Endocrinology and Metabolism

Original Articles

Triiodothyronine Is Associated with Incidence/Resolution of Steatotic Liver Disease: Longitudinal Study in Euthyroid Korean: Hye In Kim, Jun Young Kim, Jung Hwan Cho, Ji Min Han, Sunghwan Suh, Ji Cheol Bae, Tae Hyuk Kim, Sun Wook Kim, Jong Ryeal Hahm, Jae Hoon Chung; Received May 11, 2024 Accepted July 19, 2024 Published online December 4, 2024; DOI: https://doi.org/10.3803/EnM.2024.2040 [Epub ahead of print]

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Abstract PDF: Background
The positive relationship between triiodothyronine (T3) and steatotic liver disease (SLD) demonstrated only in crosssectional study. We aimed to evaluated whether total T3 (TT3) is associated with the development/resolution of SLD in longitudinal design.
Methods
This retrospective, longitudinal, population-based cohort study included 1,665 South Korean euthyroid adults with ≥4 thyroid function test. We explored the impact of mean TT3 during follow-up on development/resolution of either SLD (diagnosed by ultrasound) or modified metabolic dysfunction-associated steatotic liver disease (MASLD) using Cox proportional hazards regression models.
Results
During about median 5 years follow-up, 807/1,216 (66.3%) participants among participants without SLD at baseline developed SLD, and 253/318 (79.5%) participants among participants with SLD at baseline SLD resolved fatty liver. Mean TT3 rather than thyroid stimulating hormone or mean free thyroxine was significantly related with development (adjusted hazard ratio [HR], 1.01; 95% confidence interval [CI], 1.00 to 1.02; P=0.002) and resolution (adjusted HR, 0.97; 95% CI, 0.96 to 0.99; P=0.005) of SLD. Compared with low mean TT3 group, high mean TT3 group was positively associated with development of SLD (adjusted HR,1.20; 95% CI, 1.05 to 1.38; P=0.008) and inversely associated with resolution of SLD (adjusted HR, 0.66; 95% CI, 0.51 to 0.85; P=0.001). The statistical significance remained for development (adjusted HR, 1.29; 95% CI, 1.10 to 1.51; P=0.001) and resolution (adjusted HR, 0.71; 95% CI, 0.54 to 0.94; P=0.018) of modified MASLD.
Conclusion
In Korean euthyroid adults, TT3 level was associated with development and resolution of either SLD or modified MASLD.

Clinical Study
Predictive Performance of Glycated Hemoglobin for Incident Diabetes Compared with Glucose Tolerance Test According to Central Obesity: Suji Yoo, Jaehoon Jung, Hosu Kim, Kyoung Young Kim, Soo Kyoung Kim, Jungwha Jung, Jong Ryeal Hahm, Jong Ha Baek; Endocrinol Metab. 2020;35(4):873-881. Published online December 23, 2020; DOI: https://doi.org/10.3803/EnM.2020.798

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Background
To examine whether glycated hemoglobin (HbA1c) test would be a suitable screening tool for detecting high-risk subjects for diabetes compared to oral glucose tolerance test (OGTT) according to accompanied central obesity.
Methods
In this prospective population-based cohort study, both OGTT and HbA1c tests were performed and continued every 2 years up to 12 years among individuals with non-diabetic state at baseline (aged 40 to 69 years, n=7,512). Incident diabetes was established by a doctor, HbA1c ≥6.5%, and/or fasting plasma glucose (FPG) ≥126 mg/dL, and/or 2-hour postprandial glucose (2hPG) level based on OGTT ≥200 mg/dL. Discriminative capacities of high HbA1c (≥5.7%) versus high 2hPG (≥140 mg/dL) for predicting incident diabetes were compared using Cox-proportional hazard regression and C-index.
Results
During the median 11.5 years of follow-up period, 1,341 (17.6%) developed diabetes corresponding to an incidence of 22.1 per 1,000 person-years. Isolated high 2hPG was associated with higher risk for incident diabetes (hazard ratio [HR], 4.29; 95% confidence interval [CI], 3.56 to 5.17) than isolated high HbA1c (HR, 2.79; 95% CI, 2.40 to 3.26; P<0.05). In addition, high 2hPG provided better discriminatory capacity than high HbA1c (C-index 0.79 vs. 0.75, P<0.05). Meanwhile, in subjects with central obesity, the HR (3.95 [95% CI, 3.01 to 5.18] vs. 2.82 [95% CI, 2.30 to 3.46]) and discriminatory capacity of incident diabetes (C-index 0.75 vs. 0.75) between two subgroups became comparable.
Conclusion
Even though the overall inferior predictive capacity of HbA1c test than OGTT, HbA1c test might plays a complementary role in identifying high risk for diabetes especially in subjects with central obesity with increased sensitivity.

Citations

Citations to this article as recorded by

Assessing blood sugar measures for predicting new-onset diabetes and cardiovascular disease in community-dwelling adults
Jung-Hwan Kim, Yaeji Lee, Chung-Mo Nam, Yu-Jin Kwon, Ji-Won Lee
Endocrine.2024; 86(2): 528. CrossRef

Clinical Study
Recovery of Adrenal Function in Patients with Glucocorticoids Induced Secondary Adrenal Insufficiency: Jong Ha Baek, Soo Kyoung Kim, Jung Hwa Jung, Jong Ryeal Hahm, Jaehoon Jung; Endocrinol Metab. 2016;31(1):153-160. Published online March 16, 2016; DOI: https://doi.org/10.3803/EnM.2016.31.1.153

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Background

The chronic use of glucocorticoids (GC) suppresses function of the hypothalamic-pituitary-adrenal axis and often results in secondary adrenal insufficiency (AI). The present study aimed to determine the recovery rate of adrenal function in patients with secondary AI within 1 to 2 years and to assess the factors predictive of adrenal function recovery.

Methods

This was a retrospective observational study that enrolled patients diagnosed with GC-induced secondary AI between 2007 and 2013. AI was defined by peak serum cortisol levels <18 µg/dL during a standard-dose short synacthen test (SST). A follow-up SST was performed after 1 to 2 years, and responders were defined as those with adrenocorticotropic hormone (ACTH)-stimulated peak serum cortisol levels ≥18 µg/dL.

Results

Of the total 34 patients diagnosed with GC-induced secondary AI at first, 20 patients (58.8%) recovered normal adrenal function by the time of the follow-up SST (median follow-up period, 16.5 months). Although the baseline serum ACTH and cortisol levels at the first SST did not differ between responders and non-responders, the incremental cortisol response during the first SST was higher in responders than that of non-responders (7.88 vs. 3.56, P<0.01). Additionally, higher cortisol increments during the first SST were an independent predictive factor of the adrenal function recovery (odds ratio, 1.58; 95% confidence interval, 1.02 to 2.46; P<0.05).

Conclusion

In the present study, adrenal function recovery was achieved frequently in patients with GC-induced secondary AI within 1 to 2 years. Additionally, an incremental cortisol response at the first SST may be an important predictive factor of adrenal function recovery.

Citations

Citations to this article as recorded by

European Society of Endocrinology and Endocrine Society Joint Clinical Guideline: Diagnosis and therapy of glucocorticoid-induced adrenal insufficiency
Felix Beuschlein, Tobias Else, Irina Bancos, Stefanie Hahner, Oksana Hamidi, Leonie van Hulsteijn, Eystein S Husebye, Niki Karavitaki, Alessandro Prete, Anand Vaidya, Christine Yedinak, Olaf M Dekkers
European Journal of Endocrinology.2024; 190(5): G25. CrossRef
European Society of Endocrinology and Endocrine Society Joint Clinical Guideline: Diagnosis and Therapy of Glucocorticoid-induced Adrenal Insufficiency
Felix Beuschlein, Tobias Else, Irina Bancos, Stefanie Hahner, Oksana Hamidi, Leonie van Hulsteijn, Eystein S Husebye, Niki Karavitaki, Alessandro Prete, Anand Vaidya, Christine Yedinak, Olaf M Dekkers
The Journal of Clinical Endocrinology & Metabolism.2024; 109(7): 1657. CrossRef
Safely Withdrawing Glucocorticoid Therapy: A Case-Based Approach
Mohammed Alenazi, Khaled Aldahmani, Syed Ali Imran
Journal of Diabetes and Endocrine Practice.2024; 07(03): 129. CrossRef
Secondary Adrenal Insufficiency: Recent Updates and New Directions for Diagnosis and Management
Lucinda M. Gruber, Irina Bancos
Endocrine Practice.2022; 28(1): 110. CrossRef
Oral corticosteroid elimination via a personalised reduction algorithm in adults with severe, eosinophilic asthma treated with benralizumab (PONENTE): a multicentre, open-label, single-arm study
Andrew Menzies-Gow, Mark Gurnell, Liam G Heaney, Jonathan Corren, Elisabeth H Bel, Jorge Maspero, Timothy Harrison, David J Jackson, David Price, Njira Lugogo, James Kreindler, Annie Burden, Alex de Giorgio-Miller, Kelly Padilla, Ubaldo J Martin, Esther G
The Lancet Respiratory Medicine.2022; 10(1): 47. CrossRef
Development and Resolution of Secondary Adrenal Insufficiency after an Intra-Articular Steroid Injection
Jia Wei Tan, Sachin K. Majumdar, Osamu Isozaki
Case Reports in Endocrinology.2022; 2022: 1. CrossRef
Long‐term corticosteroid use, adrenal insufficiency and the need for steroid‐sparing treatment in adult severe asthma
M. Gurnell, L. G. Heaney, D. Price, A. Menzies‐Gow
Journal of Internal Medicine.2021; 290(2): 240. CrossRef
Glucocorticoid Withdrawal—An Overview on When and How to Diagnose Adrenal Insufficiency in Clinical Practice
Katarzyna Pelewicz, Piotr Miśkiewicz
Diagnostics.2021; 11(4): 728. CrossRef
Morning Serum Cortisol as a Predictor for the HPA Axis Recovery in Cushing’s Disease
Q. Cui, D. Liu, B. Xiang, Q. Sun, L. Fan, M. He, Y. Wang, X. Zhu, H. Ye, Giorgio Borretta
International Journal of Endocrinology.2021; 2021: 1. CrossRef
Dexamethasone-related adrenal insufficiency in patients with brain and skull base tumours
H. Benghiat, P. Sanghera, D. Stange, P. Nightingale, A. Hartley, M.W O’Reilly, N. Nundall, H. Currie, M. Ali, G. Cruickshank, D. Spooner, A. Toogood
Supportive Care in Cancer.2018; 26(12): 4031. CrossRef
Articles inEndocrinology and Metabolismin 2016
Won-Young Lee
Endocrinology and Metabolism.2017; 32(1): 62. CrossRef
The unresolved riddle of glucocorticoid withdrawal
F. Guerrero Pérez, A. P. Marengo, C. Villabona Artero
Journal of Endocrinological Investigation.2017; 40(11): 1175. CrossRef
Lessons from iatrogenic Cushing syndrome in children
Betty P Messazos, Margaret R Zacharin
Journal of Paediatrics and Child Health.2016; 52(12): 1106. CrossRef

Case Report

Thyroid
Delayed Surgery for Parathyroid Adenoma Misdiagnosed as a Thyroid Nodule and Treated with Radiofrequency Ablation: Ho-Su Kim, Bong Hoi Choi, Jung Rang Park, Jong Ryeal Hahm, Jung Hwa Jung, Soo Kyoung Kim, Sungsu Kim, Kyong-Young Kim, Soon Il Chung, Tae Sik Jung; Endocrinol Metab. 2013;28(3):231-235. Published online September 13, 2013; DOI: https://doi.org/10.3803/EnM.2013.28.3.231

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Abstract PDF PubReader

Primary hyperparathyroidism occurs as a result of isolated parathyroid adenoma in 80% to 85% of all cases. A ^99mtechnetium (^99mTc) sestamibi scan or neck ultrasonography is used to localize the neoplasm prior to surgical intervention. A 53-year-old female was referred for the exclusion of metabolic bone disease. She presented with low back pain that had persisted for the past 6 months and elevated serum alkaline phosphatase (1,253 IU/L). Four years previously, she had been diagnosed at a local hospital with a 2.3-cm thyroid nodule, which was determined to be pathologically benign. Radiofrequency ablation was performed at the same hospital because the nodule was still growing during the follow-up period 2 years before the visit to our hospital, and the procedure was unsuccessful in reducing the size of the nodule. The results of the laboratory tests in our hospital were as follows: serum calcium, 14.6 mg/dL; phosphorus, 3.5 mg/dL; and intact parathyroid hormone (iPTH), 1,911 pg/mL. Neck ultrasonography and ^99mTc sestamibi scan detected a 5-cm parathyroid neoplasm in the left lower lobe of the patient's thyroid; left parathyroidectomy was performed. This case indicated that thyroid ultrasonographers and pathologists need to be experienced enough to differentiate a parathyroid neoplasm from a thyroid nodule; ^99mTc sestamibi scan, serum calcium, and iPTH levels can help to establish the diagnosis of parathyroid neoplasm.

Citations

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Complications after radiofrequency ablation of hyperparathyroidism secondary to chronic kidney disease
Li-Ping Lin, Miao Lin, Song-Song Wu, Wei-hua Liu, Li Zhang, Yi-ping Ruan, Mei-zhu Gao, Fu-Yuan Hong
Renal Failure.2023;[Epub] CrossRef
Risk factors influencing cure of ultrasound-guided microwave ablation for primary hyperparathyroidism
Fangyi Liu, Li Zang, Yang Liu, Xiaoling Yu, Zhigang Cheng, Zhiyu Han, Jie Yu, Ping Liang
International Journal of Hyperthermia.2022; 39(1): 258. CrossRef
Efficacy and safety of radiofrequency ablation versus parathyroidectomy for secondary hyperparathyroidism in dialysis patients: a single-center retrospective study
Mian Ren, Danna Zheng, Juan Wu, Yueming Liu, Chengzhong Peng, Wei Shen, Bo Lin
Scientific Reports.2022;[Epub] CrossRef
Radiofrequency Ablation of Parathyroid Adenoma: A Novel Treatment Option for Primary Hyperparathyroidism
Iram Hussain, Shahzad Ahmad, Jules Aljammal
AACE Clinical Case Reports.2021; 7(3): 195. CrossRef
Efficacy of Ultrasound-guided Radiofrequency Ablation of Parathyroid Hyperplasia: Single Session vs. Two-Session for Effect on Hypocalcemia
Zeng Zeng, Cheng-Zhong Peng, Ji-Bin Liu, Yi-Wen Li, Hong-Feng He, Qiao-Hong Hu, Bo Lin, Xiao-Gang Shen
Scientific Reports.2020;[Epub] CrossRef
Efficacy and safety of microwave ablation for ectopic secondary hyperparathyroidism: a feasibility study
Xin Li, Ying Wei, Hongzeng Shao, Lili Peng, Chao An, Ming-An Yu
International Journal of Hyperthermia.2019; 36(1): 646. CrossRef
US-guided Microwave Ablation of Hyperplastic Parathyroid Glands: Safety and Efficacy in Patients with End-Stage Renal Disease—A Pilot Study
Li Zhuo, Li-li Peng, Yu-mei Zhang, Zhi-hong Xu, Gu-ming Zou, Xin Wang, Wen-ge Li, Ming-de Lu, Ming-an Yu
Radiology.2017; 282(2): 576. CrossRef
Safety and efficiency of microwave ablation for recurrent and persistent secondary hyperparathyroidism after parathyroidectomy: A retrospective pilot study
Ming-An Yu, Li Yao, Ling Zhang, Lili Peng, Li Zhuo, Yumei Zhang, Wenge Li, Ming-De Lv
International Journal of Hyperthermia.2016; 32(2): 180. CrossRef
A nonfunctioning parathyroid carcinoma misdiagnosed as a follicular thyroid nodule
Filomena Cetani, Gianluca Frustaci, Liborio Torregrossa, Silvia Magno, Fulvio Basolo, Alberto Campomori, Paolo Miccoli, Claudio Marcocci
World Journal of Surgical Oncology.2015;[Epub] CrossRef
Brief Review of Articles in 'Endocrinology and Metabolism' in 2013
Won-Young Lee
Endocrinology and Metabolism.2014; 29(3): 251. CrossRef

Original Articles

Differential Diagnostic Value of Total T3/Free T4 Ratio in Graves' Disease and Painless Thyroiditis Presenting Thyrotoxicosis.: Sang Min Lee, Soo Kyoung Kim, Jong Ryeal Hahm, Jung Hwa Jung, Ho Su Kim, Sungsu Kim, Soon Il Chung, Bong Hoi Choi, Tae Sik Jung; Endocrinol Metab. 2012;27(2):121-125. Published online June 20, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.2.121

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Abstract PDF

BACKGROUND
It is important to differentiate Graves' disease from that of painless thyroiditis in patients with thyrotoxicosis. In this study, we evaluated the usefulness of total T3 to free T4 ratio in making a differential diagnosis between Graves' disease and painless thyroiditis. METHODS: We reviewed medical records of thyrotoxic patients, who had been diagnosed with Graves' disease or painless thyroiditis, from October 2009 to July 2011. We assessed clinical characteristics, serum levels of total T3, free T4, thyroid stimulating hormone, thyrotropin-binding inhibitory immunoglobulin, and findings of 99mTechnetium thyroid scan. We analyzed the total T3/free T4 ratios between Graves' disease and painless thyroiditis patients. RESULTS: A total of 76 untreated thyrotoxic patients "49 Graves' disease and 27 painless thyroiditis" were examined. The total T3, free T4 levels and the total T3/free T4 ratios were significantly higher in patients with Graves' disease than in those with painless thyroiditis (P < 0.001). In the total T3/free T4 ratio > 73, the possibility of Graves' disease was significantly higher than in painless thyroiditis (sensitivity, 75.5%; specificity, 70.3%). The sensitivity and specificity of the total T3/free T4 ratio in patients with free T4 < 3.6 ng/dL have been increased (sensitivity, 100%; specificity, 71.4%). CONCLUSION: The total T3/free T4 ratios was useful for making a differential diagnosis between Graves' disease and painless thyroiditis.

Citations

Citations to this article as recorded by

Comparison of 99mTc Pertechnetate Thyroid Uptake Rates by Gamma Probe and Gamma Camera Methods for Differentiating Graves’ Disease and Thyroiditis
Meihua Jin, Jonghwa Ahn, Seong-gil Jo, Jangwon Park, Min Ji Jeon, Won Gu Kim, Tae Yong Kim, Won Bae Kim, Young Kee Shong, Jin-Sook Ryu
Nuclear Medicine and Molecular Imaging.2022; 56(1): 42. CrossRef
Interpretation of puzzling thyroid function tests
Jee Hee Yoon, Ho-Cheol Kang
Journal of the Korean Medical Association.2018; 61(4): 241. CrossRef
The High Proportion of Painless Thyroiditis as a Cause of Thyrotoxicosis in Korea
Sang Il Mo, A Jeong Ryu, Yeo Joo Kim, Sang Jin Kim
Journal of Korean Thyroid Association.2015; 8(1): 61. CrossRef

Clinical Characteristics of Patients with Hyperglycemic Emergency State Accompanying Rhabdomyolysis.: Soo Kyoung Kim, Jong Ha Baek, Kyeong Ju Lee, Jong Ryeal Hahm, Jung Hwa Jung, Hee Jin Kim, Ho Su Kim, Sungsu Kim, Soon Il Chung, Tae Sik Jung; Endocrinol Metab. 2011;26(4):317-323. Published online December 1, 2011; DOI: https://doi.org/10.3803/EnM.2011.26.4.317

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Abstract PDF

BACKGROUND
The purpose of this study was to investigate the prevalence of rhabdomyolysis and its association with both clinical course and prognosis and to evaluate the factors associated with rhabdomyolysis in patients with hyperglycemic emergencies. METHODS: We reviewed the medical records of patients with hyperglycemic emergencies who visited our hospital from May 2003 to April 2010. We assessed the clinical characteristics, biochemical profiles and clinical course of patients and analyzed these data according to the presence of rhabdomyolysis. RESULTS: The prevalence of rhabdomyolysis was 29 patients (28.4%) among 102 patients. Mean serum osmolarity, glucose and serum creatinine levels were higher in patients with rhabdomyolysis than those without rhabdomyolysis. Patients with rhabdomyolysis had higher rates of hemodialysis and mortality than those without the condition. The factors associated with rhabdomyolysis in the hyperglycemic emergency state were increased serum osmolarity and APACHE II score on admission (P < 0.05). CONCLUSION: Rhabdomyolysis commonly occurred in patients with hyperglycemic emergencies and this could aggravate their clinical course and increase mortality.

Citations

Citations to this article as recorded by

Acute diabetes complications
Salvatore Piro, Francesco Purrello
Journal of Gerontology and Geriatrics.2021; 69(4): 269. CrossRef
The Authors Reply: Clinical and Biochemical Characteristics of Elderly Patients With Hyperglycemic Emergency State at a Single Institution
Yong Jung Cho
Annals of Geriatric Medicine and Research.2017; 21(1): 38. CrossRef
Clinical and Biochemical Characteristics of Elderly Patients With Hyperglycemic Emergency State at a Single Institution
Yun Jae Shin, Dae In Kim, Dong Won Lee, Beung Kwan Jeon, Jung Geun Ji, Jung Ah Lim, Young Jung Cho, Hong Woo Nam
Annals of Geriatric Medicine and Research.2016; 20(4): 185. CrossRef

Case Reports

The Case of Accelerated Linear Growth Despite Growth Hormone and Insulin-like Growth Factor-I Deficiency.: Kyeong Ju Lee, Jong Ryeal Hahm, Tae Sik Jung, Jung Hwa Jung, Soo Kyoung Kim, Jong Ha Baek, Won Hyun Lee, Han wook Yoo, Soon Il Chung; J Korean Endocr Soc. 2009;24(3):206-211. Published online September 1, 2009; DOI: https://doi.org/10.3803/jkes.2009.24.3.206

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Abstract PDF: Here we describe a male patient who attained normal height despite combined hypopituitarism with an abnormal growth hormone-insulin-like growth factor (IGF)-I axis. When he was an 18-year-old, he presented with a short stature and underdeveloped external genitalia. The patient had not undergone normal pubertal development and he displayed a height below the fifth percentile. Hormonal and radiological studies revealed the findings of severe anterior pituitary hormone deficiency and an atrophic pituitary gland. There had been no recent follow-ups with the patient or medical treatment since that time. In the current presentation, the patient, now 22 years of age, had attained normal height, yet he remained prepubertal and showed manifestations of delayed bone age and combined hypopituitarism. In addition, the patient's IGF-II levels were increased for his age.

A Case of Central Diabetes Insipitus Combined with Septo-Optic Dysplasia and Schizencephaly in 31-year-old Woman.: Soo Kyoung Kim, Tae Sik Jung, Jong Ryeal Hahm, Sang Min Lee, Sung Won Moon, Kyeong Ju Lee, Soon Il Chung; J Korean Endocr Soc. 2007;22(5):339-343. Published online October 1, 2007; DOI: https://doi.org/10.3803/jkes.2007.22.5.339

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Abstract PDF

A 31-year-old woman was referred to our hospital for evaluation and management of poorly controlled epilepsy. The patient had been taking anti-epileptic drugs for six years. An MRI imaging study showed septo-optic dysplasia (SOD) and schizencephaly. SOD is a syndrome characterized by agenesis of the septum pellucidum or corpus callosum, optic nerve dysplasia and congenital hypothalamic-pituitary insufficiency. The patient was referred to the endocrine clinic for exclusion of any pituitary hormonal deficiencies. In a systemic review, the patient complained of polydipsia and polyuria for 20 years. In laboratory tests, measurements showed a serum osmolarity of 281 mOsm/kg, a serum sodium concentration of 144.7 mmol/L, a spot urine osmolarity of 183 mOsm/kg and a spot urine sodium concentration of 32 mmol/L. The patient underwent a water deprivation test, and was diagnosed with central diabetes insipidus. We report a case of central diabetes insipitus combined with SOD, schizencephaly and epilepsy.

Citations

Citations to this article as recorded by

A Case of Septo-Optic Dysplasia Resulting in Central Diabetes Insipidus and Nonobstructive Bilateral Hydronephrosis
Jong Hyun Kim, Kwang Bok Lee, Jeonghun Lee, Soo Min Nam, Kang-Woo Lee, Eu Gene Hwang, Geon Gil
Korean Journal of Medicine.2014; 87(2): 209. CrossRef
A Case of Septo-optic Dysplasia Associated with Anterior Pituitary Hormone Abnormalities
Jin-Woo Lee, Eui-Kyung Hwang, Tae-Ho Kim, Hyung-Young Yoon, Jae Ho Jung, Yong Won Choi, Suk-Woo Yong, Jae-Hong Ahn, Sun-Yong Kim, Ho Sung Kim, Yoon-Sok Chung
Journal of Korean Endocrine Society.2009; 24(1): 33. CrossRef

A Case of Pituitary Tumor Causing Diabetes Insipidus and Associating with Adenoid Cystic Carcinoma in the Bronchus.: Kang Wan Lee, Jong Ryeal Hahm, Mi Yean Kang, Jung Hwa Jung, Gi Dong Lee, Hyun Jin Kim, Sun Il Chung; J Korean Endocr Soc. 2003;18(3):311-317. Published online June 1, 2003

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Abstract PDF: The metastatic tumor occurs in about 6% to 20% of all cases with central diabetes insipidus. Many kinds of cancers such as breast, lung, colon, prostate, leukemia, and lymphoma can metastasize to the pituitary and its stalk. Primary adenoid cystic carcinoma arising in the bronchus is an uncommon disease. It is histologically and ultrastructurally identical to salivary gland adenoid cystic tumor and is regarded as a slowly growing, low graded-malignancy. This is a case report of a 52-year-old woman with diabetes insipidus caused by a pituitary tumor that might have been associated with adenoid cystic carcinoma arising in the bronchus. The patient was diagnosed by water deprivation test, chest CT scan, bronchoscopic biopsy, and brain MRI scan. The water deprivation test showed the patient had central diabetes insipidus, while chest CT scan revealed a lung mass lesion with distal right intermediate bronchial obstruction. The primary malignancy was confirmed by bronchoscopic biopsy. Finally, we confirmed that the patient had a 7mm-sized mass in the posterior pituitary gland and a thickened stalk by brain MRI scan.

A Case of Anterior Pituitary Agenesis in an Adult Woman.: Tae Sik Jung, Jong Ryeal Hahm, Kang Wan Lee, Jung Hwa Jung, Soo Hee Kim, Jong Ha, Hwal Suk Cho, Sun Il Chung; J Korean Endocr Soc. 2002;17(2):263-268. Published online April 1, 2002

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Abstract PDF: Dear Author, You have used abbreviations that will need to be defined in the main paper, i.e. PIT1, PROP1 and MRI. This is just for your advice. Pituitary agenesis is an uncommon cause of panhypopituitarism. It has been proposed that breech delivery, or birth trauma, is a major factor causing pituitary agenesis. Recent studies have suggested that genetic defects in the PIT1 or PROP1 gene might be involved in the pathogenesis of pituitary agenesis. In this case we report on the diagnosis of a 33-years old female patient with-growth retardation and sexual infantilism. We diagnosed anterior pituitary hormones deficiencies, with the exception of adrenocorticotropic hormone, by a combined pituitary stimulation test. We observed pituitary agenesis using sella MRI. Involvement of the PIT1 or PROP1 genes in this case remains to be determined. Here we report a case of pituitary agenesis found in an adult woman together with a brief review about this disease entity.

Original Article

Korean Adult Growth Hormone Deficiency Treatment Registry.: Sung Woon Kim, Seong Yeon Kim, Su Youn Nam, Yoon Sok Chung, Jae Hoon Chung, In Kyung Jung, Jong Ryeal Hahm, Minho Shong, Dong Sun Kim, Seong Keun Lee, Sung Dae Moon, Hyun Koo Yoon, Doo Man Kim, Sang Woo Kim, Hye Kyung Park; J Korean Endocr Soc. 2002;17(1):43-47. Published online February 1, 2002

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Abstract PDF: BACKGROUND
Adult growth hormone (GH) deficiency is related with decreased lean body mass, increased body fat, and poor quality of life. In western countries, adult GH deficiency treatment registriesy provide a database of the effects and safety of GH deficiency treatment. The Korean Adult Growth Hormone Study Group of the Korean Society of Endocrinology register adult GH deficiency since 1996. METHEODS: Subjects were aged over 15 years, had organic hypothalamo-pituitary disease, and GH deficiency as documented by GH stimulation test or serum insulin-like growth factor-I (IGF-I) level. The underlying etiology for GH deficiency, serum IGF-I level, starting and maintenance dose, and adult GH deficiency assessment (AGHDA) score were investigated. RESULTS: From January 1996 to May 2001. 115 patients were enrolled. Mean age was 43.7 13.8 years and 60% were female. Thirteen medical institutions were involved in the registry. The most common underlying diseases were Sheehan's syndrome and pituitary adenomas. GH starting dose was from 0.4 to 1.0 units. Maintenance dose was between 0.5 and 1.2 units. Serum IGF-I levels were increased after GH treatment (0-week, 93.7 69.7 ng/mL; 2-weeks, 184.9 89.0 ng/mL; 6-weeks, 188.4 94.8 ng/mL; 10-weeks, 207.6 111.1 ng/mL; 6 months, 281.9 95.5 ng/mL). AGHDA scores slightly improved from 10.25 6.70 to 8.58 5.47 after 6 months of GH deficiency treatment. CONCLUSION: The GH Treatment Registry will be beneficial in monitoring the effects of GH deficiency treatment on Korean adult GH deficient subjects

Case Report

2 Cases of Ectopic ACTH Syndrome due to Thymic Neuroendocrine Carcinoma Associated with Different Clinical Manifestations.: Yu Jeong Park, Moon Kyu Lee, Jong Ryeal Hahm, Jung Ho Do, Sang Taek Heo, Ju Sung Kim, Yong Ki Min, Myung Shik Lee, Kwang Won Kim, Joung Ho Han; J Korean Endocr Soc. 2001;16(1):115-122. Published online February 1, 2001

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Abstract PDF: Primary neuroendocrine carcinoma of the thymus (formerly known as thymic carcinoids) are unusual tumors that account for 5% of all anterior mediastinal neoplasms. Thymic neuroendocrine carcinomas exhibit a much more aggressive behavior than those originating from other foregut locations and are associated with the ectopic ACTH syndrome in 38% of cases. Patients having a thymic neuroendocrine carcinoma usually present with symptoms such as chest tightness, dyspnea, a palpable neck mass and sometimes a weight gain. We report on 2 patients with thymic neuroendocrine carcinoma who showed different clinical manifestations each other. One presented with a typical. Cushingoid appearance and the other had symptoms of fatigue and weight loss which is a common symptom of malignant tumors.

Original Articles

Comparison of Clinical Features and MRI Findings between Adamantinous and Papillary Craniopharyngioma.: Tae Wook Kang, Jong Ryeal Hahm, Sung Uk Kwon, Gun Young Cho, Ji Min Lee, Mun Hee Bae, In Kyung Chung, Tae Young Yang, Jae Hoon Chung, Yong Ki Min, Myung Shik Lee, Moon Kyu Lee, Jong Hyun Kim, Yeun Lim Suh, Jae Wook Ryoo, Dong Kyu Na, Kwang Won Kim; J Korean Endocr Soc. 2000;15(2):170-178. Published online January 1, 2001

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Abstract PDF: BACKGROUND
Craniopharyngioma is a suprasellar or intrasellar epithelial neoplasm that occurs in both children and adults. It accounts for 1.2 to 3 % of intracranial tumors with an incidence of 0.5 to 2 cases per one million populations each year. Recently, it has been postulated that it may have two pathogenetically separate subtypes, which are adamantinous and papillary craniopharyngioma, and that their clinical features may be different. However, there are some disagreements in this postulation. Therefore, we studied 22 consecutive patients with craniopharyngioma to evaluate the differences in clinical features and MRI findings between two subtypes. METHODS: We studied 22 patients with histologically proven craniopharyngioma after surgery at Samsung Medical center from 1995 to 1999. Thirteen patients were male, and nine patients were female. The average age was 30 years, with a range from 1 to 58 years. We divided 22 patients into two histopathologically separate subtypes; adamantinous and papillary subtypes. We compared the clinical features and MRI findings of two subtypes by reviewing medical records. RESULTS: Out of 22 patients with craniopharyngioma, 19 patients had an adamantinous subtype and 3 patients had a papillary subtype. The adamantinous subtype occurred frequently in the fifth decade and below twenty years, while the papillary subtype occurred predominantly in forth and fifth decades. The adamantinous subtype located in suprasellar or intrasellar portion as well as extrasellar portion, while the papillary subtype was restricted to the suprasellar location. The average tumor size of the adamantinous subtype was 3.7 cm, with a range from 1.4 to 6.0 cm, which was larger than that of the papillary subtype (average size 1.8 cm with a range from 1.5 to 2.3 cm, p< 0.05). The adamantinous subtype was predominantly cystic, while the papillary subtype was predominantly solid (p< 0.05). There were no significant differences in the preoperative clinical features and the postoperative complications between two subtypes. CONCLUSION: The adamantinous subtype had two peaks of occurrence in the fifth decade and below twenty years, while the papillary subtype occurred predominantly in forth and fifth decades. The adamantinous subtype was larger and had cystic portion, while the papillary subtype was smaller and had solid portion. The preoperative clinical features and the postoperative complications between two subtypes seemed not to be different.

Routine Measurement of Serum Calcitonin Concentration is Useful in Early Detection of Medullary Thyroid Carcinoma Among Patients with Nodular Thyroid Disease.: Jong Ryeal Hahm, Jae Hoon Chung, Eun Young Oh, In Kyung Chung, Tae Young Yang, Dong Jun Kim, Byung Ju Kim, Sung Hoon Kim, Yong Ki Min, Myung Shik Lee, Moon Kyu Lee, Kwang Won Kim; J Korean Endocr Soc. 2000;15(1):70-84. Published online January 1, 2001

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Abstract PDF: BACKGROUND
Serum calcitonin is a sensitive and specific marker for diagnosis of medullary thyroid carcinoma (MTC) and its determination leads to accurate preoperative diagnosis and gives chances of definite cure. However, since many non-MTC diseases are also associated with calcitonin elevation, its significance in patients with mild or moderately elevated basal serum calcitonin levels is not clear. Furthermore, the normal value of calcitonin using immunoradiometric assay (IRMA) kit has not so far been definitely ascertained. This study is aimed at assessing the clinical significance of routine measurement of serum basal calcitonin concentration in nodular thyroid disease patients and evaluating the pentagastrin stimulation test in case of mild or moderate elevation of basal calcitonin level. We also measured serum calcitonin value in 408 normal individuals. METHODS: The basal serum calcitonin concentrations using a commercial IRMA kit (Medgenix CT-U.S.-IRMA) were measured in 818 patients with nodular thyroid disease (average age 45 years with a range from 13 to 82 years; 125 males and 693 females) who visited thyroid clinics in Samsung Medical Center between June 1997 and December 1998. Serum concentrations of T3, T4, TSH and thyroid autoantibodies were measured and ultrasonography of thyroid and thyroid scan using 131I or 99mTc-pertechnetate were performed in all patients. We also studied 408 healthy subjects without any thyroid disease (average age 48 years with a range from 20 to 86 years; 224 females). RESULTS: The calcitonin value in normal subjects was found to range from 0 to 13 pg/mL, and it was shown that men had higher calcitonin level than women (p< 0.05). The rate of serum calcitonin elevation (> 10pg/mL) in nodular thyroid disease was 1.71% (14/818), and the incidence of MTC was 0.73% (6/818) in this study. MTC was found in all patients with basal serum calcitonin levels more than 100 pg/mL. Pentagastrin stimulation test was also required to diagnose MTC in patients with basal serum calcitonin levels between 30 and 100pg/mL. The calcitonin concentration stimulated by pentagastrin increased more than 400pg/mL or more than 3.8 times of basal concentration. It was possible to diagnose MTC with fine needle aspiration and cytology in only one case out of six patients with MTC. CONCLUSION: Fine needle aspiration and cytology in diagnosing MTC was not sensitive and not devoid of false positive results. We confirmed that serum calcitonin measurement was very useful means for the preoperative diagnosis of unsuspected MTC. Pentagastrin stimulation test may be a reliable means of evaluation in nodular thyroid disease patients with mild or moderate elevation of basal calcitonin level. We recommend routine measurement of serum calcitonin concentration in patients with nodular thyroid disease.

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