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Volume 30(4); December 2015
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Review Articles
Bone Metabolism
Growth and Age-Related Abnormalities in Cortical Structure and Fracture Risk
Ego Seeman
Endocrinol Metab. 2015;30(4):419-428.   Published online December 31, 2015
DOI: https://doi.org/10.3803/EnM.2015.30.4.419
  • 4,210 View
  • 62 Download
  • 23 Web of Science
  • 22 Crossref
AbstractAbstract PDFPubReader   

Vertebral fractures and trabecular bone loss have dominated thinking and research into the pathogenesis and the structural basis of bone fragility during the last 70 years. However, 80% of all fractures are non-vertebral and occur at regions assembled using large amounts of cortical bone; only 20% of fractures are vertebral. Moreover, ~80% of the skeleton is cortical and ~70% of all bone loss is cortical even though trabecular bone is lost more rapidly than cortical bone. Bone is lost because remodelling becomes unbalanced after midlife. Most cortical bone loss occurs by intracortical, not endocortical remodelling. Each remodelling event removes more bone than deposited enlarging existing canals which eventually coalesce eroding and thinning the cortex from 'within.' Thus, there is a need to study the decay of cortical as well as trabecular bone, and to develop drugs that restore the strength of both types of bone. It is now possible to accurately quantify cortical porosity and trabecular decay in vivo. The challenges still to be met are to determine whether measurement of porosity identifies persons at risk for fracture, whether this approach is compliments information obtained using bone densitometry, and whether changes in cortical porosity and other microstructural traits have the sensitivity to serve as surrogates of treatment success or failure.

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  • The Association of Higher Plasma Macrophage Migration Inhibitory Factor Levels with Lower Bone Mineral Density and Higher Bone Turnover Rate in Postmenopausal Women
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  • Intraskeletal variation in human cortical osteocyte lacunar density: Implications for bone quality assessment
    Randee L. Hunter, Amanda M. Agnew
    Bone Reports.2016; 5: 252.     CrossRef
  • The Bindex®ultrasound device: reliability of cortical bone thickness measures and their relationship to regional bone mineral density
    Martin Behrens, Sabine Felser, Anett Mau-Moeller, Matthias Weippert, Johannes Pollex, Ralf Skripitz, Philipp K E Herlyn, Dagmar-C Fischer, Sven Bruhn, Hans-Christof Schober, Volker Zschorlich, Thomas Mittlmeier
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Close layer
Bone Metabolism
Emerging Therapies for Osteoporosis
Michael R. McClung
Endocrinol Metab. 2015;30(4):429-435.   Published online December 31, 2015
DOI: https://doi.org/10.3803/EnM.2015.30.4.429
  • 4,250 View
  • 45 Download
  • 23 Web of Science
  • 21 Crossref
AbstractAbstract PDFPubReader   

Although several effective therapies are available for the treatment of osteoporosis in postmenopausal women and older men, there remains a need for the development of even more effective and acceptable drugs. Several new drugs that are in late-stage clinical development will be discussed. Abaloparatide (recombinant parathyroid hormone related peptide [PTHrP] analogue) has anabolic activity like teriparatide. Recent data from the phase 3 fracture prevention trial demonstrate that this agent is effective in reducing fracture risk. Inhibiting cathepsin K reduces bone resorption without decreasing the numbers or activity of osteoclasts, thereby preserving or promoting osteoblast function. Progressive increases in bone mineral density (BMD) have been observed over 5 years. Early data suggest that odanacatib effectively reduces fracture risk. Lastly, inhibiting sclerostin with humanized antibodies promotes rapid, substantial but transient increases in bone formation while inhibiting bone resorption. Marked increases in BMD have been observed in phase 2 studies. Fracture prevention studies are underway. The new therapies with novel and unique mechanisms of action may, alone or in combination, provide more effective treatment options for our patients.

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Close layer
Adrenal gland
Hypoparathyroidism: Replacement Therapy with Parathyroid Hormone
Lars Rejnmark, Line Underbjerg, Tanja Sikjaer
Endocrinol Metab. 2015;30(4):436-442.   Published online December 31, 2015
DOI: https://doi.org/10.3803/EnM.2015.30.4.436
  • 3,370 View
  • 37 Download
  • 11 Web of Science
  • 11 Crossref
AbstractAbstract PDFPubReader   

Hypoparathyroidism (HypoPT) is characterized by low serum calcium levels caused by an insufficient secretion of parathyroid hormone (PTH). Despite normalization of serum calcium levels by treatment with activated vitamin D analogues and calcium supplementation, patients are suffering from impaired quality of life (QoL) and are at increased risk of a number of comorbidities. Thus, despite normalization of calcium levels in response to conventional therapy, this should only be considered as an apparent normalization, as patients are suffering from a number of complications and calcium-phosphate homeostasis is not normalized in a physiological manner. In a number of recent studies, replacement therapy with recombinant human PTH (rhPTH(1-84)) as well as therapy with the N-terminal PTH fragment (rhPTH(1-34)) have been investigated. Both drugs have been shown to normalize serum calcium while reducing needs for activated vitamin D and calcium supplements. However, once a day injections cause large fluctuations in serum calcium. Twice a day injections diminish fluctuations, but don't restore the normal physiology of calcium homeostasis. Recent studies using pump-delivery have shown promising results on maintaining normocalcemia with minimal fluctuations in calcium levels. Further studies are needed to determine whether this may improve QoL and lower risk of complications. Such data are needed before replacement with the missing hormone can be recommended as standard therapy.

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Close layer
Adrenal gland
Diagnosis and Treatment of Hypopituitarism
Seong Yeon Kim
Endocrinol Metab. 2015;30(4):443-455.   Published online December 31, 2015
DOI: https://doi.org/10.3803/EnM.2015.30.4.443
  • 12,884 View
  • 375 Download
  • 48 Web of Science
  • 58 Crossref
AbstractAbstract PDFPubReader   

Hypopituitarism is a chronic endocrine illness that caused by varied etiologies. Clinical manifestations of hypopituitarism are variable, often insidious in onset and dependent on the degree and severity of hormone deficiency. However, it is associated with increased mortality and morbidity. Therefore, early diagnosis and prompt treatment is necessary. Hypopituitarism can be easily diagnosed by measuring basal pituitary and target hormone levels except growth hormone (GH) and adrenocorticotropic hormone (ACTH) deficiency. Dynamic stimulation tests are indicated in equivocal basal hormone levels and GH/ACTH deficiency. Knowledge of the use and limitations of these stimulation tests is mandatory for proper interpretation. It is necessary for physicians to inform their patients that they may require lifetime treatment. Hormone replacement therapy should be individualized according to the specific needs of each patient, taking into account possible interactions. Long-term endocrinological follow-up of hypopituitary patients is important to monitor hormonal replacement regimes and avoid under- or overtreatment.

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Congenital Hypogonadotropic Hypogonadism and Kallmann Syndrome: Past, Present, and Future
Soo-Hyun Kim
Endocrinol Metab. 2015;30(4):456-466.   Published online December 31, 2015
DOI: https://doi.org/10.3803/EnM.2015.30.4.456
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AbstractAbstract PDFPubReader   

The proper development and coordination of the hypothalamic-pituitary-gonadal (HPG) axis are essential for normal reproductive competence. The key factor that regulates the function of the HPG axis is gonadotrophin-releasing hormone (GnRH). Timely release of GnRH is critical for the onset of puberty and subsequent sexual maturation. Misregulation in this system can result in delayed or absent puberty and infertility. Congenital hypogonadotropic hypogonadism (CHH) and Kallmann syndrome (KS) are genetic disorders that are rooted in a GnRH deficiency but often accompanied by a variety of non-reproductive phenotypes such as the loss of the sense of smell and defects of the skeleton, eye, ear, kidney, and heart. Recent progress in DNA sequencing technology has produced a wealth of information regarding the genetic makeup of CHH and KS patients and revealed the resilient yet complex nature of the human reproductive neuroendocrine system. Further research on the molecular basis of the disease and the diverse signal pathways involved will aid in improving the diagnosis, treatment, and management of CHH and KS patients as well as in developing more precise genetic screening and counseling regime.

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Editorial
Obesity and Metabolism
Sulfonylurea: Personalized Medicine for Type 2 Diabetes
You-Cheol Hwang
Endocrinol Metab. 2015;30(4):467-468.   Published online December 31, 2015
DOI: https://doi.org/10.3803/EnM.2015.30.4.467
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PDFPubReader   
Close layer
Original Articles
Clinical Study
Association between Bsm1 Polymorphism in Vitamin D Receptor Gene and Diabetic Retinopathy of Type 2 Diabetes in Korean Population
Yong Joo Hong, Eun Seok Kang, Myoung Jin Ji, Hyung Jin Choi, Taekeun Oh, Sung-Soo Koong, Hyun Jeong Jeon
Endocrinol Metab. 2015;30(4):469-474.   Published online December 31, 2015
DOI: https://doi.org/10.3803/EnM.2015.30.4.469
  • 4,010 View
  • 45 Download
  • 23 Web of Science
  • 22 Crossref
AbstractAbstract PDFPubReader   
Background

Type 2 diabetes is one of the most common diseases with devastating complications. However, genetic susceptibility of diabetic complications has not been clarified. The vitamin D endocrine system is related with calcification and lipolysis, insulin secretion, and may be associated with many complicated disease including diabetes and cardiovascular disease. Recent studies reported that single nucleotide polymorphisms of vitamin D receptor (VDR) gene were associated with diabetic complications.

Methods

In present study, we evaluated the association of BsmI polymorphism of VDR with diabetic complications in Korean diabetes patients. Total of 537 type 2 diabetic subjects from the Endocrinology Clinic of Chungbuk National University Hospital were investigated. Polymerase chain reaction-restriction fragment length polymorphism was used to test the genotype and allele frequency of BsmI (rs1544410; BB, Bb, bb) polymorphisms.

Results

Mean age was 62.44±10.64 years and mean disease duration was 13.65±7.39 years. Patients with B allele (BB or Bb) was significantly associated with lower risk of diabetic retinopathy (severe non-proliferative diabetic retinopathy or proliferative retinopathy; 7.4%, 5/68) compared with patients without B allele (bb; 17.3%, 81/469; P=0.035). This association was also significant after adjusting for hemoglobin A1c level, body mass index, age, sex, and diabetes mellitus duration, concurrent dyslipidemia and hypertension (odds ratio, 2.99; 95% confidence interval, 1.08 to 8.29; P=0.035) in logistic regression analysis.

Conclusion

Our findings suggest that B allele of Bsm1 polymorphism in VDR gene is associated with lower risk of diabetic retinopathy in type 2 diabetic patients. Bsm1 genotype could be used as a susceptibility marker to predict the risk of diabetes complication.

Citations

Citations to this article as recorded by  
  • The Vitamin D Receptor Bsm1 Variant is not Associated With Temporomandibular Disorder With or Without Bruxism
    Serkan YILDIZ, Serbülent YİĞİT, Ayşe Feyda NURSAL, Nevin KARAKUŞ, Mehmet Kemal TÜMER
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    Shabnam Salehizadeh, Sara Ramezani, Mojgan Asadi, Mahdi Afshari, Seyed Hamid Jamaldini, Farhad Adhami Moghadam, Mandana Hasanzad
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    Caroline Severo de Assis, Tainá Gomes Diniz, João Otávio Scarano Alcântara, Vanessa Polyana Alves de Sousa Brito, Rayner Anderson Ferreira do Nascimento, Mayara Karla dos Santos Nunes, Alexandre Sérgio Silva, Isabella Wanderley de Queiroga Evangelista, Ma
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    Miłosz Caban, Urszula Lewandowska
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Close layer
Clinical Study
Characteristics of Korean Patients with Antithyroid Drug-Induced Agranulocytosis: A Multicenter Study in Korea
Hee Kyung Kim, Jee Hee Yoon, Min Ji Jeon, Tae Yong Kim, Young Kee Shong, Min Jin Lee, Bo Hyun Kim, In Joo Kim, Ji Young Joung, Sun Wook Kim, Jae Hoon Chung, Ho-Cheol Kang
Endocrinol Metab. 2015;30(4):475-480.   Published online December 31, 2015
DOI: https://doi.org/10.3803/EnM.2015.30.4.475
  • 4,102 View
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  • 16 Web of Science
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AbstractAbstract PDFPubReader   
Background

Antithyroid drugs (ATDs) can lead to the development of agranulocytosis, which is the most serious adverse effect. Characteristics of ATD-induced agranulocytosis (AIA) have seldom been reported due to the rarity. In this study, we characterized the clinical features for AIA in Korean patients.

Methods

We retrospectively reviewed data from patients with AIA diagnosed between 1997 and 2014 at four tertiary hospitals. Agranulocytosis was defined as an absolute neutrophil count (ANC) below 500/mm3.

Results

The mean age of the patients (11 males, 43 females) was 38.2±14.9 years. Forty-eight patients (88.9%) with AIA had fever and sore throat on initial presentation, 20.4% of patients developed AIA during the second course of treatment, and 75.9% of patients suffered AIA within 3 months after initiation of ATD. The patients taking methimazole (n=39) showed lower levels of ANC and more frequent use of granulocyte-macrophage colony-stimulating factor than propylthiouracil (n=15) users. The median duration of agranulocytosis was 5.5 days (range, 1 to 20). No differences were observed between the long (≥6 days) and short recovery time (≤5 days) groups in terms of age, gender, ATDs, duration of ATDs, or initial ANC levels. Four patients (7.4%) who were taking ATDs for less than 2 months died of sepsis on the first or second day of hospitalization.

Conclusion

The majority of AIA incidents occur in the early treatment period. Considering the high fatality rate of AIA, an early aggressive therapeutic approach is critical and patients should be well informed regarding the warning symptoms of the disease.

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Close layer
Clinical Study
A 5-Year Prospective Follow-Up Study of Lipid-Rich Adrenal Incidentalomas: No Tumor Growth or Development of Hormonal Hypersecretion
Camilla Schalin-Jäntti, Merja Raade, Esa Hämäläinen, Timo Sane
Endocrinol Metab. 2015;30(4):481-487.   Published online December 31, 2015
DOI: https://doi.org/10.3803/EnM.2015.30.4.481
  • 3,490 View
  • 41 Download
  • 22 Web of Science
  • 22 Crossref
AbstractAbstract PDFPubReader   
Background

Current guidelines for follow-up of adrenal incidentalomas are extensive and hampered by lack of follow-up studies. We tested the hypothesis that small lipid-rich adrenal incidentalomas, initially characterized by tumor size <40 mm and <10 Hounsfield units (HUs) on unenhanced computed tomography (CT) may not demonstrate excessive growth/hormonal hypersecretion on follow-up.

Methods

Sixty-nine incidentalomas in 56 patients were restudied with unenhanced CT and screening for hypercortisolism (dexamethasone suppression test [DST], plasma adrenocorticotropic hormone) and pheochromocytoma (24-hour urinary metanephrines and normetanephrines) 5 years later. Primary hyperaldosteronism was excluded at base-line.

Results

Tumor (n=69) size was similar before and after 5 years follow-up (19±6 mm vs. 20±7 mm). Mean tumor growth was 1±2 mm. Largest increase in tumor size was 8 mm, this tumor was surgically removed and histopathology confirmed cortical adenoma. DST was normal in 54 patients and two patients (3.6%) were still characterized by subclinical hypercortisolism. Initial tumor size was >20 mm for the patient with largest tumor growth and those with subclinical hypercortisolism. All patients had normal 24-hour urinary metanephrines and normetanephrines. Low attenuation (<10 HU) was demonstrated in 97% of 67 masses re-evaluated with unenhanced CT.

Conclusion

None of the patients developed clinically relevant tumor growth or new subclinical hypercortisolism. Biochemical screening for pheochromocytoma in incidentalomas demonstrating <10 HU on unenhanced CT is not needed. For such incidentalomas <40 mm, it seems sufficient to perform control CT and screen for hypercortisolism after 5 years.

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    Edward Buitenwerf, Tijmen Korteweg, Anneke Visser, Charlotte M S C Haag, Richard A Feelders, Henri J L M Timmers, Letizia Canu, Harm R Haak, Peter H L T Bisschop, Elisabeth M W Eekhoff, Eleonora P M Corssmit, Nanda C Krak, Elise Rasenberg, Janneke van den
    European Journal of Endocrinology.2018; 178(5): 431.     CrossRef
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    Leslie S. Eldeiry, Marina M. Alfisher, Catherine F. Callahan, Nancy N. Hanna, Jeffrey R. Garber
    Journal of Clinical & Translational Endocrinology.2018; 13: 39.     CrossRef
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    Valentina Morelli, Serena Palmieri
    Minerva Endocrinologica.2018;[Epub]     CrossRef
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    Mishal Mendiratta-Lala, Anca Avram, Adina F. Turcu, N. Reed Dunnick
    Endocrinology and Metabolism Clinics of North America.2017; 46(3): 741.     CrossRef
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    Guido Di Dalmazi
    Current Opinion in Endocrinology, Diabetes & Obesity.2017; 24(3): 193.     CrossRef
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    Glenda G. Callender, Robert Udelsman
    Current Surgery Reports.2016;[Epub]     CrossRef
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    Martin Fassnacht, Wiebke Arlt, Irina Bancos, Henning Dralle, John Newell-Price, Anju Sahdev, Antoine Tabarin, Massimo Terzolo, Stylianos Tsagarakis, Olaf M Dekkers
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Close layer
Clinical Study
Subclinical Atherosclerosis in Patients with Cushing Syndrome: Evaluation with Carotid Intima-Media Thickness and Ankle-Brachial Index
Luigi Petramala, D'Elia Lorenzo, Gino Iannucci, Antonio Concistré, Laura Zinnamosca, Cristiano Marinelli, Giuseppe De Vincentis, Antonio Ciardi, Giorgio De Toma, Claudio Letizia
Endocrinol Metab. 2015;30(4):488-493.   Published online December 31, 2015
DOI: https://doi.org/10.3803/EnM.2015.30.4.488
  • 3,578 View
  • 42 Download
  • 6 Web of Science
  • 7 Crossref
AbstractAbstract PDFPubReader   
Background

Cushing syndrome (CS) has been described as a killing disease due its cardiovascular complications. In fact, chronic cortisol excess leads to a constellation of complications, including hypertension, hyperglycemia, adiposity, and thromboembolism. The main vascular alteration associated with CS is atherosclerosis.

Methods

Aim of this study was to analyze carotid intima-media thickness (cIMT) and ankle-brachial index (ABI), two surrogate markers of subclinical atherosclerosis in a consecutive series of CS patients, compared to patients with essential hypertension (EH) and health subjects (HS).

Results

Patients with CS showed a significant increase (P<0.05) of cIMT (0.89±0.17 mm) compared to EH (0.81±0.16 mm) and HS (0.75±0.4 mm), with a high prevalence of plaque (23%; P<0.03). Moreover, CS patients showed a mean ABI values (1.07±0.02) significantly lower respect to HS (1.12±0.11; P<0.05), and a higher percentage (20%) of pathological values of ABI (≤0.9; P<0.03).

Conclusion

In conclusion, we confirmed and extended the data of cIMT in CS, and showed that the ABI represent another surrogate marker of subclinical atherosclerosis in this disease.

Citations

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    Michael Poledniczek, Christoph Neumayer, Christoph W. Kopp, Oliver Schlager, Thomas Gremmel, Alicja Jozkowicz, Michael E. Gschwandtner, Renate Koppensteiner, Patricia P. Wadowski
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    Luigi Petramala, Federica Olmati, Antonio Concistrè, Riccardo Russo, Martina Mezzadri, Maurizio Soldini, Giuseppe De Vincentis, Gino Iannucci, Giorgio De Toma, Claudio Letizia
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    Goran Koracevic, Milan Stojkovic, Dragan Lovic, Milan Pavlovic, Tomislav Kostic, Marija Kutlesic, Sladjana Micic, Maja Koracevic, Milan Djordjevic
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Close layer
Clinical Study
Association of the Preoperative Neutrophil-to-ymphocyte Count Ratio and Platelet-to-Lymphocyte Count Ratio with Clinicopathological Characteristics in Patients with Papillary Thyroid Cancer
Sang Mi Kim, Eun Heui Kim, Bo Hyun Kim, Jong Ho Kim, Su Bin Park, Yoon Jeong Nam, Kang Hee Ahn, Min Young Oh, Won Jin Kim, Yun Kyung Jeon, Sang Soo Kim, Yong Ki Kim, In Ju Kim
Endocrinol Metab. 2015;30(4):494-501.   Published online December 31, 2015
DOI: https://doi.org/10.3803/EnM.2015.30.4.494
  • 4,465 View
  • 49 Download
  • 34 Web of Science
  • 34 Crossref
AbstractAbstract PDFPubReader   
Background

Several inflammatory biomarkers, especially a high preoperative neutrophil-to-lymphocyte count ratio (NLR) and platelet-to-lymphocyte count ratio (PLR), are known to be indicator of poor prognosis in several cancers. However, very few studies have evaluated the significance of the NLR and PLR in papillary thyroid cancer (PTC). We evaluated the association of the preoperative NLR and PLR with clinicopathological characteristics in patients with PTC.

Methods

This study included 1,066 female patients who underwent total thyroidectomy for PTC. Patients were stratified into 4 quartiles by preoperative NLR and PLR. And the combination of preoperative NLR and PLR was calculated on the basis of data obtained value of tertile as follows: patients with both an elevated PLR and an elevated NLR were allocated a score of 2, and patients showing one or neither were allocated a score of 1 or 0, respectively.

Results

The preoperative NLR and PLR were significantly lower in patients aged ≥45 years and in patients with Hashimoto's thyroiditis. The PLR was significantly higher in patients with tumor size >1 cm (P=0.021).When the patients were categorized into the aforementioned four groups, the group with the higher preoperative PLR was found to have a significantly increased incidence of lateral lymph node metastasis (LNM) (P=0.018). However, there are no significant association between the combination of preoperative NLR and PLR and prognostic factors in PTC patients.

Conclusion

These results suggest that a preoperative high PLR were significant associated with lateral LNM in female patients with PTC.

Citations

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Close layer
Clinical Study
Electrolyte Imbalance in Patients with Sheehan's Syndrome
Chur Hoan Lim, Ji Hyun Han, Joon Jin, Ji Eun Yu, Jin Ook Chung, Dong Hyeok Cho, Dong Jin Chung, Min Young Chung
Endocrinol Metab. 2015;30(4):502-508.   Published online December 31, 2015
DOI: https://doi.org/10.3803/EnM.2015.30.4.502
  • 4,687 View
  • 45 Download
  • 8 Web of Science
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AbstractAbstract PDFPubReader   
Background

We investigated the prevalence of electrolyte imbalance and the relationship between serum electrolyte and anterior pituitary hormone levels in patients with Sheehan's syndrome.

Methods

In a retrospective study, we investigated 78 patients with Sheehan's syndrome. We also included 95 normal control subjects who underwent a combined anterior pituitary hormone stimulation test and showed normal hormonal responses.

Results

In patients with Sheehan's syndrome, the serum levels of sodium, potassium, ionized calcium, magnesium, and inorganic phosphate were significantly lower than those in control subjects. The prevalence of hyponatremia, hypokalemia, hypocalcemia, hypomagnesemia, and hypophosphatemia in patients with Sheehan's syndrome was 59.0% (n=46), 26.9% (n=21), 35.9% (n=28), 47.4% (n=37), and 23.1% (n=18), respectively. Levels of sodium and ionized calcium in serum were positively correlated with levels of all anterior pituitary hormones (all P<0.05). Levels of potassium in serum were positively correlated with adrenocorticotrophic hormone (ACTH) and growth hormone (GH) levels (all P<0.05). Levels of inorganic phosphate in serum were positively correlated with levels of thyroid-stimulating hormone, prolactin, and GH (all P<0.05), and levels of magnesium in serum were positively correlated with delta ACTH (P<0.01).

Conclusion

Electrolyte imbalance was common in patients with Sheehan's syndrome. Furthermore, the degree of anterior pituitary hormone deficiency relates to the degree of electrolyte disturbance in patients with this disease.

Citations

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    Elena Gradinaru, Catalin Furculescu, Andreea Trandafir, Daniela Opris-Belinski, Ioana Cristina Saulescu
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    Hui Wang, Xingrui Gong
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    Liza Das, Jayaprakash Sahoo, Neelam Dahiya, Sunil Taneja, Sanjay Kumar Bhadada, Mohammad Hayat Bhat, Paramjeet Singh, Vanita Suri, Bashir Ahmad Laway, Pinaki Dutta
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    Soumita Mandal, Pradip Mukhopadhyay, Mainak Banerjee, Sujoy Ghosh
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Close layer
Clinical Study
Clinical Characteristics of Subjects with Sulfonylurea-Dependent Type 2 Diabetes
Se Hee Min, Soo Heon Kwak, Young Min Cho, Kyong Soo Park, Hye Seung Jung
Endocrinol Metab. 2015;30(4):509-513.   Published online December 31, 2015
DOI: https://doi.org/10.3803/EnM.2015.30.4.509
  • 4,357 View
  • 65 Download
  • 3 Web of Science
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AbstractAbstract PDFPubReader   
Background

Even though several oral anti-diabetic drugs (OAD) with various modes of action are replacing sulfonylurea (SU), some patients seem to be dependent on SU for adequate glycemic control. Therefore, we evaluated the clinical characteristics of such patients.

Methods

We selected the patients with type 2 diabetes who met following criteria from 2009 to 2014 at Seoul National University Hospital: glycated hemoglobin (HbA1c) was maintained below 7.5% for at least 6 months under small dose of SU (glimepiride ≤2 mg/day or equivalent dose); after discontinuation of SU, HbA1c increased ≥1.2% within 3 months or ≥1.5% within 6 months; and after resuming SU, HbA1c reduction was ≥0.8% or reduction of fasting plasma glucose was ≥40 mg/dL within 3 months. Patients with impaired hepatic or renal function, and steroid users were excluded.

Results

Nineteen subjects were enrolled: after averaged 4.8±1.5 months of SU-free period, HbA1c increased from 6.7%±0.4% to 8.8%±0.8% even though adding other OAD such as gliptins. However, HbA1c decreased to 7.4%±0.7% after resuming SU within 2.4±0.8 months. There was no sexual predominance. Despite their old age (67±11 years) and long duration of diabetes (18±10 years), fasting C-peptide was relatively well-reserved (3.9±2.6 ng/mL), and nephropathy was not observed (albumin-creatinine ratio 21.2±16.6 mg/g and estimated glomerular filtration rate 75.8±18.0 mL/min/1.73 m2). Strong family history was also noted (73.7%).

Conclusion

Despite hypoglycemia risk of SU, it seemed indispensable for a subset of patients with regard to insulin secretion. Genetic influences would be evaluated.

Citations

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  • Incident Hepatocellular Carcinoma Risk in Patients Treated with a Sulfonylurea: A Nationwide, Nested, Case-Control Study
    Ji-Yeon Lee, Suk-Yong Jang, Chung Mo Nam, Eun Seok Kang
    Scientific Reports.2019;[Epub]     CrossRef
  • A genetic variant in GLP1R is associated with response to DPP-4 inhibitors in patients with type 2 diabetes
    Eugene Han, Hye Sun Park, Obin Kwon, Eun Yeong Choe, Hye Jin Wang, Yong-ho Lee, Sang-Hak Lee, Chul Hoon Kim, Lee-Kyung Kim, Soo Heon Kwak, Kyong Soo Park, Chul Sik Kim, Eun Seok Kang
    Medicine.2016; 95(44): e5155.     CrossRef
Close layer
Clinical Study
Characterization of Patients with Type 2 Diabetes according to Body Mass Index: Korea National Health and Nutrition Examination Survey from 2007 to 2011
Dong-Hwa Lee, Kyong Yeun Jung, Kyeong Seon Park, Kyoung Min Kim, Jae Hoon Moon, Soo Lim, Hak Chul Jang, Sung Hee Choi
Endocrinol Metab. 2015;30(4):514-521.   Published online December 31, 2015
DOI: https://doi.org/10.3803/EnM.2015.30.4.514
  • 3,511 View
  • 39 Download
  • 15 Web of Science
  • 16 Crossref
AbstractAbstract PDFPubReader   
Background

The present study aimed to investigate the clinical characteristics of type 2 diabetes mellitus (T2DM) in Korean adults according to body mass index (BMI) and to analyze the association with cardiovascular disease (CVD).

Methods

We conducted a cross-sectional study of data from the Korea National Health and Nutrition Examination Survey from 2007 to 2011. A total of 3,370 patients with T2DM were divided into categories according to BMI. We conducted a comparison of the T2DM patient population composition by BMI category between different countries. We investigated the prevalence of awareness, treatment, and target control of T2DM according to BMI.

Results

Patients with T2DM had a higher BMI, and were more likely to have a history of CVD than healthy controls. For Korean adults with T2DM, 8% had BMI ≥30 kg/m2. By contrast, the population of patients with T2DM and BMI ≥30 kg/m2 was 72% in patients in the USA and 56% in the UK. The rate of recognition, treatment, and control has worsened in parallel with increasing BMI. Even in patients with BMI 25 to 29.9 kg/m2, the prevalence of CVD or high risk factors for CVD was significantly higher than in patients with BMI 18.5 to 22.9 kg/m2 (odds ratio, 2.07).

Conclusion

Korean patients with T2DM had lower BMI than those in Western countries. Higher BMI was associated with lower awareness, treatment, and control of diabetes, and a positive association was observed between CVD or high risk factors for CVD and BMI, even for patients who were overweight but not obese.

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Clinical Study
Metabolic Health Is More Important than Obesity in the Development of Nonalcoholic Fatty Liver Disease: A 4-Year Retrospective Study
Min-Kyung Lee, Eun-Jung Rhee, Min Chul Kim, Byung Sub Moon, Jeong In Lee, Young Seok Song, Eun Na Han, Hyo Sun Lee, Yoonjeong Son, Se Eun Park, Cheol-Young Park, Ki-Won Oh, Sung-Woo Park, Won-Young Lee
Endocrinol Metab. 2015;30(4):522-530.   Published online December 31, 2015
DOI: https://doi.org/10.3803/EnM.2015.30.4.522
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  • 23 Web of Science
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AbstractAbstract PDFPubReader   
Background

The aim of this study is to compare the risk for future development of nonalcoholic fatty liver disease (NAFLD) according to different status of metabolic health and obesity.

Methods

A total of 3,045 subjects without NAFLD and diabetes at baseline were followed for 4 years. Subjects were categorized into four groups according to the following baseline metabolic health and obesity statuses: metabolically healthy, non-obese (MHNO); metabolically healthy, obese (MHO); metabolically unhealthy, non-obese (MUHNO); and metabolically unhealthy, obese (MUHO). Being metabolically healthy was defined as having fewer than two of the following five components: high blood pressure, high fasting blood glucose, high triglyceride, low high density lipoprotein cholesterol, and being in the highest decile of the homeostasis model assessment-insulin resistance index. Obesity was defined as a body mass index >25 kg/m2. The presence of NAFLD was assessed by ultrasonography.

Results

The proportions of subjects included in the MHNO, MHO, MUHNO, and MUHO groups were 71.4%, 9.8%, 13.0%, and 5.8%, respectively. The proportions of subjects who developed NAFLD were 10.5%, 31.4%, 23.2%, and 42% in the MHNO, MHO, MUHNO, and MUHO groups, respectively. The risk for developing NAFLD was highest in subjects who were metabolically unhealthy both at baseline and after 4 years compared with subjects who were consistently metabolically healthy during the follow-up period (odds ratio, 2.862). Using the MHNO group as reference, the odds ratios for the MHO, MUHNO, and MUHO groups were 1.731, 1.877, and 2.501, respectively.

Conclusion

The risk for NAFLD was lower in MHO subjects than in MUNO subjects.

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Endocrinol Metab : Endocrinology and Metabolism