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Volume 29(4); December 2014
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Review Articles
Obesity and Metabolism
2014 Clinical Practice Guidelines for Overweight and Obesity in Korea
Mee Kyoung Kim, Won-Young Lee, Jae-Heon Kang, Jee-Hyun Kang, Bom Taeck Kim, Seon Mee Kim, Eun Mi Kim, Sang-Hoon Suh, Hye Jung Shin, Kyu Rae Lee, Ki Young Lee, Sang Yeoup Lee, Seon Yeong Lee, Seong-Kyu Lee, Chang Beom Lee, Sochung Chung, In Kyung Jeong, Kyung Yul Hur, Sung Soo Kim, Jeong-taek Woo
Endocrinol Metab. 2014;29(4):405-409.   Published online December 29, 2014
DOI: https://doi.org/10.3803/EnM.2014.29.4.405
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  • 228 Web of Science
  • 247 Crossref
AbstractAbstract PDFPubReader   

The dramatic increase in the prevalence of obesity and its accompanying comorbidities are major health concerns in Korea. Obesity is defined as a body mass index ≥25 kg/m2 in Korea. Current estimates are that 32.8% of adults are obese: 36.1% of men and 29.7% of women. The prevalence of being overweight and obese in national surveys is increasing steadily. Early detection and the proper management of obesity are urgently needed. Weight loss of 5% to 10% is the standard goal. In obese patients, control of cardiovascular risk factors deserves the same emphasis as weight-loss therapy. Since obesity is multifactorial, proper care of obesity requires a coordinated multidisciplinary treatment team, as a single intervention is unlikely to modify the incidence or natural history of obesity.

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Close layer
Obesity and Metabolism
Antiobesity Pharmacotherapy for Patients with Type 2 Diabetes: Focus on Long-Term Management
Won Seon Jeon, Cheol-Young Park
Endocrinol Metab. 2014;29(4):410-417.   Published online December 29, 2014
DOI: https://doi.org/10.3803/EnM.2014.29.4.410
  • 3,641 View
  • 41 Download
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AbstractAbstract PDFPubReader   

Type 2 diabetes and obesity have a complex relationship; obesity is linked to insulin resistance, the precursor to type 2 diabetes. The management of obesity is an important method to delay onset of diabetes and improve the glycemic durability of antidiabetic agents. However, insulin and some of the oral hypoglycemic agents used to treat diabetes cause significant weight gain, and it is difficult for patients with diabetes to reduce and maintain their weight by life-style changes alone. Thus, antiobesity medications or bariatric surgery may be a necessary adjunct for certain obese patients with diabetes. In 2012, the U.S. Food and Drug Administration (FDA) approved lorcaserin and phentermine/topiramate extended-release for the management of chronic weight, and approval for naltrexone/bupropion sustained-release as an adjunct to exercise and reduced caloric intake followed in 2014. Liraglutide is pending FDA approval for antiobesity drug. Here we review the efficacy of approved and new promising drugs for the management of obesity.

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Obesity and Metabolism
Optimal Waist Circumference Cutoff Values for the Diagnosis of Abdominal Obesity in Korean Adults
Yeong Sook Yoon, Sang Woo Oh
Endocrinol Metab. 2014;29(4):418-426.   Published online December 29, 2014
DOI: https://doi.org/10.3803/EnM.2014.29.4.418
  • 6,109 View
  • 70 Download
  • 66 Web of Science
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AbstractAbstract PDFPubReader   

Abdominal obesity is associated closely with insulin resistance, diabetes, and cardiovascular disease. Waist circumference (WC) is a useful surrogate marker commonly used for abdominal adiposity. The determination of WC cutoff levels is important in the prevention and treatment of obesity, type 2 diabetes, and related cardiovascular diseases. Recent epidemiological evidence suggested that appropriate optimal cutoffs for Koreans ranged over 80 to 89.8 cm in males and 76.1 to 86.5 cm in females. We analyzed the data from two large cohorts using receiver operating characteristic curve analysis with the incidences of diabetes, hypertension, dyslipidemia, cerebrovascular disease, myocardial infarct, angina, coronary artery disease, and multiple metabolic risk factors as outcome variables. Optimal WC cutoff points for Koreans were 85 cm in males and 80 cm in females. However, considering the prevalence of abdominal obesity and the health costs for its prevention and management, 90 cm in males and 85 cm in females are probably more appropriate thresholds for abdominal obesity. These values may be modified once better research is performed through prospective studies using representative populations, common health outcomes, and proper analytical approaches.

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Close layer
Obesity and Metabolism
Metabolic and Cardiovascular Implications of a Metabolically Healthy Obesity Phenotype
Mi Hae Seo, Eun-Jung Rhee
Endocrinol Metab. 2014;29(4):427-434.   Published online December 29, 2014
DOI: https://doi.org/10.3803/EnM.2014.29.4.427
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AbstractAbstract PDFPubReader   

Metabolically healthy obesity (MHO) is a new concept in which an individual may exhibit an obese phenotype in the absence of any metabolic abnormalities. There are a number of definitions of MHO that utilize a variety of components. The findings of clinical and basic studies indicate that subjects with MHO do not exhibit an increased mortality, an increased risk of cardiovascular disease, or an increased risk of type 2 diabetes mellitus, as compared to normal-weight controls. Although these findings imply that metabolic health is a more important factor than obesity, several studies have shown that subjects with MHO have a similar risk of metabolic or cardiovascular diseases as those with metabolically unhealthy obesity. Thus, there is still debate regarding not only the implications of the MHO phenotype but its very existence. Accordingly, future studies should focus on developing a unified definition of MHO and distinguishing subjects who will be at a high risk for metabolic and cardiovascular diseases.

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Obesity and Metabolism
Roles of Protein Arginine Methyltransferases in the Control of Glucose Metabolism
Hye-Sook Han, Dahee Choi, Seri Choi, Seung-Hoi Koo
Endocrinol Metab. 2014;29(4):435-440.   Published online December 29, 2014
DOI: https://doi.org/10.3803/EnM.2014.29.4.435
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AbstractAbstract PDFPubReader   

Glucose homeostasis is tightly controlled by the regulation of glucose production in the liver and glucose uptake into peripheral tissues, such as skeletal muscle and adipose tissue. Under prolonged fasting, hepatic gluconeogenesis is mainly responsible for glucose production in the liver, which is essential for tissues, organs, and cells, such as skeletal muscle, the brain, and red blood cells. Hepatic gluconeogenesis is controlled in part by the concerted actions of transcriptional regulators. Fasting signals are relayed by various intracellular enzymes, such as kinases, phosphatases, acetyltransferases, and deacetylases, which affect the transcriptional activity of transcription factors and transcriptional coactivators for gluconeogenic genes. Protein arginine methyltransferases (PRMTs) were recently added to the list of enzymes that are critical for regulating transcription in hepatic gluconeogenesis. In this review, we briefly discuss general aspects of PRMTs in the control of transcription. More specifically, we summarize the roles of four PRMTs: PRMT1, PRMT 4, PRMT 5, and PRMT 6, in the control of hepatic gluconeogenesis through specific regulation of FoxO1- and CREB-dependent transcriptional events.

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Editorial
Adrenal gland
Subclinical Cushing's Syndrome and Metabolic Disorder
Ji Cheol Bae
Endocrinol Metab. 2014;29(4):441-442.   Published online December 29, 2014
DOI: https://doi.org/10.3803/EnM.2014.29.4.441
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Original Articles
Obesity and Metabolism
Lipid Accumulation Product Is Associated with Insulin Resistance, Lipid Peroxidation, and Systemic Inflammation in Type 2 Diabetic Patients
Parvin Mirmiran, Zahra Bahadoran, Fereidoun Azizi
Endocrinol Metab. 2014;29(4):443-449.   Published online December 29, 2014
DOI: https://doi.org/10.3803/EnM.2014.29.4.443
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  • 43 Download
  • 45 Web of Science
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AbstractAbstract PDFPubReader   
Background

Lipid accumulation product (LAP) is a novel biomarker of central lipid accumulation related to risk of diabetes and cardiovascular disease. In this study, we assessed the association of LAP with glucose homeostasis, lipid and lipid peroxidation, and subclinical systemic inflammation in diabetic patients.

Methods

Thirty-nine male and 47 female type 2 diabetic patients were assessed for anthropometrics and biochemical measurements. LAP was calculated as [waist circumference (cm)-65]×[triglycerides (mmol/L)] in men, and [waist circumference (cm)-58]×[triglycerides (mmol/L)] in women. Associations of LAP with fasting glucose, insulin, insulin resistance index, lipid and lipoprotein levels, malondialdehyde, and high-sensitive C-reactive protein (hs-CRP) were assessed.

Results

Mean age and LAP index were 53.6±9.6 and 51.9±31.2 years, respectively. After adjustments for age, sex and body mass index status, a significant positive correlation was observed between LAP index and fasting glucose (r=0.39, P<0.001), and homeostasis model assessment of insulin resistance (r=0.31, P<0.05). After additional adjustment for fasting glucose levels, antidiabetic and antilipidemic drugs, the LAP index was also correlated to total cholesterol (r=0.45, P<0.001), high density lipoprotein cholesterol (HDL-C) levels (r=-0.29, P<0.05), triglycerides to HDL-C ratio (r=0.89, P<0.001), malondialdehyde (r=0.65, P<0.001), and hs-CRP levels (r=0.27, P<0.05).

Conclusion

Higher central lipid accumulation in diabetic patients was related to higher insulin resistance, oxidative stress and systemic inflammation.

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Adrenal gland
Using Growth Hormone Levels to Detect Macroadenoma in Patients with Acromegaly
Ji Young Park, Jae Hyeon Kim, Sun Wook Kim, Jae Hoon Chung, Yong-Ki Min, Myung-Shik Lee, Moon-Kyu Lee, Kwang-Won Kim
Endocrinol Metab. 2014;29(4):450-456.   Published online December 29, 2014
DOI: https://doi.org/10.3803/EnM.2014.29.4.450
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AbstractAbstract PDFPubReader   
Background

The aim of this study was to assess the clinical differences between acromegalic patients with microadenoma and patients with macroadenoma, and to evaluate the predictive value of growth hormone (GH) levels for early detection of macroadenoma.

Methods

We performed a retrospective analysis of 215 patients diagnosed with a GH-secreting pituitary adenoma. The patients were divided into two groups: the microadenoma group and the macroadenoma group, and the clinical parameters were compared between these two groups. The most sensitive and specific GH values for predicting macroadenoma were selected using receiver operating characteristic (ROC) curves.

Results

Compared with the microadenoma group, the macroadenoma group had a significantly younger age, higher body mass index, higher prevalence of hyperprolactinemia and hypogonadism, and a lower proportion of positive suppression to octreotide. However, there were no significant differences in the gender or in the prevalence of diabetes between the two groups. The tumor diameter was positively correlated with all GH values during the oral glucose tolerance test (OGTT). All GH values were significantly higher in the macroadenoma group than the microadenoma group. Cut-off values for GH levels at 0, 30, 60, 90, and 120 minutes for optimal discrimination between macroadenoma and microadenoma were 5.6, 5.7, 6.3, 6.0, and 5.8 ng/mL, respectively. ROC curve analysis revealed that the GH value at 30 minutes had the highest area under the curve.

Conclusion

The GH level of 5.7 ng/mL or higher at 30 minutes during OGTT could provide sufficient information to detect macroadenoma at the time of diagnosis.

Citations

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    Jakob Dal, Benedikte G. Skov, Marianne Andersen, Ulla Feldt‐Rasmussen, Claus L. Feltoft, Jesper Karmisholt, Eigil H. Nielsen, Olaf M. Dekkers, Jens Otto L. Jørgensen
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    Won-Young Lee
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Adrenal gland
Clinical Characteristics and Metabolic Features of Patients with Adrenal Incidentalomas with or without Subclinical Cushing's Syndrome
Bo-Yeon Kim, A-Reum Chun, Kyu-Jin Kim, Chan-Hee Jung, Sung Koo Kang, Ji-Oh Mok, Chul-Hee Kim
Endocrinol Metab. 2014;29(4):457-463.   Published online December 29, 2014
DOI: https://doi.org/10.3803/EnM.2014.29.4.457
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AbstractAbstract PDFPubReader   
Background

The aim of this study was to examine the clinical characteristics of adrenal incidentalomas discovered by computed tomography (CT) and to investigate metabolic features of subclinical Cushing's syndrome (SCS) in patients with adrenal incidentalomas in a tertiary hospital in Korea.

Methods

This retrospective study examined the clinical aspects of 268 patients with adrenal incidentalomas discovered by CT at Soonchunhyang University Bucheon Hospital. Clinical data and endocrine function of the patients as well as histological findings were obtained from medical records, while anatomic characteristics were analyzed by reviewing imaging studies. Hormonal tests for pheochromocytoma, Cushing's syndrome, and aldosterone-secreting adenoma were performed.

Results

Most (n=218, 81.3%) cases were nonfunctioning tumors. Of the 50 patients with functioning tumors (18.7%), 19 (7.1%) were diagnosed with SCS, nine (3.4%) with overt Cushing's syndrome, 12 (4.5%) with primary aldosteronism, and 10 (3.7%) with pheochromocytoma. Malignant tumors (both primary and metastatic) were rare (n=2, 0.7%). Body mass index, fasting glucose, hemoglobin A1c, and total cholesterol were significantly higher in patients with SCS in comparison with those with nonfunctioning tumors. The prevalence of type 2 diabetes mellitus and hypertension were significantly higher in patients with SCS compared with those with nonfunctioning tumors.

Conclusion

Functioning tumors, especially those with subclinical cortisol excess, are commonly found in patients with adrenal incidentalomas, although malignancy is rare. In addition, patients with SCS in adrenal incidentalomas have adverse metabolic and cardiovascular profiles.

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    Alexandra-Ioana Trandafir, Mihaela Stanciu, Simona Elena Albu, Vasile Razvan Stoian, Irina Ciofu, Cristian Persu, Claudiu Nistor, Mara Carsote
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Close layer
Preoperative Localization and Intraoperative Parathyroid Hormone Assay in Korean Patients with Primary Hyperparathyroidism
Eirie Cho, Jung Mi Chang, Seok Young Yoon, Gil Tae Lee, Yun Hyi Ku, Hong Il Kim, Myung-Chul Lee, Guk Haeng Lee, Min Joo Kim
Endocrinol Metab. 2014;29(4):464-469.   Published online December 29, 2014
DOI: https://doi.org/10.3803/EnM.2014.29.4.464
  • 3,590 View
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AbstractAbstract PDFPubReader   
Background

The intraoperative parathyroid hormone (IOPTH) assay is widely used in patients with primary hyperparathyroidism (PHPT). We investigated the usefulness of the IOPTH assay in Korean patients with PHPT.

Methods

We retrospectively reviewed the data of 33 patients with PHPT who underwent parathyroidectomy. Neck ultrasonography (US) and 99mTc-sestamibi scintigraphy (MIBI scan) were performed preoperatively and IOPTH assays were conducted.

Results

The sensitivity of neck US and MIBI scans were 91% and 94%, respectively. A 50% decrease in parathyroid hormone (PTH) levels 10 minutes after excision of the parathyroid gland was obtained in 91% (30/33) of patients and operative success was achieved in 97% (32/33) of patients. The IOPTH assay was 91% true-positive, 3% true-negative, 0% false-positive, and 6% false-negative. The overall accuracy of the IOPTH assay was 94%. In five cases with discordant neck US and MIBI scan results, a sufficient decrease in IOPTH levels helped the surgeon confirm the complete excision of the parathyroid gland with no additional neck exploration.

Conclusion

The IOPTH assay is an accurate tool for localizing hyperfunctioning parathyroid glands and is helpful for evaluating cases with discordant neck US and MIBI scan results.

Citations

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Adrenal gland
Clinical Characteristics, Management, and Outcome of 22 Cases of Primary Hypophysitis
Sun Mi Park, Ji Cheol Bae, Ji Young Joung, Yoon Young Cho, Tae Hun Kim, Sang-Man Jin, Sunghwan Suh, Kyu Yeon Hur, Kwang-Won Kim
Endocrinol Metab. 2014;29(4):470-478.   Published online December 29, 2014
DOI: https://doi.org/10.3803/EnM.2014.29.4.470
  • 4,322 View
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AbstractAbstract PDFPubReader   
Background

Primary hypophysitis causes varying degrees of endocrine dysfunction and mass effect. The natural course and best treatment have not been well established.

Methods

Medical records of 22 patients who had been diagnosed with primary hypophysitis between January 2001 and March 2013 were retrospectively reviewed. Based on the anatomical location, we classified the cases as adenohypophysitis (AH), infundibuloneurohypophysitis (INH), and panhypophysitis (PH). Clinical presentation, endocrine function, pathologic findings, magnetic resonance imaging findings, and treatment courses were reviewed.

Results

Among 22 patients with primary hypophysitis, 81.8% (18/22) had involvement of the posterior pituitary lobe. Two patients of the AH (2/3, 66.6%) and three patients of the PH (3/10, 30%) groups initially underwent surgical mass reduction. Five patients, including three of the PH (3/10, 33.3%) group and one from each of the AH (1/3, 33.3%) and INH (1/9, 11.1%) groups, initially received high-dose glucocorticoid treatment. Nearly all of the patients treated with surgery or high-dose steroid treatment (9/11, 82%) required continuous hormone replacement during the follow-up period. Twelve patients received no treatment for mass reduction due to the absence of acute symptoms and signs related to a compressive mass effect. Most of them (11/12, 92%) did not show disease progression, and three patients recovered partially from hormone deficiency.

Conclusion

Deficits of the posterior pituitary were the most common features in our cases of primary hypophysitis. Pituitary endocrine defects responded less favorably to glucocorticoid treatment and surgery. In the absence of symptoms related to mass effect and with the mild defect of endocrine function, it may not require treatment to reduce mass except hormone replacement.

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    Shilpa Rao, Anita Mahadevan, Tanmoy Maiti, Manish Ranjan, Shivayogi Durgad Shwetha, Arimappamagan Arivazhagan, Jitender Saini
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    Won-Young Lee
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Obesity and Metabolism
Comparison of Serum Ferritin and Vitamin D in Association with the Severity of Nonalcoholic Fatty Liver Disease in Korean Adults
Dong Wook Jeong, Hye Won Lee, Young Hye Cho, Dong Won Yi, Sang Yeoup Lee, Seok Man Son, Yang Ho Kang
Endocrinol Metab. 2014;29(4):479-488.   Published online December 29, 2014
DOI: https://doi.org/10.3803/EnM.2014.29.4.479
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AbstractAbstract PDFPubReader   
Background

Increased serum ferritin and decreased vitamin D levels associated with nonalcoholic fatty liver disease (NAFLD). However, their association with the severity of NAFLD has not been fully evaluated. The aim of this study was to compare the association of serum ferritin and 25(OH)D3 levels with the severity of ultrasonographically detected NAFLD (US-NAFLD) and hepatic steatosis defined by fatty liver index (FLI) in Korean adults.

Methods

A cross-sectional analysis of clinical and anthropometric data, including serum ferritin and 25(OH)D3, from men (n=295) and women (n=263) who underwent a routine health check-up in 2012.

Results

In men, with an increase in the quartile of serum ferritin level, the incidences of subjects with metabolic syndrome (P=0.002), US-NAFLD (P=0.041), and FLI ≥60 (P=0.010) were significantly elevated. In women, the incidence of subjects with US-NAFLD was also significantly elevated with increases in the serum ferritin quartile (P=0.012). Regarding 25(OH)D3, no statistical differences were observed among the different quartiles in either gender. Serum ferritin level significantly increased as the severity of US-NAFLD increased (P<0.001); however, no significant differences in 25(OH)D3 level were observed in men. No significant differences in either serum ferritin or 25(OH)D3 level were observed among women with different levels of severity of US-NAFLD.

Conclusion

Increased serum ferritin level showed a closer association with severity of NAFLD compared with level of serum vitamin D, suggesting that serum ferritin level may be a better marker than vitamin D level for predicting the severity of US-NAFLD and hepatic steatosis in a clinical setting.

Citations

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  • Serum 25-hydroxyvitamin D levels and the risk of non-alcoholic fatty liver: A two-sample Mendelian randomization study
    Qi Sheng, Huanchen Shi, Shousheng Liu, Likun Zhuang, Zhenzhen Zhao, Yongning Xin
    Saudi Journal of Gastroenterology.2023; 29(1): 39.     CrossRef
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    Michael H. Le, Yee Hui Yeo, Xiaohe Li, Jie Li, Biyao Zou, Yuankai Wu, Qing Ye, Daniel Q. Huang, Changqing Zhao, Jie Zhang, Chenxi Liu, Na Chang, Feng Xing, Shiping Yan, Zi Hui Wan, Natasha Sook Yee Tang, Maeda Mayumi, Xinting Liu, Chuanli Liu, Fajuan Rui,
    Clinical Gastroenterology and Hepatology.2022; 20(12): 2809.     CrossRef
  • Do Vitamin D Levels Affect Bone Mineral Density in Reproductive Women with Low Ferritin Levels?
    Hatice Hamarat, Göknur Yorulmaz, Ayşe Ekim Aydemir, Emel Örge Gönüllü, Ahmet Musmul, Sinem Gürcü
    Turkish Journal of Osteoporosis.2022; 28(1): 26.     CrossRef
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    Xin Su, Danping Zhang, Zhe Chen, Xu Han, Peichen Xia, Minhao Yin, Hong Zhu
    SSRN Electronic Journal .2022;[Epub]     CrossRef
  • Ferritin as a key risk factor for nonalcoholic fatty liver disease in children with obesity
    Junfeng Zhang, Jiajia Cao, Hui Xu, Guanping Dong, Ke Huang, Wei Wu, Jingjing Ye, Junfen Fu
    Journal of Clinical Laboratory Analysis.2021;[Epub]     CrossRef
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    AhmedA Hassan, MohieeE.-D.A El-Aziz Awad, HananH Soliman, RedaA.F Usef, DinaS Ata
    Alexandria Journal of Pediatrics.2021; 34(3): 253.     CrossRef
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    Li-Wei Chen, Cheng-Hung Chien, Sheng-Fong Kuo, Chia-Ying Yu, Chih-Lang Lin, Rong-Nan Chien
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Thyroid
Clinicopathological, Biochemical, and Sonographic Features of Thyroid Nodule Predictive of Malignancy among Adult Filipino Patients in a Tertiary Hospital in the Philippines
Edwin Jadulco Cañete, Cherrie Mae Sison-Peña, Cecilia Alegado Jimeno
Endocrinol Metab. 2014;29(4):489-497.   Published online December 29, 2014
DOI: https://doi.org/10.3803/EnM.2014.29.4.489
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AbstractAbstract PDFPubReader   
Background

Thyroid nodules may harbor cancer in 5% to 15% of cases. Specific clinical and sonographic features predictive of malignancy have been investigated in various populations, but due to differences in epidemiology, risk factors and iodine nutrition status, these predictors may not be valid in the Philippines. This study determined the clinicopathological, biochemical, and sonographic features of thyroid nodules predictive of malignancy among adult Filipino patients at the University of the Philippines-Philippine General Hospital (UP-PGH).

Methods

We reviewed the medical records of Filipino patients ≥19 years of age who underwent thyroid surgery in UP-PGH from 2008 to 2011.

Results

A total of 837 of 1,670 patients (50.1%) were enrolled in the study, which included 417 benign and 420 malignant tumors. The mean age at diagnosis was 38±11 years, with female predominance. Multiple logistic regression analysis showed that the presence of a hard or firm nodule (odds ratio [OR], 58.8, P<0.001; OR, 12.8, P<0.001), presence of microcalcifications (OR, 11.1; P<0.001), irregular margins on ultrasound (OR, 4.5; P<0.001), and absence of associated symptoms (OR, 2.3; P<0.002) increased significantly the likelihood of thyroid malignancy.

Conclusion

Similar to international data, the absence of associated symptoms, firm to hard thyroid nodules, and the presence of microcalcifications and irregular margins were significant predictors of thyroid malignancy.

Citations

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Obesity and Metabolism
Clinical Implications of Various Criteria for the Biochemical Diagnosis of Insulinoma
Chang Ho Ahn, Lee-Kyung Kim, Jie Eun Lee, Chan-Hyeon Jung, Se-Hee Min, Kyong Soo Park, Seong Yeon Kim, Young Min Cho
Endocrinol Metab. 2014;29(4):498-504.   Published online December 29, 2014
DOI: https://doi.org/10.3803/EnM.2014.29.4.498
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AbstractAbstract PDFPubReader   
Background

Among the various diagnostic criteria for insulinoma, the ratio criteria have been controversial. However, the amended insulin-glucose ratio exhibited excellent diagnostic performance in a recent retrospective cohort study, although it has not yet been validated in other patient cohorts. We examined the diagnostic performance of the current criteria of the Endocrine Society, insulin-glucose ratio, C-peptide-glucose ratio, and amended ratios in terms of differentiating insulinomas.

Methods

We reviewed the medical records of patients who underwent evaluation for hypoglycemia from 2000 to 2013. Fourteen patients with histopathologically confirmed insulinoma and 18 patients without clinical evidence of insulinoma were included. The results of a prolonged fast test were analyzed according to the abovementioned criteria.

Results

Fulfilling all three Endocrine Society criteria-plasma levels of glucose (<3.0 mmol/L), insulin (≥8 pmol/L), and C-peptide (≥0.2 nmol/L)-exhibited 100% sensitivity and 89% specificity. Fulfilling the glucose and C-peptide criteria showed 100% sensitivity and 83% specificity, while fulfilling the glucose and insulin criteria showed 100% sensitivity and 72% specificity. Among the ratio criteria, the insulin-glucose ratio [>24.0 (pmol/L)/(mmol/L)] gave the highest area under the receiver operating characteristic curve, with 93% sensitivity and 94% specificity.

Conclusion

Fulfilling the glucose, insulin, and C-peptide criteria of the Endocrine Society guidelines exhibited the best diagnostic performance for insulinoma. Nonetheless, the insulin-glucose ratio may still have a role in the biochemical diagnosis of insulinoma.

Citations

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Close layer
Thyroid
The Frequency and Clinical Implications of the BRAFV600E Mutation in Papillary Thyroid Cancer Patients in Korea Over the Past Two Decades
A Ram Hong, Jung Ah Lim, Tae Hyuk Kim, Hoon Sung Choi, Won Sang Yoo, Hye Sook Min, Jae Kyung Won, Kyu Eun Lee, Kyeong Cheon Jung, Do Joon Park, Young Joo Park
Endocrinol Metab. 2014;29(4):505-513.   Published online December 29, 2014
DOI: https://doi.org/10.3803/EnM.2014.29.4.505
  • 4,051 View
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AbstractAbstract PDFPubReader   
Background

Over the past several decades, there has been a rapid worldwide increase in the prevalence of papillary thyroid cancer (PTC) as well as a number of changes in the clinicopathological characteristics of this disease. BRAFV600E, which is a mutation of the proto-oncogene BRAF, has become the most frequent genetic mutation associated with PTC, particularly in Korea. Thus, the present study investigated whether the prevalence of the BRAFV600E mutation has increased over the past two decades in the Korean population and whether various PTC-related clinicopathological characteristics have changed.

Methods

The present study included 2,624 patients who underwent a thyroidectomy for PTC during two preselected periods; 1995 to 2003 and 2009 to 2012. The BRAFV600E mutation status of each patient was confirmed using the polymerase chain reaction-restriction fragment length polymorphism method or by the direct sequencing of DNA.

Results

The prevalence of the BRAFV600E mutation in Korean PTC patients increased from 62.2% to 73.7% (P=0.001) over the last two decades. Additionally, there was a greater degree of extrathyroidal extension (ETE) and lymph node metastasis in 2009 to 2012 patients with the BRAFV600E mutation and a higher frequency of thyroiditis and follicular variant-PTC in 2009 to 2012 patients with wild-type BRAF. However, only the frequency of ETE was significantly higher in 1995 to 2003 patients with the BRAFV600E mutation (P=0.047). Long-term recurrence rates during a 10-year median follow-up did not differ based on BRAFV600E mutation status.

Conclusion

The BRAFV600E mutation rate in Korean PTC patients has been persistently high (approximately 70%) over the past two decades and continues to increase. The present findings demonstrate that BRAFV600E-positive PTC was associated with more aggressive clinicopathological features, especially in patients who were recently diagnosed, suggesting that BRAFV600E mutation status may be a useful prognostic factor for PTC in patients recently diagnosed with this disease.

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