Endocrinology and Metabolism

Original Article

Clinical Study
Efficacy and Safety of Pitavastatin in a Real-World Setting: Observational Study Evaluating SaFety in Patient Treated with Pitavastatin in Korea (PROOF Study): In-Kyung Jeong, Sung-Rae Kim; Endocrinol Metab. 2020;35(4):882-891. Published online December 2, 2020; DOI: https://doi.org/10.3803/EnM.2020.723

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Background
While randomized controlled trials provide useful information about drug safety and efficacy, they do not always reflect the observed results in the real world. The prospective, observational, non-comparative trial in South Korea was designed to evaluate the efficacy and safety of pitavastatin in clinical practice in 28,343 patients.
Methods
This study was conducted in 893 facilities in Korea from April 2, 2012 to April 1, 2017. This study was designed to administer 1, 2, or 4 mg pitavastatin to patients with hyperlipidemia at the age of 20 or older for at least 8 weeks.
Results
For 126 days of mean duration of administration of pitavastatin, the % change of low density lipoprotein cholesterol indicated a dose dependent reduction: –23.4%, –29.1%, and –35.2% in the 1, 2, and 4 mg groups, respectively in patients who have not been treated with lipid lowering medications prior to study. Only 1.74% (492/28,343) of pitavastatin-treated patients experienced adverse events, of which 0.43% (123/28,343) were adverse drug reactions. Less than 1% of patients experienced the grade 2 or more toxicity (Common Terminology Criteria for Adverse Events v4.03) in alanine aminotransferase, aspartate aminotransferase, serum creatinine, and serum creatine phosphokinase. Although there were no rhabdomyolysis in 28,343 patients, 0.04% of patients had been reported pitavastatin-related musculoskeletal disorders.
Conclusion
Overall, this observational study showed that pitavastatin was well tolerated and effectively modified the lipid profile, reducing cardiovascular and cerebrovascular risk in Korean patients with hypercholesterolemia in the real world.

Citations

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Low-Density Lipoprotein Cholesterol Level, Statin Use and Myocardial Infarction Risk in Young Adults
Heekyoung Jeong, Kyungdo Han, Soon Jib Yoo, Mee Kyoung Kim
Journal of Lipid and Atherosclerosis.2022; 11(3): 288. CrossRef

Case Reports

A Case of Bezafibrate Induced Rhabdomyolysis.: Chung Gu Cho, Kyoung Nyeon Kim, Bong Joo Shin, Hyeong Eon Kim, Nam Jin Yoo; J Korean Endocr Soc. 1994;9(1):50-53. Published online November 6, 2019

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Abstract PDF: The case is presented a 49-year-old man had several year history with chronic renal failure with hyperlipidemia due to diabetes mellitus. Treatment of hyperlipidemia was started by oral bezafibrate intake 600 mg per day. Several days later, patient noticed muscle weakness and myalgia. The serum CK, LDH, AST levels were remarkably elevated, myoglobulinuria was also noticed The symptoms of the patient were resolved after the drug was discontinued, thus the diagnosis was established as having bezafibrate induced rhabdomyolysis. On the basis of the above description, bezafibrate may induce muscle damage if dose is excess over the renal capacity. Extreme caution is warranted when the patient is placed on bezafibrate and has renal dysfunction.Strict dose adjustment is necessary in taking account of renal function to avoid muscle damage including rhabdomyolysis.

Thyroid
Rhabdomyolysis and Acute Kidney Injury Associated with Hypothyroidism and Statin Therapy: Pyoung Ahn, Hyun-Jun Min, Sang-Hyun Park, Byoung-Mu Lee, Myung-Jin Choi, Jong-Woo Yoon, Ja-Ryong Koo; Endocrinol Metab. 2013;28(4):331-334. Published online December 12, 2013; DOI: https://doi.org/10.3803/EnM.2013.28.4.331

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Abstract PDF PubReader

Rhabdomyolysis is a syndrome involving the breakdown of skeletal muscle that causes myoglobin and other intracellular proteins to leak into the circulatory system, resulting in organ injury including acute kidney injury. We report a case of statin-induced rhabdomyolysis and acute kidney injury that developed in a 63-year-old woman with previously undiagnosed hypothyroidism. Untreated hypothyroidism may have caused her hypercholesterolemia requiring statin treatment, and it is postulated that statin-induced muscle injury was aggravated by hypothyroidism resulting in her full-blown rhabdomyolysis. Although this patient was successfully treated with continuous venovenous hemofiltration and L-thyroxin replacement, rhabdomyolysis with acute kidney injury is a potentially life-threatening disorder. Physicians must pay special attention to the possible presence of subclinical hypothyroidism when administering statins in patients with hypercholesterolemia.

Citations

Citations to this article as recorded by

Case report: Rhabdomyolysis and kidney injury in a statin-treated hypothyroid patient–kill two birds with one stone
Wen-Fang Chiang, Jenq-Shyong Chan, Po-Jen Hsiao, Shih-Hua Lin
Frontiers in Medicine.2022;[Epub] CrossRef
Secondary dyslipidemia: its treatments and association with atherosclerosis
Hidekatsu Yanai, Hiroshi Yoshida
Global Health & Medicine.2021; 3(1): 15. CrossRef
Hypothyroidism-associated rhabdomyolysis: A new case report and review of the reported cases
FahmiYousef Khan, TheebOsama Sulaiman, RazaAli Akbar
Imam Journal of Applied Sciences.2021; 6(2): 31. CrossRef
Phenotyping of Korean patients with better-than-expected efficacy of moderate-intensity statins using tensor factorization
Jingyun Choi, Yejin Kim, Hun-Sung Kim, In Young Choi, Hwanjo Yu, Katriina Aalto-Setala
PLOS ONE.2018; 13(6): e0197518. CrossRef
Discovery of potential novel microsomal triglyceride transfer protein inhibitors via virtual screening of pharmacophore modelling and molecular docking
Ludi Jiang, Yusu He, Ganggang Luo, Yongqiang Yang, Gongyu Li, Yanling Zhang
Molecular Simulation.2016; 42(15): 1223. CrossRef
Statin‐related aminotransferase elevation according to baseline aminotransferases level in real practice in Korea
H.‐S. Kim, S. H. Lee, H. Kim, S.‐H. Lee, J. H. Cho, H. Lee, H. W. Yim, S.‐H. Kim, I.‐Y. Choi, K.‐H. Yoon, J. H. Kim
Journal of Clinical Pharmacy and Therapeutics.2016; 41(3): 266. CrossRef
Creatinine as predictor value of mortality and acute kidney injury in rhabdomyolysis
R. Baeza‐Trinidad, A. Brea‐Hernando, S. Morera‐Rodriguez, Y. Brito‐Diaz, S. Sanchez‐Hernandez, L. El Bikri, E. Ramalle‐Gomara, J. L. Garcia‐Alvarez
Internal Medicine Journal.2015; 45(11): 1173. CrossRef
Brief Review of Articles in 'Endocrinology and Metabolism' in 2013
Won-Young Lee
Endocrinology and Metabolism.2014; 29(3): 251. CrossRef
The 2013 American College of Cardiology/American Heart Association guidelines for the treatment of dyslipidemia: mind the gaps!
Vasilios G. Athyros, Niki Katsiki, Asterios Karagiannis, Dimitri P. Mikhailidis
Current Medical Research and Opinion.2014; 30(9): 1701. CrossRef

Original Article

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

A Case of Pseudohypoparathyroidism Worsened by Rhabdomyolysis.: Won Jun Kim, Sin Je Moon, Hye Young Kim, Chang Beom Lee; J Korean Endocr Soc. 2009;24(3):195-200. Published online September 1, 2009; DOI: https://doi.org/10.3803/jkes.2009.24.3.195

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Abstract PDF

The term pseudohypoparathyroidism describes a rare disorder characterized by resistance to the action of immunoreactive parathyroid hormone (PTH) in peripheral tissue rather than a deficiency of PTH. Patients present with tetany, spasm, hypocalcemia, hyperphosphatemia, and Albright's hereditary osteodystrophy (AHO). We present a case of symptomatic hypocalcemia due to pseudohypoparathyroidism aggravated by rhabdomyolysis. A 21-year-old man presented with tetany, AHO phenotypes and an ankle infection. Rhabdomyolysis was confirmed by marked elevation of serum creatine phosphokinase, more than 10 times above normal. Spasm was observed and the serum value of total calcium was as low as 3.7 mg/dL and that of phosphate was as high as 7.0 mg/dL, and the peak level of PTH was at 80.4 pg/mL. Although not surveyed by Ellsworth-Howard test and molecular study, it was classified as pseudohypoparathyroidism type 1a or 1c. The clinical and laboratory abnormalities were corrected by vitamin D in addition to calcium. The patient's mother, sister, and grandmother had AHO phenotypes without clinical and biochemical manifestations. To the best of our knowledge, this is the first case by maternal inheritance that AHO phenotypes appear for three generations of a family in Korea.

Citations

Citations to this article as recorded by

A Case of Pseudohypoparathyroidism with Graves' Disease
Gil Woo Lee, Jae Hoon Kim, Kang Won Lee, Sa Il Kim, Sang Mo Hong, Dong Sun Kim, Woong Hwan Choi, You Hern Ahn, Tae Wha Kim
Endocrinology and Metabolism.2010; 25(3): 221. CrossRef

A Case of Thyrotoxic Periodic Paralysis with Rhabdomyolysis.: Seo Hee Lee, Seong Yeol Kim, Hae Ri Lee, Jun Goo Kang, Ohk Hyun Ryu, Chul Sik Kim, Byung Wan Lee, Seong Jin Lee, Eun Gyoung Hong, Hyeon Kyu Kim, Doo Man Kim, Jae Myung Yu, Sung Hee Ihm, Moon Gi Choi, Hyung Joon Yoo; J Korean Endocr Soc. 2008;23(6):425-429. Published online December 1, 2008; DOI: https://doi.org/10.3803/jkes.2008.23.6.425

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Abstract PDF: Hyperthyroidism combined with rhabdomyolysis is extremely rare. There are only 6 reported cases of hyperthyroidism accompanied with rhabdomyolysis in the medical literature. Rhabdomyolysis is a syndrome involving the breakdown of skeletal muscle, and this causes myoglobin and intracellular protein to leak into the circulation. The causes of rhabdomyolysis include trauma, electrolyte abnormality, infection, drug, toxin and hypothyroidism. We report here on a patient who presented with thyrotoxic periodic paralysis and rhabdomyolysis with hypokalemia. He complained of lower leg paralysis along with muscle tenderness, and the laboratory findings showed elevated creatine kinase (CK) levels. After treatment by hydration, potassium replacement and drug medication, including propylthiouracil and beta-blocker, his CK levels were normalized and his symptoms were much improved. For patient with thyrotoxic periodic paralysis and muscle tenderness, the possibility of rhabdomyolysis should be clarified by examining the CK levels.

A Case of Thyrotoxicosis Presented as Rhabdomyolysis.: Yil Sik Hyun, Chang Beom Lee, Yong Soo Park, Dong Sun Kim, Woong Hwan Choi, Tae Wha Kim, You Hern Ahn; J Korean Endocr Soc. 2005;20(4):381-384. Published online August 1, 2005; DOI: https://doi.org/10.3803/jkes.2005.20.4.381

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Abstract PDF

There have been a few reports on rhabdomyolysis caused by thyroid storm, but no cases of thyrotoxicosis related rhabdomyolysis have been reported until now. Here, a rare case of rhabdomyolysis, accompanied by thyrotoxicosis, is reported. A 21-year-old man was admitted to our hospital with severe pain and weakness in both legs. The initial laboratory findings revealed a high muscle enzyme level and severe hypokalemia. In evaluation of the rhabdomyolysis, the thyroid function test was compatible with that of Graves' disease, with the rhabdomyolysis subsequently diagnosed, presenting as thyrotoxicosis. The possible mechanisms for this complaint were hypokalemia-induced muscle ischemia, a thyrotoxicosis-induced excessive hypermetabolic state and pressure-induced muscle ischemia. Therefore, the work up for the cause of rhabdomyolysis should include thyrotoxicosis. The management of rhabdomyolysis is hydration, prevention of acute renal failure, correction of aggravating factors and treatment of the underlying cause, for example, thyrotoxicosis.

Citations

Citations to this article as recorded by

A Case of Thyrotoxic Periodic Paralysis with Rhabdomyolysis
Seo Hee Lee, Seong Yeol Kim, Hae Ri Lee, Jun Goo Kang, Ohk Hyun Ryu, Chul Sik Kim, Byung Wan Lee, Seong Jin Lee, Eun-Gyoung Hong, Hyeon Kyu Kim, Doo-Man Kim, Jae Myung Yu, Sung-Hee Ihm, Moon Gi Choi, Hyung Joon Yoo
Journal of Korean Endocrine Society.2008; 23(6): 425. CrossRef

A Case of Licorice Induced Hypokalemic Paralysis with Rhabdomyolysis.: Hyun Il Hong, Koon Hee Han, Jung Won Hwang, Young Don Kim, Myung Sook Shim, Jin Yub Kim; J Korean Endocr Soc. 2005;20(2):179-182. Published online April 1, 2005; DOI: https://doi.org/10.3803/jkes.2005.20.2.179

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Abstract PDF

Prolonged ingestion of licorice can cause hypermineralocorticoidism, with sodium retention, potassium loss and hypertension. Nevertheless, its initial presentation with a very severe degree of hypokalemic paralysis and rhabdomyolysis are exceedingly rare. We describe a patient who experienced hypokalemic paralysis and rhabdomyolysis after licorice ingestion. The patient's initial blood pressure was 160/80mmHg. The major biochemical abnormalities included; hypokalemia(K+ 1.3mEq/L), metabolic alkalosis, with a pH of 7.64, and urine myoglobin > 3000ng/mL. The plasma rennin activity and aldosterone level were suppressed. The 24 hour urine cortisol concentration was normal. The patients, over a 1 month period, had ingested 500g of licorice boiled in water. After quitting the licorice, the hypokalemia and muscle paralysis gradually improved and blood pressure returned to normal

Citations

Citations to this article as recorded by

A case of chronic licorice intoxication-induced apparent mineralocorticoid excess syndrome
Young Jae Lim, Ji Eun Kim
Journal of The Korean Society of Clinical Toxicology.2023; 21(2): 151. CrossRef
Hypokalemic Periodic Paralysis Developed in a Patient with Neurogenic Diabetes Insipidus
Jihyeon Hwang, Joo Hye Sung, Ye Eun Kim, Keonyeup Kim, Seong-Hwan Kim, Young Bin Park, Seol-Hee Baek
Journal of the Korean Neurological Association.2021; 39(3): 177. CrossRef
Electrical storm induced by hypokalemia associated with herbal medicines containing licorice
Hyun Kuk Kim, Sung Soo Kim
Translational and Clinical Pharmacology.2019; 27(2): 69. CrossRef
Influence of Herbal Complexes Containing Licorice on Potassium Levels: A Retrospective Study
WooSang Jung, SeungWon Kwon, JinWook Im, SeongUk Park, SangKwan Moon, JungMi Park, ChangNam Ko, KiHo Cho
Evidence-Based Complementary and Alternative Medicine.2014; 2014: 1. CrossRef

A Case of Panhypopituitarism with Rhabdomyolysis.: Sung Wook Hong, Eun Jung Lee, Ji Young Park, Ji Sung Yoon, Ji O Mok, Yeo Joo Kim, Hyeong Kyu Park, Jae Woo Kim, Chul Hee Kim, Sang Jin Kim, Dong Won Byun, Kyo Il Suh, Myung Hi Yoo; J Korean Endocr Soc. 2005;20(2):174-178. Published online April 1, 2005; DOI: https://doi.org/10.3803/jkes.2005.20.2.174

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Abstract PDF: Rhabdomyolysis is the consequence of extensive muscle injury with the release of muscle cell constituents into plasma. It can arise from trauma and also from a variety of nontraumatic causes. Trauma, drugs, toxins and infection are the major causes of rhabdomyolysis, but it is rarely associated with metabolic disorders such as severe electrolyte disturbance, diabetic ketoacidosis, hyperosmolar nonketotic coma, hypothyroidism and thyrotoxicosis. There have been several reported cases of metabolic rhabdomyolysis, but panhypopituitarism as a cause has never been identified. We experienced a case of acute rhabdomyolysis associated with panhypopituitarism. Thus, So we report this case with the review of related literature. Metabolic disorder is a rare cause of rhabdomyolysis, but it should always be considered in a patient having and unexplained increased of the creatine kinase concentration

Rhabdomyolysis Associated with Hyponatremia.: Kyoung Wook Lee, Seong Bin Hong, Seung Baik Han, Bon Ju Jeong, Hwi Ra Park, Eun Sil Kim, Dong Hyo Hyun, Moon Suk Nam, Yong Seong Kim; J Korean Endocr Soc. 2003;18(3):306-310. Published online June 1, 2003

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Abstract PDF: Hyponatremia is a frequent condition of body fluid and electrolyte imbalance encountered in clinical practice. However, rhabdomyolysis has rarely been reported in association with hyponatremia. We experienced a 56-year-old woman who had developed symptomatic hyponatremia after prolonged nausea and subsequent rhabdomyolysis. Hyponatremia was probably mediated by hypersecretion of antidiuretic hormones.The woman had developed severe hypotonic hyponatremia with an alternation in mental status after suffering from severe nausea and vomiting for x months/years. She recovered with intensive supportive therapy, including hypertonic saline administration. One day after hospitalization, she complained of thigh pains; furthermore her serum creatine phosphokinase level had increased. She was treated with alkaline diuresis. Renal failure or compartment syndrome did not complicate the clinical course. The patient was discharged and returned to her normal daily activities. The possibility of rhabdomyolysis should be considered in patients with acute hyponatremia who have developed muscle pain.

A Case of Acute Rhabdomyolysis as a first Manifestation of Primary Hypothyroidism.: Jung Min Lee, Hyun Shik Son, Hye Jung Lee, Sook Hee Hong, Jong Min Lee, Bong Yun Cha, Kwang Woo Lee, Ho Young Son, Sung Koo Kang; J Korean Endocr Soc. 2003;18(1):79-84. Published online February 1, 2003

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Abstract PDF: Various symptoms, such as bradycardia, hypotension, fatigue, constipation, myalgia, muscle weakness, delayed tendon reflex, and so forth, presented in hypothyroidism. Of these symptoms, muscle weakness, myalgia, and delayed tendon reflex are common features of hypothyroid myopathy. Acute rhabdomyolysis, a very severe form of myopathy, but is a rare manifestation of primary hypothyrodism. A 29-year-old man developed acute rhabdomyolysis, associated with primary hypothyroidism as a first manifestation. After thyroxine replacement therapy, he exhibited some improvement in muscle weakness and in non-pitting edema. We report a case of primary hypothyroidism presenting with spontaneous rhabdomyolysis as a first manifestation.

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