Pheochromocytoma with Markedly Abnormal Liver Function Tests and Severe Leukocytosis

Pheochromocytoma is a rare neuroendocrine tumor arising from the medulla of the adrenal glands, which causes an overproduction of catecholamines. The common symptoms are headache, palpitations, and sweating; however, various other clinical manifestations might also be present. Accurate diagnosis of pheochromocytoma is important because surgical treatment is usually successful, and associated clinical problems are reversible if treated early. A 49-year-old man with a history of uncontrolled hypertension and diabetes mellitus presented with chest pain, fever, and sweating. His liver function tests and white blood cell counts were markedly increased and his echocardiography results suggested stress-induced cardiomyopathy. His abdominal computed tomography showed a 5x5-cm-sized tumor in the left adrenal gland, and laboratory tests confirmed catecholamine overproduction. After surgical resection of the left adrenal gland, his liver function tests and white blood cell counts normalized, and echocardiography showed normal cardiac function. Moreover, his previous antihypertensive regimen was deescalated, and his previously uncontrolled blood glucose levels normalized without medication.

Effect of Eplerenone, a Selective Aldosterone Blocker, on the Development of Diabetic Nephropathy in Type 2 Diabetic Rats

BACKGROUND: Aldosterone antagonists are reported to have beneficial effects on diabetic nephropathy by effective blocking of the renin-angiotensin-aldosterone system. We investigated the renoprotective effect of the selective aldosterone receptor blocker eplerenone, the angiotensin converting enzyme inhibitor lisinopril, and combined eplerenone and lisinopril treatment in type 2 diabetic rats. METHODS: Animals were divided into six groups as follows: Otsuka Long-Evans Tokushima Fatty (OLETF) rat control, OLETF rats treated with a low dose of eplerenone (50 mg/kg/day), OLETF rats treated with a high dose of eplerenone (200 mg/kg/day), OLETF rats treated with lisinopril (10 mg/kg/day), OLETF rats treated with a combination of both drugs (eplerenone 200 mg/kg/day and lisinopril 10 mg/kg/day), and obese non-diabetic Long-Evans Tokushima Otsuka rats for 26 weeks. RESULTS: Urinary albumin excretion was significantly lower in the lisinopril group, but not in the eplerenone group. Urinary albumin excretion was decreased in the combination group than in the lisinopril group. Glomerulosclerosis and renal expression of type I and type IV collagen, plasminogen activator inhibitor-1, transforming growth factor-beta1, connective tissue growth factor, and fibronectin mRNA were markedly decreased in the lisinopril, eplerenone, and combination groups. CONCLUSION: Eplerenone and lisinopril combination showed additional benefits on type 2 diabetic nephropathy compared to monotherapy of each drug.

Invasive Aspergillosis of the Paranasal Sinuses Invading Skull Base : Successful Treatment with Voriconazole / 감염과화학요법

Skull base-invading, invasive aspergillosis is rare, but it is a potentially life-threatening disease. Nevertheless, the standard method and the optimal duration of treatment are not known yet. A 52-year-old female diabetic patient complained of ophthalmalgia and decreased visual acuity. MRI and CT scan revealed an enhancing mass in the right orbital fissure and showed an infiltrating process in the skull base around the right orbit apex and paranasal sinuses. The histological investigation revealed invasive aspergillosis of paranasal sinuses and the skull base. Clinical improvement occurred after marsupialization and post-operative systemic antifungal therapy with voriconazole for 14 weeks. We suggest that voriconazole treatment could show effective results for invasive aspergillosis of skull base and paranasal sinuses.

Invasive Aspergillosis of the Paranasal Sinuses Invading Skull Base : Successful Treatment with Voriconazole / 감염과화학요법

Skull base-invading, invasive aspergillosis is rare, but it is a potentially life-threatening disease. Nevertheless, the standard method and the optimal duration of treatment are not known yet. A 52-year-old female diabetic patient complained of ophthalmalgia and decreased visual acuity. MRI and CT scan revealed an enhancing mass in the right orbital fissure and showed an infiltrating process in the skull base around the right orbit apex and paranasal sinuses. The histological investigation revealed invasive aspergillosis of paranasal sinuses and the skull base. Clinical improvement occurred after marsupialization and post-operative systemic antifungal therapy with voriconazole for 14 weeks. We suggest that voriconazole treatment could show effective results for invasive aspergillosis of skull base and paranasal sinuses.

The prevalence of microalbuminuria and associated factors in newly diagnosed type 2 diabetes mellitus in Korea / 대한내과학회지

BACKGROUND: To determine the prevalence and the associated factors of microalbuminuria in Korean subjects with newly diagnosed type 2 diabetes mellitus. METHODS: A total of 304 patients with newly diagnosed type 2 diabetes mellitus that visited Anam Hospital, Korea University Medical Center, were studied cross-sectionally for the presence of microalbuminuria and other micro- and macrovascular complications. Microalbuminuria was calculated by the amount of albumin excretion in the urine for 24 hrs (30-299 mg/24hr) or by the albumin creatinine ratio in a spot urine sample (30-299 mg/g creatinine). Subjects were divided into two groups: the normoalbuminuria group and the microalbuminuria group. RESULTS: The prevalence of microalbuminuria, normoalbuminuria and overt proteinuria in patients with newly diagnosed type 2 diabetes mellitus was 17.1%, 80.3% and 2.6%. respectively. Microalbuminuria was significantly correlated with the body mass index (BMI), fasting insulin level, fasting C-peptide level and triglyceride level. The number of metabolic syndrome components was significantly correlated with the amount of microalbuminuria. In patients with microalbuminuria and without retinopathy, the correlation of microalbuminuria and the presence of metabolic syndrome was also significant. CONCLUSIONS: The prevalence of microalbuminuria in 304 Korean patients with newly diagnosed type 2 diabetes mellitus was 17.1%, and microalbuminuria had a correlation with the BMI, fasting insulin level, fasting C-peptide level, HOMA level, triglyceride level and the presence of metabolic syndrome.

Therapeutic effects of a long-acting formulation of lanreotide in Korean patients with acromegaly / 대한내과학회지

BACKGROUND: The present study was conducted to examine the effects of a long-acting formulation of lanreotide (Somatulin-Autogel(R)) in Korean acromegalic patients who had undergone surgery. METHODS: The subjects in the study were 11 acromegalic patients (5 men and 6 women) who had undergone transsphenoidal tumor resection at Korea University Guro Hospital. The anthropometric parameters, blood pressure, fasting blood glucose (FBG), IGF-1, HbA1C, mass size and GH level following a 75 gm oral glucose tolerance test (OGTT) were measured in each subject before and after treatment with a long-acting formulation of lanreotide. RESULTS: The median age of the subjects was 41 yrs (range: 28-52 yrs) (Table 1). The mean pre-operative levels of serum IGF-1 in the 11 patients was 1185+/-323.58 ng/mL, and post-operatively it was 862+/-314.06 ng/mL. The mean serum IGF-1 concentration decreased from 862+/-314.06 ng/mL to 549+/-371.62 ng/mL after 6 months treatment with the long-acting formulation of lanreotide (p=0.003, vs baseline, n=11), and it decreased further to 439+/-342.53 ng/mL after 12 months treatment (p=0.005 vs baseline, n=10) (Table 3). Two patients achieved the target level of IGF-1. The HbA1C measured before and after lanreotide treatment was 5.8+/-0.5% and 5.9+/-0.3%, respectively. CONCLUSIONS: This study showed that a long-acting formulation of lanreotide decreased the IGF-1 and GH levels without significant side effects. In spite of the small number of subjects in this study, these findings suggest that this formulation of lanreotide is effective for the post-operative management of acromegaly.