Endocrinology and Metabolism

Original Article

Estrogen Receptor Gene Polymorphism, Urinary Estrogen Metabolites and Bone Mineral Density in Korean Postmenopausal Women.: Ji Hyun Lee, Sung Kil Lim, Young Jun Won, Seok Ho Kwon, Bong Soo Cha, Young Duk Song, Hyun Chul Lee, Kap Bum Huh; J Korean Endocr Soc. 1996;11(4):468-478. Published online November 7, 2019

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Abstract PDF: Background
Estrogen status is important for maintaining the homeostasis of bone. Estrogen has direct effects on bone cells, through binding to the high-affinity estrogen receptor. Several recent studies suggest that there might be genetically determined variations in biosynthesis and function of estrogen receptor in postmenopausal osteoporosis. Also the main cause of postmenopausal osteoporosis is decreased level of serum estrogen, whereas there had been some suggestion that the remaining estrogen have some effect on bone metabolism after menopause. We investigated the relationship between estrogen receptor gene PvulI polymorphism and bone mineral density(BMD), and the relationship between 18 urinary metabolites of estrogen and BMD in Korean postmeno- pausal osteoporosis. Methods: We examined the PvuII polymorphism of the estrogen receptor gene in 5' upstream region and the first intron by restrietion frapnent length polymorphism analysis in 62 postmeno- pausal wornen, BMD was measured by DEXA. The urinary estrogen metabolites were determined by GC/MS(Gas Chromatography-Mass Spectrometry) at Korean Institute of Science and Techno- logy Doping Control Center. Results: BMD of the spine and the femoral neck correlated with body weight, height, body mass index as we expected. There was no polymorphism of PvuII restriction site on 5 upstream region of estrogen receptor gene. Whereas the prevalen~ee of the PP, Pp, pp genotype in the first intron of estrogen receptor was 12.9%, 45.2%, 41.9%, respectively. But, there was no correlation between PvuII genotype and the spinel and femoral neck BMD. 2(OH)E2 among 18 urinary metabolites of estrogen, showed a negative correlation with the spinal and femoral neck BMD(r =-0.2551, p<0.05, and r =-0.3341, p<0.01, respectively), and the ratio of 16a(OH)E2/2(OH)E1> revealed a positive correlation with the spinal BMD(r =0.3057, p<0.05). In stepwise multiple regression analysis, body weight, 2(OH)E2, 16a(OH)E1, 2(Meo)E1 were independent predictors of the spinal bone density, and body weight and 2(OH)E2 were independent predictors of the femoral neck bone density. Conclusion: These results suggested that restrietion fragment length polymorphism analysis of the estrogen receptor gene with PvuII restriction enzyme was not helpful for early detection of patients at risk of developing osteoporosis. However, the ratio of 16-hydroxylation to 2-hydroxylation of estrogen metabolism was reduced in postmenopausal women and high catecholestrogen formation might be a greater risk factor for osteoporosis.

Case Report

A Case of Giant Adrenal Adenoma Presenting Primary Aldosteronism.: Ji Hyun Lee, Bong Soo Cha, Moon Suk Nam, Young Duk Song, Sung Kil Lim, Hyun Chul Lee, Kap Bum Huh, Hyung Chan Suh, Young Hwa Choi, Jae Min Park, Jung Soo Park, Soon Won Hong, Dong Hwan Shin; J Korean Endocr Soc. 1996;11(3):348-354. Published online November 7, 2019

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Abstract PDF: Primary aldosteronism is a syndrome chracterized by hypokalemic alkalosis and hypertension. Small sized adrenal cortical adenomas have been the major cause of this syndrome in most of the patients. However, if the adrenal mass is larger than 6cm in diameter and with irregular consistency, malignancy is more favored. We experienced a patient who had a giant adrenal adenoma with primary aldosteronism. A 24-year-old female presented with hypertension, hypokalemia, low plasma renin, and high plasrna aldosterone levels, was found to have a 6×5.5×5 cm sized left adrenal tumor by MRI. Her clinical laboratory feature did not revealed any evidence of Cushing's syndrome or pheochromocytoma. Preoperatively adrenal carcinoma presenting pure adrenal aldosteronism was suspected due to large size and heterogenous signal character of the adrenal mass in radiologic study. At operation well encapsulated, round giant adrenal tumor weighing 65gm(4.5×4×4 cm) was removed. There was no evidence of metastasis with return of adrenal function to normal after surgery. Benign adrenal adenoma was confirmed by the gross morphology and the histologic features.

Original Articles

Clinical and Sellar MR Findings in Central Diabets Inspidus.: Bong Soo Cha, Young Duk Song, Sung Kil Lim, Kyung Rae Kim, Hyun Chul Lee, Kap Bum Huh, Su Youn Nam, Eun Jig Lee, Sei Chang Oh, Byung Hee Lee, Dong Ik Kim; J Korean Endocr Soc. 1996;11(3):285-292. Published online November 7, 2019

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Abstract PDF: Background
s: Diabetes insipidus(DI) is a clinical syndrome characterized by excretion of copious volumes of dilute urine combined with persistent intake of abnormally large quantities of fluid. Central DI, caused by lack of antidiuretic hormone(ADH), most often results from lesions in the hypothalamic-neurohypophyseal axis. Magnetic resonance(MR) imaging is particularly useful in documenting the presence of a structural lesion, as opposed to assigning a diagnosis of idiopathic DI for which only symptomatic therapy is prescribed. Recently, several reports have described a specific MR finding in central DI, that is absence of normal posterior pituitary bright spot(PPBS). Methods: We retrospectivesly studied the clinical and MR findings in 25 patients with central DI, diagnosed by warter deprivation test. Results: 1) The subjects included 17 males and 8 females, between the ages of 2 and 58 years. 2) 24-hour urine volumes were 2,340~13,750 mL, and mean urine osmolarity was 147.7±65.8 mOsm/kg. The 23 subjects diagnosed complete central DI by warter deprivation test. 3) We found that the most common cause of cntral DI was infiltrative lesions of hypothalmic-neurohypophyseal axis(60%). Germ cell tumor was the single leading cause in present study, accounting for 36% of cases. The other causes were found, including pituitary apoplexy, meningitis, and trauma. Idiopathic central DI accounted for 20% of all cases. 4) Growth hormone deficiency was the most common accompanying anterior pituitary deficit, and panhypopituitarism was found in 7 cases, Hyperprolactinernia was seen in 6 cases. 5) In all patients, PPBS on Tl weighted MR images were not observed. A thickened pituitary stalk was seen in 15 cases(9 patients with germ cell tumor, 3 patients with histiocytosis X, 1 patient with tuberculosis, 2 patients with unknown origin). Conclusion: In our results, the most common causes of central DI was suprasellar infiltrative lesions. MR is currently the imaging methods of choice in the evaulation of dysfunction of the hypothalamic-neurohypophyseal system in patients with central DI. A specific MR finding, that is loss of normal PPBS allows a confirmative diagnosis of central DI.

Reduction of Central Dopamine Release in Hyperprolactinemia.: Bong Soo Cha, Young Duk Song, Sung Kil Lim, Kyung Rae Kim, Hyun Chul Lee, Kap Bum Huh, Su Youn Nam, Eun Jig Lee, Bong Chul Chung, Jung Han Kim, Sei Chang Oh; J Korean Endocr Soc. 1996;11(3):277-284. Published online November 7, 2019

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Abstract PDF: Background
Prolactin(PRL) secretion is tonically inhibited by doparnine that originates from the hypothalamic tuberoinfundibular tract and reaches the lactotroph via the hypophyseal portal vessel. Hyperprolactinemia associated with oligomenorrhea-amenorrhea, galactorrhea and/or infertility is mainly due to PRL-secreting pituitary adenoma(PA). The diagnosis of idiopathic hyperprolac- tinemia(IHP) is made, when hyperprolactinemia is sustained and all causes of hyperprolactinemia are excluded without radiological abnormality. It is not known, whether IHP and PA are two distinct entities or two subsequent phases of the same disease. The etiology of both disorders remains unresolved. We investigated that PRL hypersecretion in patients with IHP and PA may be the result of a defect in the central nervous system(CNS)-dopamine release, and that there may be some differences in pathogenesis of both diseases. Methods: We measured 24 hour-urinary dopamine, norepinephrine, epinephrine, and serum and 24 hour-urinary VMA(vanillyl rnandelic acid), HVA(homovanilic acid), DOPAC(3,4-dihydroxy phenylaceticacid), MHPG(3-methoxy 4-hydroxy phenylglycol) in 10 normal controls, 9 patients with IHP, and 17 patients with PA in the early follicular phase. Results: Urinary HVA and DOPAC concentrations, the major metabolites of CNS dopaminergic activity, were signficantly lower in both patients with IHP and PA compared with those in normal controls(p 0.05), whereas they were not different in both disease groups. Dopamine, norepine-phrine, epinephrine, MHPG concentrations were similar to those of the normal controls. Although VMA concentrations of both disease groups were significantly higher than those of normal controls, all of them were within normal range. Conelusion: Although our data are unable to establish the precise biochemical defect responsible for central dopamine deficiency in pathogensis of IHP and PA, we can support the presence of a pathological reduction of brain dopamine activity in IHP and PA.

Case Reports

A Case of Adult Fanconi Syndrome with Hypophosphatemic Osteomalacia.: Ji Hyun Lee, Young Sup Byun, Bong Soo Cha, Moon Suk Nam, Young Duk Song, Sung Kil Lim, Kyung Rae Kim, Hyun Chul Lee, Kap Bum Huh, Jin Kim, Jong In Yook; J Korean Endocr Soc. 1996;11(1):93-101. Published online November 7, 2019

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Abstract PDF: The Fanconi syndrome is characterized by generalized disturbance of tubular function. It leads to excessive losses of amino acids, glucose, phosphate, bicarbonate, and other organic and inorganic substrates handled by the proximal tubules. The metabolic consequences are acidosis, hypophosphatemia, hypocalemia, dehydration, rickets, osteomalacia, osteoporosis, and growth retardation. This syndrome may either be congenital or acquired, primary or secondary. Acquired Fanconi syndrome may result from multiple myeloma, Wilsons disease, primary amyloidosis, light chain nephropathy, and heavy metal poisoning such as lead, mercury, and cadmium. A 33-year-old female presented with multiple bone pain, and progressive proximal muscle weakness for 15 months. The blood urea nitrogen, creatinine, calcium, phosphate, and uric acid were 12.1 mg/dL, 1.5 mg/dL, 8.4 mg/dL, 1.8 mg/dL, and 1.7 mg/dL, respectively. The urine volume, protein, calcium, phosphate, and creatinine clearance were 2,330 ml, 343.7 mg, 146 mg, 424 mg, and 44.6 ml/min, respectively in 24 hour collection urine study. The tubular reabsorption rate of phosphate was decreased. In arterial blood gas analysis study, pH was 7.348, bicarbonate was 17.6 mmol/L, which means metabolic acidosis. In chest X-ray, fracture was seen in eighth and ninth left ribs. The whole body bone scan revealed hot uptake at both first and second ribs, right third rib, both eighth and ninth ribs, left sacroiliac joint and right hip joint. Bone densitometry showed moderate osteopenia in spine and femur neck. After NE4Cl loading, the urine pH was decreased below 5.0 at two and third hour, which means proximal renal tubular acidosis. Amino acid such as, hydroxyproline, threonine, serine, asparagine, glutamine excreted much more than normal in 24 hour urine. Bone biopsy showed the presence of increased osteoid volume and osteoid seam width and marked decreased mineral appositional rate as evidence for osteomalacia. The patients symptoms, including bone pain and proximal muscle weakness, were relieved after supplement of calcitonin, Vitamin D and calcium carbonate. We report a case of Fanconi syndrome with hypophosphatemic osteomalacia with brief review of literature.

A Case of Anterior Cervical Lipoma Mimicking Diffuse Goiter.: Eun Jig Lee, Moon Suk Nam, Su Youn Nam, Young Duk Song, Sung Kil Lim, Hyun Chul Lee, Kap Bum Huh, Kyung Rae Kim, Jun Sik Na, Yee Hyun Nam, Jeon Hong Kang, Jung Ki Seo; J Korean Endocr Soc. 1995;10(4):418-423. Published online November 7, 2019

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Abstract PDF: Lipoma is a benign fatty tumor that can arise in any location of the body where fat is present. It is found most commonly in the upper half of the body, particularly the head and neck, shoulders, and back. A mass in the antero-inferior part of the neck may be initially thought to be thyroid masses and then other cervical masses should be considered. Ultrasongraphic examination of benign lipoma demonstrates solid and echogenic mass and may differentiate nonthyroid from thyroid masses. Although the location of tumors, its consistency, and its motion with deglutition, seperation from the thyroid on sonographic examination, all pointed to nonthyroidal origin, did not rule out a possible mass that isolated from the lobes of the thyroid. Fine needle aspiration and biopsy can provide clear answer.We herein report a case of anterior cervical mass in a 48-yr-old male patient presenting a non-tender, slightly hard and nodular mass slowly growing for several years and moved with swallowing, and diagnosed his case as benign lipoma using thyroid scan and ultrasonography. When we encounter patients with anterior neck mass, we should consider benign lipoma mimicking diffuse goiter.

Original Articles

Clinical and Endocrinologic Differences between Prolactinoma and Pseudoprolactinoma Proven by Immunohistochemical Study.: Jae Wha Jo, Eun Jig Lee, Moon Suk Nam, Su Youn Nam, Young Duk Song, Hyun Chul Lee, Kap Bum Huh, Tae Seung Kim, Sun Ho Kim, Kyung Rae Kim, Bong Soo Cha, Ji Hyun Lee, Sung Kil Lim; J Korean Endocr Soc. 1995;10(4):362-369. Published online November 7, 2019

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Abstract PDF: Hyperprolactinemia is the most common hypothalamo-pituitary disorder encountered in clinical endocrinology. Excluding the drug-induced hyperprolactinemia, the most common cause of this disorder is a pituitary tumor. Prolactinoma is mainly made up of prolactin-secreting cells but pseudoprolactinoma is tumor that does not secrete prolactin itself. The pseudoprolactinoma interrupts the flow of prolactin inhibiting factor, dopamine, from the hypothalamus through the pituitary stalk to the normal pituitary. The differentiation prolactinoma from pseudoprolactinoma is vitally important since true prolactinomas are most commonly responded well in terms of tumor shrinkage to medical treatment using dopamine agonist therapy, whereas pseudoprolactinomas do not. Thus surgical treatment is clearly indicated as first-line treatment if we know that a lesion is a pseudoprolactinoma. We compared prolactinoma with pseudoprolactinoma in clinical and endocrinologic characteristics of 48 cases after immunohistochemical diagnosis. We could not find any differential point of both tumors in clinical and radiological characteristics although some differences were exist. But we had found the relationship between the mean level of pretreatment serum prolactin and the presence of positive immunohistochemical stain for prolactin. The pretreatment serum prolactin level was significantly higher in patients with tumors showing many prolactin immunohistochemical staining cells than in those with none(p<0.05). When the pretreatment serum prolactin exceeded 100ng/ml, the tumors contain 94% of prolactin positive cells in stain. So, if the pretreatment serum prolactin exceeds 100ng/ml, we primarily suspect prolactinoma and medical treatment should be considered. If the pretreatment level below 100ng/ml, we suspect pseudoprolactinoma and surgical treatment should be considered.

Immunohistochemical Study of c - Myc, c - Fos and c - Jun Oncoprotein Expression in the Human Pheochromocytoma.: Jae Wha Jo, Eun Jig Lee, Moon Suk Nam, Kyung Rae Kim, Su Youn Nam, Young Duk Song, Sung Kil Lim, Hyun Chul Lee, Kap Bum Huh, Yong Hye Lee, Tae Seung Kim, Kwan Woo Lee; J Korean Endocr Soc. 1995;10(1):26-34. Published online November 6, 2019

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Abstract PDF: A large number of studies for genes involved in oncogenesis have been done during last decade. Over 20 oncogenes have been isolated characterized, and the oncogene expressions in human tumors have been examined. The proto-oncogenes of c-Myc, c-Fos and c-Jun, which modulate the transcription factors, have overexpressed in a variety of human cancers. Immunohistochemical method was used in this study to examine c-Myc, c-Fos and c-Jun oncoprotein expression in 31 patients with human pheochromocytoma 28(90.0%) were benign and 3(10.0%) malignant. C-Myc oncoprotein immunoreactivity was found in 24 cases(77.4%), c-Fos in 29(93.5%), and c-Jun in 25(80.6%). Twenty-one(67.7%) showed positive immunoreactivity for all these oncoproteins, six(19.4%) for 2 oncoproteins, 3 for one oncoprotein. Only 1 case showed negative immunoreactivity for all 3 oncoproteins. The oncoprotein immunoreactivity did not correlate with the amount of 24 hour urinary catecholamine excretion. Although the number of malignant pheochromocytomsa was not so many, most of them showed that the immunoreactivity for oncoprotein was more than 30 percent of tumor cells.The expression of c-Myc, c-Fos and c-Jun oncoprotein were frequently found in human pheochromocytoma. These results suggest that the oncoprotein expression may play an important role in tumorogenesis and proliferation of human pheochromocytoma.

Case Reports

A Case of Giant Cell Granuloma of The Pituitary Gland.: Eun Jig Lee, Young Duk Song, Sung Kil Lim, Hyun Chul Lee, Kap Bum Huh, Tae Seung Kim, Sun Ho Kim, Bong Soo Cha, Dong Hun Choi, Jeong Il Jeong; J Korean Endocr Soc. 1994;10(3):284-288. Published online November 6, 2019

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Abstract PDF: Granulomatous disease of the pituitary gland are uncommon disorders which are rarely diagnosed in patients presenting for hypophysectomy. The majority of reported cases come from neuropsy material and include infectious and systemic disease such as tuberculosis, sarcoidosis, syphilis and fungal infections. We experienced giant cell granuloma of the pituitary gland in a 47 years-old woman. The patient suffered from headache, polyuria and polydipsia. MR images of brain demonstrated a hyposignaled mass. The fibrous tissues were removed by transsphenoidal approach. The clinical and histopathological features of this rare entity are reviewed.

A Case of Idiopathic Juvenile Osteoporosis.: Moon Suk Nam, Young Duk Song, Sung Kil Lim, Hyun Chul Lee, Kap Bum Huh, Young Joon Weon, Bong Soo Cha, Ji Hyun Lee, Jung Ho Lee; J Korean Endocr Soc. 1994;10(3):278-283. Published online November 6, 2019

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Abstract PDF: Idiopathic juvenile osteoporosis is a rare disease of heterogenous etiology and occurs on children between the age of 8 and 15. Manifestations include bone pain, fractures in minimal trauma, reduced bone density at areas of new bone growth, and loss of height. It is important to exclude other causes of osteoporosis.We experienced a case of a 14 year old boy with idiopathic juvenile osteoporosis. He had suffered from pain in the back and difficulty on walking for two months. Radiologic finding of the thoracolumbar area of the spine showed generalized severe osteoporosis and multiple vertebral collapse. We could not find the causes of osteoporosis in biochemical study, bone marrow study, skin biopsy and hormonal study. He was treated with alphacalcidol and CaCO_3. After 4 month of initial management, his subjective symtoms were improved and we did not find any signs of progression of disease. On bone mineral density measured after 26 month, we observed markedly increased bone mineral density.We report our experience of follow up of this case and review with the disease reported in the literature.

Original Articles

Complication and Prognosis of Craniopharyngioma According to the Age of Onset.: Eun Jig Lee, Moon Suk Nam, Young Duk Song, Sung Kil Lim, Hyun Chul Lee, Kap Bum Huh, Kyung Rae Kim, Kun Hoon Song, Bong Soo Cha, Ji Hyun Lee; J Korean Endocr Soc. 1994;10(3):262-272. Published online November 6, 2019

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Abstract PDF: Craniopharyngioma is the most common tumor involving the hypothalamo-pituitary area in childhood and adolescence. Recently, we carried out collective review of 70 patients with craniopharyngioma treated from January 1980 to December 1994 in order to inverstigate the endocrine outcome and survival according to the age of onset.The following results were obtained:1) The male to female ratio was 1:1. Age at diagnosis ranged from 2 to 64 years(mean age: 23) with the greatest frequency in the 2nd decade of life(28.6%). Of the 70 cases, the first group, 27 cases were under the age of 15, and the other group, 43 cases were over 15 year-old.2) The most common symptom at diagnosis in both groups was headache. In the adult group, symptoms related to hypogonadism(amenorrhea, decreased libido, galactorrhea etc.) were not uncommon. The lag of time between onset of symptom and hospital visit ranged from 3 days to 156 months(mean: 20 months).3) The main site of tumor was suprasellar region in both groups. The most common CT finding in both groups was calcification in sella turcica.4) In pre-operative combined pituitary function test, the most common, abnormal responses were shown in growth hormone and thyroid stimulating hormone in both groups. In addition, prolactin frequently showed abnormal response in the adult group.In post-operative combined pituitary function test, more hormones tended to reveal abnormal response in the group treated with surgery plus radiation therapy.5) The operation by subtotal removal followed by radiation therapy was the most commonly used method in treatment of both groups. After treatment, panhypopituitarism was occurred more frequently in the group treated with RT after surgery than those treated with surgery alone, but the difference was not statistically significant(p=0.136 in childhood, 0.436 in adults). Except the cases with panhypopituitarism, the most commonly encountered endocrine abnormalities were growth retardation in the children group, and hypogonadism in adult. The recurrence was clinically observed in 11 cases. The recurrence rate were 11.1% in children, and 18.6% in adult respectively. The mean time from the initial treatment to recurrence was 23 months. There was no significant difference in recurrence rate between the group treated with RT after subtotal removal and the group treated with total removal(p=0.475).The overall five-year survival rate after treatment was 82.8%. According to the treatment modalities, the patients undergone RT after subtotal removal survived much longer than those treated with other modalities such as subtotal removal only or total removal, but the differences in survival were not statistically significant(Log rank test, p=0.0539).

The Effect of Tumor Necrosis Factor - α on Extra Thyroidal Conversion of T4 to T3 in Slices and Extracts of Porcine Liver and Kidney.: Jae Wha Jo, Moon Suk Nam, Su Youn Nam, Young Duk Song, Sung Kil Lim, Hyun Chul Lee, Kap Bum Huh, Kyung Rae Kim, Eun Jig Lee; J Korean Endocr Soc. 1994;10(3):242-248. Published online November 6, 2019

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Abstract PDF: Abnormal thyroid function is seen in a wide variety of patients with acute and chronic nonthyroidal-illness, consisting of reduction in both thyroid function and peripheral T_4 to T_3 conversion including decreased serum thyroxin(T_4), decreased triiodothyronine and normal or slightly increased serum TSH. Recently increasing awareness of the role tumor necrosis factor-alpha(TNF-alpha) in systemic illness led us to consider a possible contribution of TNF-alpha to thyroid dysfunction in this setting. So we hypothesized that TNF-alpha might affect peripheral conversion of T_4 to T_3. We, therefore, explored the effects of TNF-alpha in slices and extracts of porcine liver and kidney. Thyroxine(T_4, 5ug/ml) was incubated in 0.15M phosphate buffer(PH 7.4) with slices(approximately 0.3 g-equivalent of tissue) and extracts(approximately 0.23 g-equivalent of tissue) of porcine liver and kidney with various concentrations(0-500pg/ml) of recombinant human TNF-alpha for 2 hours at 37 degree, and the T_3 generated during incubation was measured by radioimmunoassay of an ethanol extracts of the extracts and the homogenates of the slices. The slices produced more T_3 than extracts and the kidney was more active than the liver. TNF-alpha inhibited T_4 to T_3 conversion in dose-dependent manner in slices and extracts of porcine liver and kidney. Our data suggest that TNF-alpha have inhibitory effect of T_4 to T_3 conversion in liver and kidney(J Kor Soc Endocrinol 10: 242-248, 1995).

The Effect of Tumor Necrosis Factor - α on the Thyroglobulin Synthesis and TSH Action in Cultured Porcine Thyroid Cells.: Jae Wha Jo, Eun Jig Lee, Moon Suk Nam, Su Youn Nam, Young Duk Song, Sung Kil Lim, Hyun Chul Lee, Kap Bum Huh, Kyung Rae Kim; J Korean Endocr Soc. 1994;10(3):220-228. Published online November 6, 2019

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Abstract PDF: Abnormal thyroid function is seen in a wide variety of patients with acute and chronic nonthyroidal-illness, consisting of reduction in both thyroid function and peripheral T_4 to T_3 conversion including decreased serum thyroxin(T_4), decreased triiodothyronine and normal or slightly increased serum TSH. Recently increasing awareness of the role of tumor necrosis factor-alpha(TNF-alpha) in systemic illness led us to consider a possible contribution of TNF-alpha to thyroid dysfunction in this setting. So we hypothesized that TNF-alpha might affect the function of the thyroid gland. We, therefore, explored the effects of TNF-alpha on the cultured porcine thyroid cells in TSH-stimulated and TSH-nonstimulated conditions. Primarily cultured porcine thyroid cells were incubated with various concentrations(-500pg/ml) of recombinant buman TNF-alpha and bTSH(1mu/ml), with measurement of secreted thyroglobulin(Tg) and cyclic AMP(c-AMP) as the end points of stimulation, and produced intracellular Tg by pulse-labelling. TNF-alpha significantly inhibited TSH-stimulated intracellular Tg synthesis and extracellar Tg secretion at 200 and 500pg/ml concentration. TNF-alpha didn't affect c-AMP production at any concentration tested. So we conclude that increased in serum TNF-alpha may be responsible for reduced thyroid function in patients with acute and chronic nonthyroidal-illness.

Case Report

A Case of Primary Hyperparathyroidism Associated with Hypercalcemic Crisis and Systemic Calcinosis.: Young Duk Song, Sung Kil Lim, Hyun Chul Lee, Kap Bum Huh, Bong Sou Park; J Korean Endocr Soc. 1994;10(2):148-152. Published online November 6, 2019

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Abstract PDF: Recent reports have fueled on interest in the prevalance and significance of metastatic calcium deposition in patients with chronic hyperparathyroidism. Nephrocarcinosis and cutaneous cacifications have been recognized in patients with chronic renal failure, but the hypercalcemic crisis and systemic calcinosis are extremely rare in patients with primary hyperparathyroidism. We experienced a patient with primary hyperparathyroidism, presented with hypercalcemic crisis and metastatic calcification in the lungs, stomach, liver, and disappeared by successful parathyroidectomy.

Original Article

Seasonal Variation in Serum 25-Hydroxyvitamin D in The Elderly in Korean.: Eun Jig Lee, Kyung Rae Kim, Young Duk Song, Hyun Chul Lee, Kap Bum Huh, Choon Hee Chung, Sung Kil Lim, Yoon Sok Chung; J Korean Endocr Soc. 1994;9(2):121-127. Published online November 6, 2019

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Abstract PDF: The seasonal variations in the parameters of calcium metabolism including 25-hydroxyvitamin D were analyzed in 19 free-living elderly subjects (mean age:68.7±6.7 yr) in Seoul. Mean serum total calcium concentration was 9.0±0.3 mg/dl in March and had risen to 9.3±0.3mg/dl in the following September(p<0.001). Despite their comparable calcium intake. Serum phosphorus and alkaline phosphatase concentrations did not show any seasonal variations, whereas serum PTH concentrations were significantly lower in September than in March(20.1±8.6 vs. 32.5±8.4 pg/ml, p<0.001). Seasonal changes in serum 25-hydroxyvitamin D concentrations were also found between the value(17.3±6.9 ng/ml) in March and that (28.5±7.4 ng/ml) in September(p<0.001). There was a significant correlation between seasonal increase in 25-hydroxyvitamin D and seasonal reduction in serum PTH/Cr(r=-0.5394, p<0.05). This study suggests that the winter minimum of serum 25-hydroxyvitamin D concentration and the elevated PTH may be a contributing risk factor for the development of osteopenia especially in the elderly individuals. When exposure to sunlight is reduced, as in the case of nursing home population, an additional exogenous form of the vitamin D may be advisable.

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