Endocrinology and Metabolism

Volume 27(3); September 2012

Review Articles

RET: A Multi-Faceted Gene in Human Cancer.: Massimo Santoro, Francesca Carlomagno, Rosa Marina Melillo; Endocrinol Metab. 2012;27(3):173-179. Published online September 19, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.3.173

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Abstract PDF: REarranged during Transfection (RET) gene encodes a receptor tyrosine kinase and it was initially discovered as an in vitro transforming gene. For many years, RET has been involved in papillary thyroid carcinoma and medullary thyroid carcinoma. More recently, lung adenocarcinoma and chronic myelomonocytic leukemia samples have been found to display RET gene rearrangements. This knowledge is stimulating the search for protein kinase inhibitors to combat RET-driven malignancies.

Reproduction and Metabolism: Insights from Polycystic Ovary Syndrome.: Prathima Jasti, Andrea Dunaif; Endocrinol Metab. 2012;27(3):180-190. Published online September 19, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.3.180

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Abstract PDF

Until the 1980s, polycystic ovary syndrome (PCOS) was considered to be a poorly defined reproductive disorder. During that decade, it was recognized that PCOS was associated with profound insulin resistance and a substantially increased risk for type 2 diabetes mellitus in young women. Accordingly, the mechanisms linking the reproductive and metabolic features of the syndrome became the subject of intense investigation. Insulin is now recognized as a reproductive as well as a metabolic hormone and insulin signaling in the central nervous system participates in normal reproductive function. These insights have been directly translated into a novel therapy for PCOS with insulin sensitizing drugs. Androgens also have reversible metabolic actions to decrease insulin sensitivity and increase visceral fat. Prenatal androgen administration to non-human primates, sheep and rodents produces reproductive and metabolic features of PCOS suggesting that the disorder also has developmental origins. PCOS is highly heritable and male as well as female relatives have reproductive and metabolic phenotypes. A number of confirmed genetic susceptibility loci have now been mapped for PCOS and genes in well-known as well as novel biologic pathways have been implicated in disease pathogenesis.

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The Role of Foxo3 in Leydig Cells
Young Suk Choi, Joo Eun Song, Byung Soo Kong, Jae Won Hong, Silvia Novelli, Eun Jig Lee
Yonsei Medical Journal.2015; 56(6): 1590. CrossRef
FoxO1 Is a Negative Regulator of FSHβ Gene Expression in Basal and GnRH-Stimulated Conditions in Female
Young-Suk Choi, Hyeon Jeong Lee, Cheol Ryong Ku, Yoon Hee Cho, Mi Ran Seo, Yoo Jeoung Lee, Eun Jig Lee
Endocrinology.2014; 155(6): 2277. CrossRef

Editorial

Environmental Factors and Thyroid Dysfunction.: Hyun Kyung Chung; Endocrinol Metab. 2012;27(3):191-193. Published online September 19, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.3.191

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No abstract available.

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A study on the health effects of residents in Namhae and Hadong - Centered on health insurance data
YoonDeok Han, Sunghyeon Jung, Kwang-tae Ha, Seung-Mi Kwon, Seog-Ju Cho, Jin-Ho Sin, Yong-Seung Shin, Bu-Soon Son
Journal of Odor and Indoor Environment.2020; 19(3): 268. CrossRef
Cost-of-Illness Trends Associated with Thyroid Disease in Korea
Kyung-Rae Hyun, Sungwook Kang, Sunmi Lee
Endocrinology and Metabolism.2014; 29(3): 257. CrossRef
The Biochemical Prognostic Factors of Subclinical Hypothyroidism
Myung Won Lee, Dong Yeob Shin, Kwang Joon Kim, Sena Hwang, Eun Jig Lee
Endocrinology and Metabolism.2014; 29(2): 154. CrossRef

Original Articles

Predictive Factors for Incidental Contralateral Carcinoma in Patients with Unilateral Micropapillary Thyroid Carcinoma.: Jung Eun Huh, Sang Soo Kim, Ji Hyun Kang, Bo Gwang Choi, Byung Joo Lee, Jin Choon Lee, Yun Kyung Jeon, Bo Hyun Kim, Soo Geun Wang, Yong Ki Kim, In Joo Kim; Endocrinol Metab. 2012;27(3):194-199. Published online September 19, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.3.194

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BACKGROUND
Whether thyroid lobectomy alone is a sufficient treatment for papillary thyroid microcarcinoma (PTMC) remains controversial. The aim of this study is to evaluate the predictive factors for incidental contralateral carcinoma in patients confirmed of unilateral PTMC preoperatively. METHODS: Between January 2007 and December 2009, 393 patients underwent thyroid surgery for unifocal and unilateral PTMC preoperatively at Pusan National University Hospital. A total thyroidectomy with central neck dissection was routinely performed for these patients during this study period. RESULTS: Among the 393 cases in the cohort, 77 patients (19.6%) had incidental PTMC in the contralateral lobe. In patients with incidental contralateral carcinoma, there was higher prevalence in extrathyroid extension, occult ipsilateral carcinoma, pathologic Hashimoto's thyroiditis, and central lymph node metastasis compared to those without contralateral carcinoma. The mean tumor size also increased in patients with contralateral carcinoma. Multivariate logistic regression showed that extrathyroid extension (P = 0.049), occult ipsilateral carcinoma (P < 0.001), pathologic Hashimoto's thyroiditis (P = 0.038), and central lymph node metastasis (P = 0.002) were predictive factors for incidental contralateral carcinoma. CONCLUSION: In conclusion, multifocality in the ipsilateral lobe, central lymph node metastasis, extrathyroid extension, and Hashimoto's thyroiditis is associated with the presence of contralateral carcinoma. Thus, if these factors are found by preoperative and/or postoperative evaluation, total thyroidectomy or completion thyroidectomy is necessary for the treatment of PTMC.

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Extent of surgery did not affect recurrence during 7‐years follow‐up in papillary thyroid cancer sized 1‐4 cm: Preliminary results
Min Joo Kim, Myung‐Chul Lee, Guk Haeng Lee, Hoon Sung Choi, Sun Wook Cho, Su‐jin Kim, Kyu Eun Lee, Young Joo Park, Do Joon Park
Clinical Endocrinology.2017; 87(1): 80. CrossRef

Thyroid Dysfunction of North Korean Women Living in South Korea, Focusing on Subclinical Hypothyroidism.: Joo Hyung Kim, Sol Ah Park, Nam Hoon Kim, Jae Hee Ahn, Yoon Jung Kim, Myongjin Cho, Yoon Jung Lee, Hye Jin Yoo, Hee Young Kim, Ji A Seo, Nan Hee Kim, Kyung Mook Choi, Sei Hyun Baik, Dong Seop Choi, Sin Gon Kim; Endocrinol Metab. 2012;27(3):200-207. Published online September 19, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.3.200

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Abstract PDF

BACKGROUND
Thyroid function depends on ethnic and environmental factors. North Korean refugees have the same genetic background as South Koreans, but they have been exposed to different environments. This study examines the prevalence and pattern of thyroid disorders in North Korean women living in South Korea, focusing on subclinical hypothyroidism (SCH). METHODS: The intended sample was a total of 327 North Korean women residing in Seoul. Health questionnaires and medical examinations, including serum thyrotropin (thyroid stimulating hormone, TSH), free thyroxine, and thyroid autoantibodies, were conducted. RESULTS: The prevalence of SCH was 9.4%. In logistic regression analysis, smoking, menopause, length of stay in South Korea, body mass index, history of thyroid disease, and metabolic syndrome were not associated with the risk of SCH. Whereas, the positivity of autoantibodies were associated with a high risk for SCH (odds ratio [OR], 4.840; 95% confidence interval [CI], 1.80-13.017; P = 0.002), and age was associated with a low risk for SCH (OR, 0.94; 95% CI, 0.888-0.994; P = 0.031). The serum TSH levels also decreased with increasing age, and in particular, there was significant difference between 30-39 years, and over 60 years (2.33 +/- 1.51 microIU/mL vs. 1.54 +/- 0.73 microIU/mL, P = 0.028). CONCLUSION: In North Korean women, the positivity of autoantibodies was associated with a high risk for SCH. But interestingly, a younger age was associated with a high risk for SCH. Considering that they suffered from severe famine at the period of growth, and this led to malnutrition, their thyroid dysfunction might be associated with the peculiar environment that they experienced.

Citations

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Systematic review of evidence on public health in the Democratic People’s Republic of Korea
John J Park, Ah-Young Lim, Hyung-Soon Ahn, Andrew I Kim, Soyoung Choi, David HW Oh, Owen Lee-Park, Sharon Y Kim, Sun Jae Jung, Jesse B Bump, Rifat Atun, Hee Young Shin, Kee B Park
BMJ Global Health.2019; 4(2): e001133. CrossRef
Environmental Factors and Thyroid Dysfunction
Hyun-Kyung Chung
Endocrinology and Metabolism.2012; 27(3): 191. CrossRef

Lipid Profiles and Prevalence of Dyslipidemia in Korean Adolescents.: Shin Hye Kim, Byung Chul Ahn, Hyojee Joung, Mi Jung Park; Endocrinol Metab. 2012;27(3):208-216. Published online September 19, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.3.208

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BACKGROUND
The aim of this study is to investigate the distribution of plasma cholesterol and triglyceride levels as well as the prevalence of dyslipidemia among Korean adolescents. METHODS: We analyzed data for 3,045 adolescents aged 10-18 years (1,622 boys and 1,423 girls) who participated in the Korea National Health and Nutrition Examination Surveys from 2007 to 2010. RESULTS: The mean values of total cholesterol, triglycerides, low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) were 159, 89, 89, and 52 mg/dL, respectively. Plasma cholesterol levels were significantly higher in girls than those in boys (162.1 mg/dL vs. 155.6 mg/dL, P < 0.0001). The 90th percentile values of total cholesterol, triglycerides, and LDL-C were 192, 149, 117 mg/dL for boys, and 195, 147, 119 mg/dL for girls. The 10th percentile value of HDL-C was 38 mg/dL for boys and 40 mg/dL for girls. Triglyceride, LDL-C cholesterol levels increased, whereas plasma HDL-C levels decreased with increasing the body mass index (P < 0.0001) in both genders. Total cholesterol levels significantly increased with increasing the body mass index, especially in boys (P < 0.0001). The prevalence of dyslipidemia was 25.2% for boys and 21.7% for girls; this value significantly increased with overweight (37-40%) and obesity (53-56%). Independent predictors (odds ratio) of dyslipidemia were age (1.49), overweight (2.06), and obesity (5.11) for boys; overweight (1.95) and obesity (3.22) for girls. CONCLUSION: Adolescent dyslipidemia is strongly associated with obesity. Lipid screening for overweight or obese youths should be emphasized. Further, longitudinal studies examining the impact of childhood obesity and dyslipidemia on subsequent cardiovascular diseases are needed.

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Lipid Profile and the Frequency of Dyslipidemia in Iranian Adolescents with Severe Obesity, Who Were Candidates for Bariatric Surgery
Fahimeh Soheilipour, Fatemeh Geram
Obesity Surgery.2024; 34(2): 618. CrossRef
Screening and Management for Dyslipidemia in Korean Children and Adolescents
Jong Seo Yoon, Il Tae Hwang
The Ewha Medical Journal.2022;[Epub] CrossRef
Impact of the COVID-19 Pandemic on Seasonal Variations in Childhood and Adolescent Growth: Experience of Pediatric Endocrine Clinics
Jin-Ah Han, Yae-Eun Chung, In-Hyuk Chung, Yong-Hee Hong, Sochung Chung
Children.2021; 8(5): 404. CrossRef
Prevalence and treatment of pediatric dyslipidemia
Kyungchul Song, Ho-Seong Kim, Hyun Wook Chae
Journal of the Korean Medical Association.2021; 64(6): 410. CrossRef
Trends in Serum Lipid Profiles Among Korean Adolescents, 2007–2018
Da-Young Jeong, Shin-Hye Kim, Moon Young Seo, Sinyoung Kang, Mi Jung Park
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Trends of physiological and lifestyle risk factors of cardiovascular disease in Korea adolescents: Using Korean National Health and Nutrition Examination Survey data (2007–2015)
Yeo Jin Lee, Seon Young Hwang
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2017 Clinical practice guidelines for dyslipidemia of Korean children and adolescents
Jung Sub Lim, Eun Young Kim, Jae Hyun Kim, Jae-Ho Yoo, Kyung Hee Yi, Hyun Wook Chae, Jin-Ho Choi, Ji Young Kim, Il Tae Hwang
Annals of Pediatric Endocrinology & Metabolism.2020; 25(4): 199. CrossRef
2017 Clinical practice guidelines for dyslipidemia of Korean children and adolescents
Jung Sub Lim, Eun Young Kim, Jae Hyun Kim, Jae-Ho Yoo, Kyung Hee Yi, Hyun Wook Chae, Jin-Ho Choi, Ji Young Kim, Il Tae Hwang
Clinical and Experimental Pediatrics.2020; 63(12): 454. CrossRef
Short Stature is Associated with Increased Risk of Dyslipidemia in Korean Adolescents and Adults
Na-Kyung Oh, Yun-Mi Song, Shin-Hye Kim, Mi Jung Park
Scientific Reports.2019;[Epub] CrossRef
Distribution of the Fasting Lipid Levels and Validation of the Reference Interval in Korean Adolescents
Seyoung Kwon, Youngak Na
The Korean Journal of Clinical Laboratory Science.2018; 50(3): 253. CrossRef
Impact of lifestyle factors on trends in lipid profiles among Korean adolescents: the Korea National Health and Nutrition Examination Surveys study, 1998 and 2010
Shin-Hye Kim, Young-Hwan Song, Sangshin Park, Mi-Jung Park
Korean Journal of Pediatrics.2016; 59(2): 65. CrossRef
Consumption of Added Sugars and Lipid Profiles in Korean Population from a Cohort Study
Sang Yeun Kim, Sun Ha Jee
Journal of Lipid and Atherosclerosis.2015; 4(1): 17. CrossRef
Dyslipidemia in Children and Adolescents: When and How to Diagnose and Treat?
Jung Min Yoon
Pediatric Gastroenterology, Hepatology & Nutrition.2014; 17(2): 85. CrossRef
The current state of dyslipidemia in Korean children and adolescents and its management in clinical practice
Jung Sub Lim
Annals of Pediatric Endocrinology & Metabolism.2013; 18(1): 1. CrossRef

Case Reports

A Case of Ectopic Thyroid Tissue Diagnosed by Fine Needle Aspiration in the Lateral Neck.: Kyung Nam Lee, Sang Mi Kim, Jin Hee Choi, Kwang Duck Ryu, Bo Won Kim, Min Ji Shin, Bo Hyun Kim, In Ju Kim; Endocrinol Metab. 2012;27(3):217-221. Published online September 19, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.3.217

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Abstract PDF

Ectopic thyroid glands generally occur in the midline as a result of abnormal median migration and their presence in lateral to the midline is rare. Embryologically, the thyroid gland is derived from two anlages: a large median endodermal anlage and two lateral anlages. The median anlage produces most of the thyroid parenchyma, whereas the lateral anlage is derived from the fourth pharyngeal pouch and contributes 1-30% of the thyroid weight. In rare cases, failure of the lateral anlage to fuse with the median anlage can result in lateral ectopic thyroid gland. For many years, lateral, aberrant thyroid tissue in adults was a term used almost exclusively for metastatic thyroid carcinoma. However, aberrant, benign ectopic thyroid tissue rarely occurs. We present a 47-year-old man who had incidentally detected mass on the right lateral neck. He was clinically in a euthyroid status and the thyroid function test results were normal as well. Neck ultrasonography revealed a mild diffuse goiter and a 1.22 x 0.65 cm sized ovoid mass like lesion was located in the right level IV of the neck. The result of fine needle aspiration cytology was adenomatous goiter without lymphoid tissue or any malignancy. We rarely report aberrant, benign ectopic thyroid presence as a lateral neck mass.

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Ectopic Thyroid Mimicking Lymph Node Metastasis of Thyroid Cancer
Min Young Cho, Dong Young Kim
Korean Journal of Otorhinolaryngology-Head and Neck Surgery.2023; 66(6): 417. CrossRef
A Case of Lateral Ectopic Thyroid Mimicking the Metastatic Lymphadenopathy
Seung Ho Kim, Jung Heob Sohn, Jung Yeon Kim
Korean Journal of Otorhinolaryngology-Head and Neck Surgery.2019; 62(10): 588. CrossRef

A Case of Actinomycotic Thyroiditis in an Adult with Piriform Sinus Fistula.: Hyun Ju Choi, Bo Won Kim, Min Ji Shin, Bo Kwang Choi, Ji Hyun Kang, Yun Kyung Jeon, Sang Soo Kim, Bo Hyun Kim, In Ju Kim, Yong Ki Kim; Endocrinol Metab. 2012;27(3):222-226. Published online September 19, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.3.222

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Abstract PDF

Acute suppurative thyroiditis is an uncommon infectious thyroid disease affecting mainly children and young adults. The route of infection is frequently a pyriform sinus fistula. The major pathogens responsible for acute bacterial suppurative thyroiditis are the Streptococcus and Staphylococcus species. In contrast, Actinomyces species are a very rare cause of acute suppurative thyroiditis. We experienced a case of a 23-year-old man who has presented general weakness and neck pain. Thyroid ultrasonography showed an ill-defined area of heterogeneous hypoechogenicity in the left lobe of the thyroid gland. Histologic examination by fine needle aspiration demonstrated gram-positive, filamentous-like organisms with branching hyphae and characteristic sulfur granules. Barium esophagogram showed a linear barium-filled track at the left pyriform sinus. We report a case of actinomycotic thyroiditis in a young adult with pyriform sinus fistula along with a brief review of related literature.

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A Case of Pyriform Sinus Fistula Concurrent with Papillary Thyroid Carcinoma in a 72-Year-Old Patient
Yun Young Jung, Dongbin Ahn, Heejin Kim, Jin Ho Sohn
Korean Journal of Otorhinolaryngology-Head and Neck Surgery.2015; 58(1): 48. CrossRef

A Case of Incidental Struma Ovarii Confounded with the Metastasis of Papillary Thyroid Cancer.: Young Hee Jung, Sung Min Jung, Jong Min Lee, Yi Sun Jang, In Suk Lee, Jong Ok Kim, Hye Soo Kim; Endocrinol Metab. 2012;27(3):227-231. Published online September 19, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.3.227

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Abstract PDF: A focal radioactive iodine uptake in the pelvis of a patient with differentiated thyroid cancer needs differential diagnosis besides bone metastasis. Struma ovarii is a rare monodermal ovarian teratoma composed predominantly of mature thyroid tissue; 5-10% of these tumors are malignant. As diagnosis and surgery of thyroid cancer have increased recently, incidental cases of struma ovarii, after radioactive iodine treatment, were occasionally reported. Rare cases of ovary metastasis of thyroid cancer were also reported. We report a case of benign struma ovarii incidentally found in a patient with papillary thyroid cancer. The patient showed a sustained high level of thyroglobulin and focal radioactive iodine uptake in the right pelvis, confused with distant metastasis, after total thyroidectomy and radioactive iodine treatment.

A Case of Adipsic Hypernatremia Associated with Anomalous Corpus Callosum in Adult with Mental Retardation.: Boo Gyoung Kim, Ka Young Kim, Youn Jeong Park, Keun Suk Yang, Ji Hee Kim, Hee Chan Jung, Hee Chul Nam, Young Ok Kim, Yu Seon Yun; Endocrinol Metab. 2012;27(3):232-236. Published online September 19, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.3.232

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Abstract PDF

Adipsic hypernatremia cause chronic hyperosmolality and hypernatremia through a combination of impaired thirst and osmotically stimulated antidiuretic hormone secretion. This syndrome can be grouped together as disorders of osmoreceptor dysfunction due to the various degrees of osmoreceptor destruction related with different types of intracranial lesions around the anterior hypothalamus, consistent with the location of primary osmoreceptor cells. Adipsic hypernatremia, associated with developmental disorder of corpus callosum, is very rare. Most cases are diagnosed at infancy and early childhood; the replacement of desmopressin is necessary. Herein, we report adipsic hypernatremia associated with anomalous corpus callosum in adult with mental retardation; they were treated with only free water without desmopressin.

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Adipsic Hypernatremia after Clipping of a Ruptured Aneurysm in the Anterior Communicating Artery: A Case Report
Won Ki Kim, Taeho Lee, Ae Jin Kim, Han Ro, Jae Hyun Chang, Hyun Hee Lee, Wookyung Chung, Ji Yong Jung
Electrolytes & Blood Pressure.2021; 19(2): 56. CrossRef
The use of diffusion tractography to characterize a corpus callosum malformation in a dog
Philippa J. Johnson, Erica F. Barry, Wen‐Ming Luh, Emma Davies
Journal of Veterinary Internal Medicine.2019; 33(2): 743. CrossRef

A Case of Ectopic ACTH Syndrome Associated with Metastatic Prostate Cancer.: Eun Ky Kim, Soo Heon Kwak, Hwa Young Ahn, Ah Reum Khang, Hyo Jin Park, So Yeon Park, Sang Eun Lee, Hak Chul Jang, Seong Yeon Kim, Young Joo Park; Endocrinol Metab. 2012;27(3):237-243. Published online September 19, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.3.237

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Abstract PDF: Ectopic adrenocorticotropic hormone (ACTH) syndrome is mostly associated with neuroendocrine tumors and small cell carcinoma of the lung. This syndrome of prostate cancer is rare and has been reported in only a few cases. We report a patient with ectopic ACTH production associated with metastatic prostate cancer. A 70-year-old patient with metastatic prostate cancer was admitted to our hospital with septic shock. He had a history of hormonal therapy and transurethral prostatectomy. Adrenocortical function was checked due to consistent fever and poor general condition, which revealed markedly increased levels of basal plasma ACTH and serum cortisol. The patient did not present typical signs of the Cushing's syndrome, however, hypokalemia and a history of hypertension were found. He died in days as a result of multi-organ failure. On pathology, the prostatectomy specimen showed a tumor composed of mixed populations of adenocarcinoma and small cell carcinoma. The tumor cells in the small cell component were positive for chromogranin and ACTH. Although neuroendocrine differentiation in prostate cancer is rare, etopic ACTH production should be considered in patients with prostate cancer as well as in clinical features of ACTH hypersecretion.

A Case of Diabetic Mastopathy.: Seok Hong Lee, Bo Min Kim, Jae Woong Kim, Moon Ki Hong, Seonghyeop Hyeon, Mi Yi Kim, Jaetaek Kim, Jihyun Ahn; Endocrinol Metab. 2012;27(3):244-246. Published online September 19, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.3.244

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Abstract PDF: Diabetic mastopathy is an unusual fibroinflammatory breast lesion that is characteristically presented in premenopausal women with long-standing diabetes with multiple microvascular complications. This patient was a 49-year-old postmenopausal woman with diabetic nephropathy, neuropathy, and retinopathy. Although palpable mass was detected on the left breast, an ultrasonography could not distinguish it from breast cancer. Excisional biopsy was conducted. Histological findings indicated diabetic mastopathy with keloid-like fibrosis, perivascular lymphocytic infiltration, and lymphocytic lobulitis without evidence of malignancy. After excision, there has been no recurrence until now.

1-34 PTH Could Reverse Impaired Bone Mineralization Induced By the Overdose of Bisphosphonate.: Kyeong Hye Park, Kwang Joon Kim, Han Seok Choi, Kyoung Min Kim, Eun Young Lee, Seonhui Han, Hyun Sil Kim, Daham Kim, Hannah Seok, Eun Yeong Choe, Yumie Rhee, Sung Kil Lim; Endocrinol Metab. 2012;27(3):247-250. Published online September 19, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.3.247

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Abstract PDF: Bisphosphonates are the mainstay of osteoporosis treatment. Despite the fact that bisphosphonates have a relatively good safety record and are tolerated well by the majority of patients, serious adverse events have been associated with their use. A 41-year-old man had been diagnosed with osteoporosis and had taken etidronate 200 mg/day daily for 2 years due to the judgmental error. He was referred for the management of refractory bone pain and generalized muscle ache. Serum calcium, phosphate, 25-hydroxy-vitamin D (25(OH)D), and immunoreactive parathyroid hormone (iPTH) were within normal range. Plain X-ray showed multiple fractures. Whole body bone scan confirmed multiple sites of increased bone uptakes. Tetracycline-labeled bone biopsy showed typical findings of osteomalacia. He was diagnosed with iatrogenic, etidronate-induced osteomalacia. The patient received daily parathyroid hormone (PTH) injection for 18 months. PTH effectively reverses impaired bone mineralization caused by etidronate misuse. Currently, he is doing well without bone pain. Bone mineral density significantly increased, and the increased bone uptake was almost normalized after 18 months. This case seems to suggest that human PTH (1-34) therapy, possibly in association with calcium and vitamin D, is associated with important clinical improvements in patients with impaired bone mineralization due to the side effect of bisphosphonate.

Letter

Letter: Frequency of RAS Mutations and PAX8/PPARgamma Rearrangement in Follicular Thyroid Tumors in Korea.: Sang Jin Kim; Endocrinol Metab. 2012;27(3):251. Published online September 19, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.3.251

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Abstract PDF: No abstract available.

Comment

Response: Frequency of RAS Mutations and PAX8/PPARgamma Rearrangement in Follicular Thyroid Tumors in Korea.: Jae Hoon Chung; Endocrinol Metab. 2012;27(3):252-253. Published online September 19, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.3.252

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Abstract PDF: No abstract available.

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