Endocrinology and Metabolism

Volume 27(4); December 2012

Review Articles

Vitamin D: A D-Lightful Vitamin for Health.: Michael F Holick; Endocrinol Metab. 2012;27(4):255-267. Published online December 20, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.4.255

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Vitamin D is a sunshine vitamin that has been produced on this earth for more than 500 million years. Because foods contain so little vitamin D most humans have always depended on sun exposure for their vitamin D requirement. Vitamin D deficiency has been defined as a serum 25-hydroxyvitamin D concentration < 20 ng/mL (50 nmol/L); vitamin D insufficiency as a serum 25-hydroxyvitamin D of 21-29 ng/mL and vitamin D sufficiency as a serum 25-hydroxyvitamin D of 30-100 ng/mL whereas toxicity is usually not seen until blood levels are above 150 ng/mL. Vitamin D deficiency is a global health problem that increases risk for metabolic bone diseases in children and adults as well as many chronic illnesses including autoimmune diseases, type 2 diabetes, cardiovascular disease, infectious disease, and cancer. The major causes of vitamin D deficiency are lack of adequate sensible exposure to sunlight, inadequate dietary intake and obesity. The United States Endocrine Society recommended that to prevent vitamin D deficiency in those at risk, children 1 year and older require 600-1,000 international unit (IU) of vitamin D daily and adults require 1,500-2,000 IU of vitamin D daily. Obese patients require 2-3 times more vitamin D to both treat and prevent vitamin D deficiency.

Citations

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Higher intakes of dietary caffeine are associated with 25-hydroxyvitamin D deficiency
Qiwei Chen, Hamed Kord-Varkaneh, Heitor O. Santos, Rafael Genario, Minyan Dang
International Journal for Vitamin and Nutrition Research.2022; 92(2): 85. CrossRef
WITHDRAWN: Higher intakes of dietary caffeine are associated with 25-hydroxyvitamin D deficiency: a study from the NHANES
Fang Yang, Ning Wang
Nutrition.2021; : 111380. CrossRef
Association of metabolic syndrome and 25‐hydroxyvitamin D with cognitive impairment among elderly Koreans
Eun Young Lee, Su Jin Lee, Kyoung Min Kim, Young Mi Yun, Bo Mi Song, Jong Eun Kim, Hyeon Chang Kim, Yumie Rhee, Yoosik Youm, Chang Oh Kim
Geriatrics & Gerontology International.2017; 17(7): 1069. CrossRef
Korean Society for Bone and Mineral Research Task Force Report: Perspectives on Intermittent High-dose Vitamin D Supplementation
Han Seok Choi, Yong-Ki Min, Dong Won Byun, Myung Hoon Hahn, Kyoung Min Kim, Beom Jun Kim, Ki-Won Oh
Journal of Bone Metabolism.2017; 24(3): 141. CrossRef
Efficacy and safety of vitamin D3 B.O.N intramuscular injection in Korean adults with vitamin D deficiency
Han Seok Choi, Yoon-Sok Chung, Yong Jun Choi, Da Hea Seo, Sung-Kil Lim
Osteoporosis and Sarcopenia.2016; 2(4): 228. CrossRef
Endocrine Risk Factors for Cognitive Impairment
Jae Hoon Moon
Endocrinology and Metabolism.2016; 31(2): 185. CrossRef
The effect of thyroid stimulating hormone suppressive therapy on bone geometry in the hip area of patients with differentiated thyroid carcinoma
Jae Hoon Moon, Kyong Yeun Jung, Kyoung Min Kim, Sung Hee Choi, Soo Lim, Young Joo Park, Do Joon Park, Hak Chul Jang
Bone.2016; 83: 104. CrossRef
Serum 25‐hydroxyvitamin D level and the risk of mild cognitive impairment and dementia: the Korean Longitudinal Study on Health and Aging (KLoSHA)
J.H. Moon, S. Lim, J.W. Han, K.M. Kim, S.H. Choi, K.W. Kim, H.C. Jang
Clinical Endocrinology.2015; 83(1): 36. CrossRef
Vitamin D Status in Korea
Han Seok Choi
Endocrinology and Metabolism.2013; 28(1): 12. CrossRef

Neuroendocrine Regulation of Energy Metabolism.: Marcelo O Dietrich, Tamas L Horvath; Endocrinol Metab. 2012;27(4):268-273. Published online December 20, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.4.268

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Abstract PDF

Significant advancements have been made in the past century regarding the neuronal control of feeding behavior and energy expenditure. The effects and mechanisms of action of various peripheral metabolic signals on the brain have become clearer. Molecular and genetic tools for visualizing and manipulating individual components of brain homeostatic systems in combination with neuroanatomical, electrophysiological, behavioral, and pharmacological techniques have begun to elucidate the molecular and neuronal mechanisms of complex feeding behavior and energy expenditure. This review article highlights some of these advancements that have led to the current understanding of the brain's involvement in the acute and chronic regulation of energy homeostasis.

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Neuronal HSF-1 coordinates the propagation of fat desaturation across tissues to enable adaptation to high temperatures in C. elegans
Laetitia Chauve, Francesca Hodge, Sharlene Murdoch, Fatemeh Masoudzadeh, Harry-Jack Mann, Andrea F. Lopez-Clavijo, Hanneke Okkenhaug, Greg West, Bebiana C. Sousa, Anne Segonds-Pichon, Cheryl Li, Steven W. Wingett, Hermine Kienberger, Karin Kleigrewe, Mari
PLOS Biology.2021; 19(11): e3001431. CrossRef

Editorial

APOA5 Polymorphism Is Associated with Metabolic Syndrome in Korean Postmenopausal Women.: Mi Hae Seo, Won Young Lee; Endocrinol Metab. 2012;27(4):274-275. Published online December 20, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.4.274

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Abstract PDF: No abstract available.

Original Articles

APOA5 Polymorphism Is Associated with Metabolic Syndrome in Korean Postmenopausal Women.: Doh Hee Kim, Seung Hee Lee, Kyung Hoon Han, Chae Bong Kim, Kwan Young Song, Sook Cho, Kye Heui Lee; Endocrinol Metab. 2012;27(4):276-281. Published online December 20, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.4.276

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Abstract PDF

BACKGROUND
Menopause is an independent risk factor in metabolic syndrome which induced an alteration of the lipid metabolism by hormonal changes. Apolipoprotein A5 gene (APOA5) was related to the regulation of triglyceride and high density lipoprotein cholesterol (HDL-C) level with biosynthesis and decomposition. This study was conducted to investigate the relationship between APOA5 polymorphism and metabolic syndrome in Korean postmenopausal women. METHODS: This study included 307 postmenopausal women with anthropometric and biochemical measurement in 2010-2011. The polymorphism of APOA5 was analyzed by polymerase chain reaction-restriction fragment length polymorphism method with MseI restriction enzyme. RESULTS: The metabolic syndrome prevalence with TT genotype was significantly lower than the frequency in those with TC/CC (27.09%, 38.46%, and 45.71% for TT, TC, and CC, respectively; P < 0.05). Multiple regression analysis of metabolic syndrome risk factors indicated that postmenopausal women with CC genotype had a higher risk with 3 times than that in TT genotype (P < 0.05). APOA5 C carriers showed an increased risk of triglyceride level (odd ratio, 2.93 and 1.85 for CC and TC+CC, respectively; P < 0.05). Interestingly, HDL-C was related to triglyceride directly in comparison to APOA5. CONCLUSION: The results of this study indicate that APOA5 has an influence on serum triglyceride and HDL-C, which contribute to metabolic syndrome in Korean postmenopausal women.

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Effects of a 3-year dietary intervention on age-related changes in triglyceride and apolipoprotein A-V levels in patients with impaired fasting glucose or new-onset type 2 diabetes as a function of the APOA5 -1131 T > C polymorphism
Minjoo Kim, Jey Sook Chae, Miri Kim, Sang-Hyun Lee, Jong Ho Lee
Nutrition Journal.2014;[Epub] CrossRef
APOA5Polymorphism Is Associated with Metabolic Syndrome in Korean Postmenopausal Women
Mi Hae Seo, Won Young Lee
Endocrinology and Metabolism.2012; 27(4): 274. CrossRef

Expression and Purification of Phospholipase C-beta4, and Chimeric Phospholipase C and Characterization of Them.: Do Joon Park; Endocrinol Metab. 2012;27(4):282-288. Published online December 20, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.4.282

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Abstract PDF: BACKGROUND
Phospholipase C-beta4 (PLC-beta4) is known to be one of the most important signal transducing molecules; however, its biophysical and chemical characteristics are not well known due to the difficulty in purifying PLC-beta4 from bovine retina. In the present study, we used the baculovirus expression system in order to express and purify large amounts of PLC-beta4. With this system, we also tried to produce chimeric PLC-beta3/beta4 and PLC-beta4/beta3 protein in order to study the structure-activity relationship between N terminal and C terminal portion of PLC-betas. METHODS: I cloned PLC-beta4 to the baculovirus expression system by the polymerase chain reaction method and infected the PLC-beta4 to Sf9 cells. I purified recombinant PLC-beta4 proteins using sequential high performnance liquid chromatography (HPLC) by using the TSK phenyl-5PW column and the TSK heparin-5PW column. With this similar method, I was able to express chimeric PLC-beta3/beta4 and PLC-beta4/beta3 proteins. RESULTS: With the two step HPLC, I was able to purify PLC-beta4 by 30-fold; this purified PLC-beta4 contained PLC activity. I also expressed chimeric PLC-beta3/beta4 and PLC-beta4/beta3 using the baculovirus system, and their expression was confirmed by the immunoblot method. However, chimeric PLC-beta4/beta3 did not show PLC activity, while chimeric PLC-beta3/beta4 retained its PLC-activity. CONCLUSION: Expression of chimeric PLC-beta4 using the baculovirus system was an efficient method to obtain a large amount of protein. Moreover, this expression and purification method would be useful in studying the physical and chemical characteristics of this protein. In my study using chimeric PLC-beta protein by swapping the N terminal and C terminal portions of PLC-beta3 and beta4, chimeric protein lost its activity completely in PLC-beta4/beta3 chimera. This result suggested a minute change in the tertiary structure of the protein, which may significantly affect its function.

The Association between Serum Endogenous Secretory Receptor for Advanced Glycation End Products and Vertebral Fractures in Type 2 Diabetes.: Cheol Ho Lee, Min Kyung Lee, Hyun Jeong Han, Tae Ho Kim, Jae Hyuk Lee, Se Hwa Kim; Endocrinol Metab. 2012;27(4):289-294. Published online December 20, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.4.289

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Abstract PDF

BACKGROUND
Patients with type 2 diabetes are known to have an increased risk for osteoporotic fractures compared with non-diabetic subjects. We investigated whether the serum endogenous secretory receptor for advanced glycation end products (esRAGE) or pentosidine was associated with prevalent vertebral fractures in patients with type 2 diabetes. METHODS: We enrolled 140 patients with type 2 diabetes mellitus (73 men aged 50 or older and 67 postmenopausal women). Lateral X-ray films of the spine revealed prevalent vertebral fractures. The serum concentration of esRAGE and pentosidine were measured. RESULTS: The mean age of all patients was 66.2 +/- 6.5 years and 22% of patients had prevalent vertebral fractures. Serum pentosidine levels were similar between those with and without vertebral fractures. There were no significant correlations between serum esRAGE levels and age, body mass index, duration of diabetes, and hemoglobin A1c. However, patients with moderate or severe vertebral fractures have a lower esRAGE level compared to those without after adjusting for age and gender (0.33 +/- 0.12 ng/mL vs. 0.24 +/- 0.03 ng/mL, P < 0.05). Logistic regression analysis demonstrated that patients in the lowest tertile of esRAGE had a higher risk of moderate or severe vertebral fractures (odds ratio, 16.6; 95% confidence interval, 1.4-198.5) than patients in the highest tertile. CONCLUSION: These results revealed that a low esRAGE level was independently associated with moderate or severe vertebral fractures in type 2 diabetic patients.

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Letter: The Association between Serum Endogenous Secretory Receptor for Advanced Glycation End Products and Vertebral Fractures in Type 2 Diabetes (Endocrinol Metab 2012;27:289-94, Cheol Ho Lee et al.)
You-Cheol Hwang
Endocrinology and Metabolism.2013; 28(1): 76. CrossRef

Case Reports

A Case of Hypothyroidism in Remission during Pregnancy.: Ha Do Song, Eun Jin Han, Sung Ja Lee, Ji Hoon Yang, So Young Park, Sung Hoon Kim, Ki Ok Han, Hyun Koo Yoon, Chang Hoon Yim; Endocrinol Metab. 2012;27(4):295-298. Published online December 20, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.4.295

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Abstract PDF: Hypothyroidism should be treated in pregnancy, because it has been associated with an increased risk of adverse pregnancy complications, as well as detrimental effects upon fetal neurocognitive development. The goal of L-thyroxine (LT4) treatment is to normalize maternal serum TSH values within the trimester-specific pregnancy reference range. 50% to 85% of hypothyroid women being treated with exogenous LT4 need to increase the dose during pregnancy. In this study, we report a case of a 29-year-old woman with hypothyroidism who had been in remission and discontinued LT4 treatment during her pregnancy. Three months after delivery she had a relapse of hypothyroidism and was retreated with LT4. Many factors can influence the gestational requirement for LT4, therefore maternal serum TSH should be monitored and the LT4 dose should be adjusted in pregnant patients with treated hypothyroidism.

Thyrotoxic Periodic Paralysis Induced by Dexamethasone.: Eun Ju Lee, Tae Kyoon Kim, Min Jeong Kwon, Soon Hee Lee, Jeong Hyun Park; Endocrinol Metab. 2012;27(4):299-302. Published online December 20, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.4.299

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Abstract PDF

Thyrotoxic periodic paralysis (TPP) is a disease characterized by sudden onset and muscle paralysis. It occurs in the setting of hypokalemia of thyrotoxicosis. Cases of TPP induced by a glucocorticoid such as prednisolone or methylprednisolone have been reported. We report on two patients, each of whom received a dexamethasone injection and subsequently developed TPP. Both patients experienced sudden, flaccid paralysis of both extremities after the injection but recovered completely after receiving a potassium replacement. Laboratory results revealed thyrotoxicosis. The patients were diagnosed with Graves' disease and discharged after receiving treatment with methimazole and propranolol. This report provides the clinical description of TPP induced by dexamethasone injection. These cases suggest that clinicians must consider the presence of hyperthyroid disease in patients who develop acute paralysis after treatment with a glucocorticoid, even in the absence thyrotoxic symptoms. Furthermore, physicians should be aware that TPP can occur even in response to dexamethasone used for treatment of thyrotoxic crisis or Graves' ophthalmopathy.

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Glucocorticoid-Induced Hypokalemic Periodic Paralysis after Short-Term Use of Tenofovir with Hypophosphatemia: A Case Report
Yujin Shin, Yonglee Kim, Kyong Young Kim, Jong Ha Baek, Soo Kyoung Kim, Jung Hwa Jung, Jong Ryeal Hahm, Min Young Kim, Jaehoon Jung, Hosu Kim
Medicina.2021; 58(1): 52. CrossRef

A Case of Lingual Thyroid Treated by 131I Ablation.: Myeong Ho Yeon, Yong Hyeok Choi, Young Rak Choi, Woo Ri Park, Hyung Jin Choi, Tae Keun Oh, Hyun Jeong Jeon; Endocrinol Metab. 2012;27(4):303-307. Published online December 20, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.4.303

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Abstract PDF: A lingual thyroid is a rare developmental anomaly caused by the failure of the descent of the thyroid gland anlage early in the course of embryogenesis. The incidence of lingual thyroid has been reported to be 1/100,000. Lingual thyroid is often asymptomatic but may cause dysphagia, dysphonia, upper airway obstruction and hemorrhage. In this report, we described the case of a 50-year-old women experiencing lingual thyroid who had subclinical hypothyroidism. She underwent successful 131I ablation and has done well on thyroid hormone replacement therapy.

Pancytopenia Associated with Hypopituitarism in an Acromegaly Patient: A Case Report and a Review of the Literature.: Jung Hee Koh, Yong Jae Lee, Ji Hyun Kang, Bo Kwang Choi, Yun Kyung Jeon, Sang Soo Kim, Bo Hyun Kim, In Joo Kim; Endocrinol Metab. 2012;27(4):308-313. Published online December 20, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.4.308

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Abstract PDF

We present the case of a patient with acromegaly who had pancytopenia with hypopituitarism secondary to the excision of a pituitary macroadenoma and radiation therapy. A 28-year-old man presented with pancytopenia and serum electrolyte abnormalities. He was diagnosed with acromegaly and underwent surgery and gamma-knife radiotherapy for a pituitary macroadenoma at the age of 22 years. A recent brain magnetic resonance imaging showed an empty sella, and the basal hormonal profile demonstrated deficiencies of pituitary hormones except thyrotropin. As presenting pancytopenia, his bone marrow biopsy showed hypocellular marrow. The total number of hemocytes increased after hydrocortisone replacement. Hypopituitarism was a possible cause of pancytopenia, and glucocorticoids had crucial effects on converting pancytopenia to normal in this case.

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A 24-Year-Old Male with Gigantism, Growth Hormone Deficiency, Suspected Clivus Chordoma, Primary Hypothyroidism, Hypogonadism and Pancytopenia
W.A. Arsana, M.I. Diah Pramudianti
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY.2019; 26(2): 249. CrossRef
Hormones and the Bone Marrow: Panhypopituitarism and Pancytopenia in a Man with a Pituitary Adenoma
Dianna Lang, Jennifer S. Mead, David B. Sykes
Journal of General Internal Medicine.2015; 30(5): 692. CrossRef

A Case of Fulminant Type 1 Diabetes Mellitus with Human Leukocyte Antigen DR4-DQ4.: Ye Ri So, Ja Won Koo, Young Hak Cho, You Cheol Hwang, Kyu Jeung Ahn, Ho Yeon Chung, In Kyung Jeong; Endocrinol Metab. 2012;27(4):314-317. Published online December 20, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.4.314

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Abstract PDF: The clinical characteristics of fulminant type 1 diabetes are abrupt onset of disease, very short (<1 week) duration of diabetic symptoms, ketoacidosis at diagnosis, negativity for islet-related autoantibodies, virtually no C-peptide secretion (fasting plasma C-peptide <0.3 ng/mL), a near normal hemoglobin A1c (HbA1c) level and an elevated serum pancreatic enzyme level. The pathogenesis has not yet been clarified, however the involvement of both genetic background and viral infections has been suggested. We reported a case of fulminant type 1 diabetes. A 37-year-old woman was admitted with stuporous consciousness to our hospital. Four days prior to the admission, she was hospitalized with the diagnosis of acute pancreatitis in another hospital, and at that time her glucose level was 79 mg/dL. Three days after the hospitalization, her state of consciousness became stuporous and she was transferred to our hospital. The laboratory results were as follows: pH 6.94, glucose 1,602 mg/dL, and HbA1c 5.5%. She was negative for islet-related autoantibodies and viral antibodies. HLA haplotypes were DRB1*04:05/*04:06, DQB1*03:02/*04:01 which might be a considerable risk allele for fulminant type 1 diabetes. She was diagnosed with fulminant type 1 diabetes, and has been treated with multiple component insulin regimens.

A Case of Latent Autoimmune Diabetes in Adults Developed after Surgical Cure of Growth Hormone Secreting Pituitary Tumor.: Wonjin Kim, Jung Ho Kim, Youngsook Kim, Ji Hye Huh, Su Jin Lee, Mi Sung Park, Eun Yeong Choe, Jeong Kyung Park, Myung Won Lee, Jae Won Hong, Byung Wan Lee, Eun Seok Kang, Bong Soo Cha, Eun Jig Lee, Hyun Chul Lee; Endocrinol Metab. 2012;27(4):318-322. Published online December 20, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.4.318

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Abstract PDF: Acromegaly is generally caused by a benign growth hormone (GH)-secreting pituitary adenoma. It is characterized by a wide range of complications; cardiovascular, respiratory, bone and joint, and metabolic complications. Among them, impaired glucose tolerance and diabetes mellitus, due to GH-induced insulin resistance, has been reported in approximately 16-46% and 19-56%. They are usually improved following the treatment of acromegaly, surgical or medical therapy. We report a first case of 36-year-old man who was paradoxically diagnosed with GAD antibody positive latent autoimmune diabetes in adults (LADA) after the surgical cure of acromegaly.

A Case of Adrenal Cystic Pheochromocytoma with Contralateral Adrenocortical Adenoma Causing Subclinical Cushing's Syndrome.: Chang Jun Park, Joo Wan Seo, Hyeog Gyu Seoung, Jung Hee Koh, Yong Jae Lee, Bo Hyun Kim, In Ju Kim; Endocrinol Metab. 2012;27(4):323-328. Published online December 20, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.4.323

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Abstract PDF

Bilateral adrenal neoplasms are associated with metastatic cancer, pheochromocytoma and lymphoma. The coexistence of a unilateral functioning adrenocortical adenoma with contralateral pheochromocytoma is extremely rare. A 52-year-old woman complained of fatigue, headache, palpitation, and progressive weight gain. Hormonal assessment demonstrated high 24 hours urine epinephrine, norepinephrine, and free cortisol. A dexamethasone suppression test (overnight 1 mg, low dose 2 mg) showed insuppressible cortisol. Computerized tomographic scanning revealed a bilateral adrenal tumor. To preserve adrenal function, right adrenalectomy along with left adrenal tumorectomy was performed. Histological finding of the right adrenal tumor was pheochromocytoma and the left adrenal tumor was adrenocortical adenoma. This patient was the first case of a functional adrenocortical adenoma with contralateral cystic pheochromocytoma in Korea. We report the case with a review of the literature.

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A Case of Bilateral ACTH-independent Adrenal Adenomas with Cushing's Syndrome Treated by Ipsilateral Total and Contralateral Partial Laparoscopic Adrenalectomy
Seung Ah Park, Dong min Jung, Soon young Kim, Nan Young Choi, Tae-jun Kim, Yong kyun Kim, Seong kyun Na, Chul Sik Kim, Seong Jin Lee, Sung-Hee Ihm, Jun Goo Kang
The Korean Journal of Obesity.2013; 22(4): 254. CrossRef

Two Case of Primary Aldosteronism Induced by Aldosterone Producing Adrenal Adenoma in a Family.: Young Rock Jang, Sei Hyun Kim, Young Sil Eom, Ki Young Lee; Endocrinol Metab. 2012;27(4):329-333. Published online December 20, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.4.329

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Abstract PDF: Primary aldosteronism, is defined as a group of disorders characterized by the excess of aldosteron, with suppressed rennin activity, resulting in hypertension and hypokalemia. In most cases, primary aldosteronism is sporadic due to a unilateral adrenal adenoma or bilateral adrenal hyperplasia. Familial hyperaldosteronism is a rare cause of primary aldosteronism and its prevalence has not been established well. We describe two cases of primary aldosteronism in a family involving a sister and brother due to an aldosterone producing adenoma in the left adrenal gland. Their hypokalemia and hypertension were cured by complete resection of the adrenal adenoma. Genetic analyses could not be done because of patients' rejection.

A Case of Multiple Osteoporotic Compression Fractures in Young Man with Budd-Chiari Syndrome.: Sun Hwa Kim, Tae Un Yang, Byeong Kwang Choi, Hye Jin Yoo, Ji A Seo, Kyung Mook Choi, Nan Hee Kim, Sin Gon Kim, Sei Hyun Baik, Dong Seop Choi, Hae Yoon Choi; Endocrinol Metab. 2012;27(4):334-339. Published online December 20, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.4.334

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Abstract PDF: Osteoporosis in young men is extremely rare. In this report, we demonstrate a rare case of multiple vertebral fractures discovered in a young man with Budd-Chiari syndrome without prior history of trauma. A 29-year-old man was diagnosed as Budd-Chiari syndrome 12 years ago and underwent a mesocaval shunt to relieve the hepatic vein obstruction and was on warfarin therapy. He suffered from low back pain and it was not relieved by analgesics. A T-L spine X-ray revealed multiple compression fractures and the z-score at lumbar spine was -3.7 which is below the expected range for that age. The patient was treated with calcium, vitamin D and bisphosphonate, and showed clinical improvement. This case highlights the importance of the investigation for secondary osteoporosis in young adults with an underlying disease that alters bone metabolism.

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