]. In addition, the normal osteoclastogenic response to unloading was missing in bones from osteocyte-depleted mice, confirming that osteocytes are indispensable for the skeletal adaptation to weightlessness. Because osteocyte apoptosis is inhibited not only by mechanical stimulation but also by estrogens and bisphosphonates, these findings raise the intriguing possibility that preservation of osteocyte viability contributes to the anti-remodeling properties of these agents.
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BACKGROUND Both thyroid and breast cancers occur more frequently in women than in men. Some suggest that estrogen plays a role in the tumorigenesis of both cancers. The aim of this study was to identify the prevalence and clinico-pathologic characteristics of primary thyroid cancer in patients with breast cancer. METHODS: We retrospectively obtained clinical and pathologic data for 112 patients diagnosed with both thyroid and breast cancer from a single center. Patients with thyroid cancer were grouped according to the chronological sequence of tumor diagnosis. When thyroid and breast cancers were diagnosed within 12 months of each other, they were considered to have been diagnosed simultaneously. Female patients who had only papillary thyroid cancer were used as a historic control. RESULTS: Between 1994 and 2008, 7,827 patients at our hospital were diagnosed with breast cancer and 6,571 patients with thyroid cancer. There were 112 patients who had both thyroid and breast cancer. All thyroid cancers (111/112) except one hurthle cell cancer were papillary thyroid cancers. Average tumor size of thyroid cancer cases diagnosed 1) after or 2) simultaneously with the diagnosis of breast cancer was significantly lower than that for 3) thyroid cancer cases found before breast cancer diagnosis or 4) historical controls with papillary thyroid cancer [sizes (in cm), respectively, were: 1) 0.9 +/- 0.6 2) 0.9 +/- 0.5 vs 3) 1.4 +/- 0.9 4) 1.4 +/- 1.1, P < 0.05]. No patients had distant metastases and there were no statistically significant differences in known risk factors for recurrence and survival of patients with thyroid cancer. CONCLUSION: Thyroid cancer is the most common second primary malignancy in patients with breast cancer and most of them are papillary thyroid cancers. There are no differences in risk factors for tumor recurrence and patient survival compared with those with conventional papillary thyroid cancer except for differences in tumor size. These difference in size may reflect an increase in medical surveillance in patients after they are diagnosed with breast cancer.
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Survival Outcomes in Thyroid Cancer Patients with Co-Occurring Breast Cancer: Evidence of Mortality Risk Attenuation Matheus Wohlfahrt Baumgarten, Iuri Martin Goemann, Rafael Selbach Scheffel, Ana Luiza Maia Clinical Breast Cancer.2024; 24(6): e519. CrossRef
The prognosis and treatment of primary thyroid cancer occurred in breast cancer patients: comparison with ordinary thyroid cancer Chang Min Park, Young Don Lee, Eun Mee Oh, Kwan-Il Kim, Heung Kyu Park, Kwang-Pil Ko, Yoo Seung Chung Annals of Surgical Treatment and Research.2014; 86(4): 169. CrossRef
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J Korean Endocr Soc. 2009;24(4):247-253. Published online December 1, 2009
BACKGROUND Reports on pituitary apoplexy in Korea are limited. There are two treatment options for pituitary apoplexy - surgical decompression and conservative management. In this study, we examined clinical presentation and outcomes following different therapies in Korean patients with pituitary apoplexy. METHODS: Clinical data and treatment outcomes from 52 patients with pituitary apoplexy who visited Seoul National University Hospital between January 1992 and June 2008 were reviewed retrospectively. Patients were divided into 2 groups according to management options (a surgery group vs. a conservative management group) and their outcomes were compared. For patients who underwent surgery due to neurological symptoms, outcomes were compared between early and late surgery groups. RESULTS: Headache (73.1%) was the most common presenting symptom, and more than half of the patients were reported to have visual symptoms. The most common type of pathology was a nonfunctioning pituitary adenoma (67.3%). Nine patients received conservative management and 43 underwent surgical decompression. Their recovery from neurological and endocrinological abnormalities were similar. Among patients who showed neurological symptoms, 9 underwent surgery within 1 week of symptom onset and 24 underwent surgery after 1 week. There was no significant difference between outcomes of early and late surgery groups except recovery from impaired visual deficit was greater in the late surgery group. CONCLUSION: Patients with pituitary apoplexy in Korea show similar clinical features as similar patients in other countries. In our study, there was no significant difference between clinical outcomes of the surgery group and the conservative treatment group.
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The Outcomes of Pituitary Apoplexy with Conservative Treatment: Experiences at a Single Institution Youngbeom Seo, Yong Hwy Kim, Yun-Sik Dho, Jung Hee Kim, Jin Wook Kim, Chul-Kee Park, Dong Gyu Kim World Neurosurgery.2018; 115: e703. CrossRef
Characteristics and Treatment Options of Pituitary Apoplexy Dong-Sun Kim Journal of Korean Endocrine Society.2009; 24(4): 237. CrossRef
BACKGROUND Primary aldosteronism is the most common cause of secondary hypertension in humans. Its prevalence is estimated to be 10-15% among hypertensive patients. It is also associated with insulin resistance and diabetes mellitus. The aim of our study was to compare the prevalence of primary aldosteronism in hypertensive patients with presence of diabetes mellitus. METHODS: We reviewed retrospectively the clinical records of 104 hypertensive patients for whom we also measured plasma renin activity (PRA) and plasma aldosterone concentrations (PAC). RESULTS: Among 104 hypertensive patients, 44 had diabetes and 60 did not. There were no significant differences in clinical characteristics between non-diabetic and diabetic patients except for age and the number of antihypertensive agents. Patients with target organ damage were more common among diabetic patients. There was no correlation between PAC and the number of target organs damaged. In addition, Four patients from the non-diabetic and two from the diabetic group had a ratio over 30 for PRA/PAC and a PAC of over 15 ng/dL. Two non-diabetic patients and one diabetic patient were found, on abdomen CT, to have an adrenal adenoma. The rest of the patients refused further tests. CONCLUSION: The prevalence of primary aldosteronism in diabetic patients does not differ significantly from that in non-diabetic patients. Therefore, the present routine screening test for primary aldosteronism in hypertensive diabetic patients is not recommended.
Yoon Jung Kim, Ji A Seo, Ji Mi Moon, Young Jin Seo, Hae Yoon Choi, Hye Sook Kim, Sin Gon Kim, Kyeung mook Choi, Sei Hyun Baik, Dong Seop Choi, Nan Hee Kim
J Korean Endocr Soc. 2009;24(4):260-264. Published online December 1, 2009
Persistent or recurrent primary hyperparathyroidism after initial parathyroid surgery occurs at rates of 1.5~10%. A single missed parathyroid adenoma accounts for the majority of persistent hyperparathyroidism, whereas metachronous parathyroid adenoma is a rare cause of recurrent hypercalcemia. We report a case of a 39-year-old female who presented with recurrent pancreatitis. She had symptoms of hyperparathyroidism such as hypercalcemia, hypophosphatemia, hypercalciuria, nephrocalcinosis, and osteoporosis. She had a 2-cm firm neck mass under the right submandibular area. She was diagnosed with primary hyperparathyroidism 22 years ago. At that time, the right upper and lower parathyroid glands were removed after exploration of all parathyroid glands, and a right upper parathyroid adenoma was diagnosed. Now, she had a second surgery to remove the right submandibular mass with intraoperative PTH monitoring, which was diagnosed as a parathyroid adenoma in an ectopic supernumerary parathyroid gland. Because of hungry bone syndrome, she received calcium carbonate replacement therapy and has no evidence of recurrence. Here, we report a recurrent parathyroid adenoma in the undescended, supernumerary parathyroid gland after a long interval from the initial surgery.
Multiple endocrine neoplasia type 2A (MEN 2A) is an autosomal dominant syndrome characterized by the presence of medullary thyroid carcinoma, pheochromocytoma, and hyperparathyroidism. MEN 2A arises due to a germline missense mutation of the RET proto-oncogene. Specific RET mutation analysis has revolutionized the diagnosis and therapy of this disorder, and early thyroidectomy may have lowered the morbidity and mortality associated with these diseases. Ectopic adrenocorticotropic hormone (ACTH) syndrome is characterized by hypercortisolism due to the hypersecretion of ACTH outside of the pituitary gland; the most common causes are malignancies, but rarely adrenal pheochromocytoma may be the cause.
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Hematological disorders, and especially single lineage abnormalities, have been described in patients suffering with thyrotoxicosis, but pancytopenia is a rare complication of thyrotoxicosis. Pancytopenia with thyrotoxicosis has been reported to be totally reversible with antithyroid drug treatment. We experienced a case with pancytopenia associated with Graves' disease in a 57-year-old woman who had no specific cause of pancytopenia. She presented with dyspnea and palpitation. The laboratory findings revealed thyrotoxicosis and pancytopenia. Increased radioisotope uptake was seen on the thyroid scan and normal cellularity and maturation were found in the bone marrow aspiration biopsy. Based on these findings, she was diagnosed as suffering from Gravesyendisease with pancytopenia. After treatment with propylthiouracil, the blood cell counts were restored to normal as the patient achieved a euthyroid state. We report here on a case of Graves' disease that was complicated by pancytopenia, and all this was normalized after treatment for hyperthyroidism.
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Pancytopenia in a surgical patient, a rare presentation of hyperthyroidism Prabhat Jha, Yogendra Prasad Singh, Bikal Ghimire, Binit Kumar Jha BMC Surgery.2014;[Epub] CrossRef
A Case of Pancytopenia with Hyperthyroidism Tae Hoon Kim, Ji Sung Yoon, Byung Sam Park, Dong Won Lee, Jae Ho Cho, Jun Sung Moon, Eui Hyun Kim, Kyu Chang Won, Hyoung Woo Lee Yeungnam University Journal of Medicine.2013; 30(1): 47. CrossRef
Topiramate is a drug used to treat epilepsy, and is known for its effects including reduced appetite resulting in lower body weight, and the lowering of neutral fat. In addition, topiramate is known to reduce blood sugar levels by increasing insulin sensitivity and by increasing insulin secretion by glucose stimulation. The authors report a case of persistent hypoglycemia, in a patient who had been administrating topiramate, as a treatment for epilepsy following an episode of cerebral infarction.
Insulin autoimmune syndrome is one of the rare causes of hypoglycemia, and characterized by hyperinsulinemic hypoglycemia associated with high titer of antibodies to endogenous insulin. We report a case of insulin autoimmune syndrome in a 57-year-old woman, presenting with mental changes due to hypoglycemia. She had no history of diabetes or insulin administration. The serum C-peptide level was 4.69 ng/mL and the insulin concentration was 229.55 microU/mL, when fasting plasma glucose level was 32 mg/dL. The insulin-to-glucose ratio was 7.17, while there was no radiologic evidence of insulinoma. The insulin antibody level was over 100 microU/mL, resulting in the diagnosis of insulin autoimmune syndrome. Hormonal studies revealed partial hypopituitarism and a lack of glucagon-response to hypoglycemia. Hypoglycemia disappeared with replacement of prednisolone with levothyroxine therapy. Under secretion of growth hormone and of adrenocorticotropic hormone due to hypopituitarism were associated with insufficient counterregulation to hypoglycemia. One should keep in mind that insulin autoimmune syndrome or hypopituitarism is one cause of hypoglycemia in patients with no history of diabetes, and corticosteroid can be an effective treatment for both diseases.
Autoimmune thyroid diseases, including Hashimoto's thyroiditis (HT), are common organ-specific autoimmune disorders that often occur in conjunction with other autoimmune diseases. Autoimmune hepatitis (AIH) is a relatively rare disease of unknown etiology. In this condition, progressive destruction of the liver parenchyma occurs. Without proper treatment with immunosuppressive agents, such as prednisone and azathioprine, this condition leads to cirrhosis and liver failure. Timely detection and appropriate treatment of the AIH is prerequisite for the long-term survival of affected patients. We report here a case of HT accompanied by AIH confirmed by liver biopsy. On the basis of this case report, we suggest that, a sustained elevation of aminotransferases refractory to thyroid dysfunction correction should result in a liver biopsy to differentiate AIH from other forms of liver dysfunction or secondary to thyroid disorders. Treatment should commence promptly.
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Sporadic medullary thyroid carcinoma (MTC) is the most common form of MTC and somatic RET proto-oncogene mutations account for approximately 25% of the patients with sporadic MTC. However, other pathogeneses of sporadic MTC are still unclear. Not only RET mutation, but also polymorphisms of RET may have an association with sporadic MTC. We herein describe the association of MTC and RET proto-oncogene polymorphism. A 51-year-old man was diagnosed with MTC, which was incidentally found on a thyroid sonogram. The patient underwent total thyroidectomy and genetic mutational analysis of the RET gene. Genetic testing detected a polymorphism in codon 691 (G691S) on exon 11 of the RET proto-oncogene. His son and daughter had the same polymorphism. We report on this case along with a review of the related literature on RET gene polymorphism of sporadic MTC.