Optimal Waist Circumference Cutoff Values for Metabolic Syndrome Diagnostic Criteria in a Korean Rural Population

The Korean Society for the Study of Obesity (KSSO) has defined the waist circumference cutoff value of central obesity as 90 cm for men and 85 cm for women. The purpose of this investigation was to determine the corresponding waist circumference values. A total of 3,508 persons in the Korean Rural Genomic Cohort Study were enrolled in this survey. Receiver operating characteristic (ROC) curve analysis was used to find appropriate waist circumference cutoff values in relation to insulin resistance determined by homeostasis model assessment for insulin resistance (HOMA-IR), body mass index (BMI), and components of metabolic syndrome. The optimal waist circumference cutoff values were 87 cm for men and 83 cm for women by ROC analysis to HOMA-IR and 86 cm for men and 83 cm for women by ROC analysis to value with more than two components of metaobolic syndrome. By using a BMI > or =25 kg/m2, 86 cm for men and 82 cm for women were optimal waist circumference cutoff values. In this study, we suggest that the most reasonable waist circumference cutoff values are 86-87 cm for men and 82-83 cm for women.

Aldose Reductase Inhibitor Ameliorates Renal Vascular Endothelial Growth Factor Expression in Streptozotocin-Induced Diabetic Rats

PURPOSE: The vascular endothelial growth factor (VEGF) expression of podocyte is one of the well-known major factors in development of diabetic nephropathy. In this study, we investigated the effects of aldose reductase inhibitor, fidarestat on diabetic nephropathy, and renal VEGF expression in a type 1 diabetic rat model. MATERIALS AND METHODS: Twenty four Sprague-Dawley male rats which were performed intraperitoneal injection of streptozotocin and normal six rats were divided into four groups including a normal control group, untreated diabetic control group, aldose reductase (AR) inhibitor (fidarestat, 16 mg.kg(-1).day(-1)) treated diabetic group, and angiotensin receptor blocker (losartan, 20 mg.kg(-1).day(-1)) treated diabetic group. We checked body weights and blood glucose levels monthly and measured urine albumin-creatinine ratio (ACR) at 8 and 32 weeks. We extracted the kidney to examine the renal morphology and VEGF expressions. RESULTS: The ACR decreased in fidarestat and losartan treated diabetic rat groups than in untreated diabetic group (24.79 +/- 11.12, 16.11 +/- 9.95, and 84.85 +/- 91.19, p < 0.05). The renal VEGF messenger RNA (mRNA) and protein expression were significantly decreased in the fidarestat and losartan treated diabetic rat groups than in the diabetic control group. CONCLUSION: We suggested that aldose reductase inhibitor may have preventive effect on diabetic nephropathy by reducing renal VEGF overexpression.

A TSH-secreting pituitary microadenoma diagnosed with inferior petrosal sinus sampling: Case report / 대한내과학회지

Thyroid stimulating hormone (TSH)-secreting pituitary adenomas are rare tumors of the pituitary gland and represent 1~2% of all pituitary adenomas. A TSH-secreting pituitary adenoma shows as a normal or elevated thyrotropin level in a hyperthyroid patient. We present a 32-year-old woman who was diagnosed with a TSH-secreting pituitary microadenoma. She had a high free T4, with a normal TSH and alpha-subunit. Bilateral inferior petrosal sinus sampling (IPSS) was done to confirm the alpha-subunit secreting adenoma, and the concentration of the alpha-subunit was high on the tumor side. The pituitary microadenoma was removed, and her TSH and free T4 levels decreased to normal. IPSS may help give an accurate diagnosis in the patient with a normal alpha-subunit.

Relationship between Menopausal Status and Metabolic Syndrome Components in Korean Women / 당뇨병

BACKGROUND: Postmenopausal status is associated with a 60% increased risk for metabolic syndrome. It is thought to be associated with decreased estrogens and increased abdominal obesity in postmenopausal women with metabolic syndrome. The purpose of this study was to investigate the association between metabolic syndrome components and menopausal status. METHODS: A total of 1,926 women were studied and divided into three groups according to their menstrual stage (premenopausal, perimenopausal or postmenopausal). The presence of metabolic syndrome was assessed using the National Cholesterol Education Program's (NCEP) Adult Treatment Panel III criteria. RESULTS: The prevalence of metabolic syndrome was 7.1% in premenopause, 9.8% in perimenopause, and 24.2% in postmenopause. The strong correlation was noted between the metabolic syndrome score and waist circumference in postmenopause (r = 0.56, P < 0.01) and perimenopause (r = 0.60, P < 0.01). Along the menopausal transition, the risk of metabolic syndrome increased with high triglyceride after the age-adjusted (odds ratio (OR) 1.517 [95% confidence interval (CI) 1.014~2.269] in perimenopausal women and OR 1.573 [95% CI 1.025~2.414] in postmenopausal women). In addition, the prevalence of metabolic syndromeincreased in accordance with elevated alanine aminotransferase (ALT) and gamma-glutamyl transpeptidase (GGT) levels. CONCLUSION: Triglyceride and waist circumference were important metabolic syndrome components, though ALT and GGT may also be related for predicting metabolic syndrome during the transition to menopause.

Prevalence of Thyroid Cancer at a Medical Screening Center: Pathological Features of Screen-detected Thyroid Carcinomas

PURPOSE: To assess the incidence of thyroid malignancy in an adult population screened by high-resolution ultrasonography at a medical screening center and to compare the clinical and pathological features of screen-detected thyroid carcinomas to symptomatic overt thyroid carcinomas. MATERIALS AND METHODS: We calculated the prevalence of screen-detected thyroid cancer at a medical screening center using high- resolution ultrasonography and fine needle aspiration. We then compared the clinical and pathological features of screen-detected thyroid cancers (n = 46) to clinical symptomatic thyroid cancers (n = 157). We evaluated age, gender, size, perithyroidal extension, lymphovascular extension, stage, histological lymph node metastasis, and the type of cancer. We also compared the above findings of micropapillary carcinomas to papillary thyroid carcinomas that were larger than 1cm in diameter. RESULTS: Screen-detected thyroid nodule patients were 2,747 (37%) of 7,491 patients. Nodules selected for fine needle aspiration were 658 and cytology confirmed malignancy were 79 (12%) nodules. When screen-detected thyroid cancers (n = 46) were compared to symptomatic overt thyroid cancers (n = 157), only statistically significant factor was size (p = 0.002). Papillary thyroid carcinomas that were larger than 1 cm had more frequent capsular invasion (p = 0.000) and a higher stage (p = 0.027), and a higher prevalence of lymph node metastases (p = 0.002). CONCLUSION: Screen-detected thyroid cancers should be managed as same as symptomatic thyroid cancers in respect to size, and an assessment should strictly be based on the ultrasound features and fine needle aspiration biopsy findings.

Short Insulin Tolerance Test Can Determine the Effects of Thiazolidinediones Treatment in Type 2 Diabetes

PURPOSE: The short insulin tolerance test is a simple and reliable method of estimating insulin sensitivity. This study was designed to compare the insulin sensitizing effects of thiazolidinediones (TZDs) on the degree of insulin resistance, determined by a short insulin tolerance test (Kitt) in type 2 diabetic patients. PATIENTS AND METHODS: Eighty-three subjects (mean age = 57.87 +/- 10.78) with type 2 diabetes mellitus were enrolled and received daily one dose of rosiglitazone (4mg) or pioglitazone (15mg). The mean follow-up duration was 25.39 +/- 9.66 months. We assessed insulin sensitivity using HOMA-IR and the short insulin tolerance test before and after TZDs treatment. RESULTS: When we compared patients' characteristics before and after TZDs treatment, the mean fasting glucose level was significantly decreased (183.27 +/- 55.04 to 137.35 +/- 36.42mg/dL, p or = 2.5%/min; 3.50 +/- 0.75%/min to 2.75 +/- 1.12%/min, p = 0.002). CONCLUSION: The glucose lowering effects of TZDs by improving insulin resistance could be determined by using Kitt. However, Kitt may be a beneficial tool to determine TZDs' effects only when patients' Kitt values are less than 2.5%/min.

Beneficial Effects of Thiazolidinediones on Diabetic Nephropathy in OLETF Rats

PURPOSE: Diabetic nephropathy is the most serious of complications in diabetes mellitus. Thiazolidinedione (TZD) is thought to ameliorate diabetic nephropathy; however, the mechanism underlying this effect has not been elucidated. We hypothesized that the vascular endothelial growth factor (VEGF) participates in the pathogenesis of diabetic nephropathy and that TZD may be beneficial for the treatment of diabetic nephropathy because of the effect it has on VEGF. MATERIALS AND METHODS: 23 Otsuka- Long-Evans-Tokushima-Fatty (OLETF) rats and eight control Long-Evans-Tokushima-Otsuka (LETO) rats were divided into the following four groups: LETO group, control OLETF group, pioglitazone treated group (10mg/kg/day), and rosiglitazone treated group (3mg/kg/day). RESULTS: A progressive increase in urinary protein excretion was observed in the diabetic rats. Glomerular VEGF expression in the control OLETF rats was significantly higher than in the control LETO rats. However, there was a significant reduction in both the glomerular VEGF expression and the VEGF mRNA levels after treatment with pioglitazone and rosiglitazone. The twenty-four hour urine protein levels were significantly decreased in both groups of the treated OLETF rats. CONCLUSION: These results suggest that TZD may have beneficial effects on diabetic nephropathy by reducing the VEGF expression.

Angiopoietins in Diabetic Nephropathy / 대한신장학회지

PURPOSE: It has been reported that angiopoietins and Tie-2 receptor play an important role in the maintenance of glomerular filtration barrier in various glomerulonephritis models. We studied the role of angiopoietins on renal injury in diabetes. METHODS: In this study, we examined the changes of angiopoietin-1, angiopoietin-2, Tie-2 receptor, and nephrin expression in the experimental diabetic nephropathy and also determined whether these changes were modified by renoprotective intervention by angiotensin II receptor blocker, alpha-lipoic acid, and peroxisome proliferator activated receptor (PPAR)-agonist. RESULTS: A marked increase in urinary albumin excretion and glomerular volume was observed in diabetic rats. Renal angiopoietin-2 and Tie-2 receptor expression were significantly higher in diabetic rats than in the control groups, with a significant reduction in renal angiopoietin-2 expression, albuminuria, and renal hypertrophy in angiotensin II receptor blocker-treated diabetic rats. And there was a significant reduction in renal Tie-2 expression and renal hypertrophy in alpha-lipoic acid-treated and PPAR-gamma agonist-treated diabetic rats. CONCLUSION: These results demonstrate that the dysregulation of angiopoietins and Tie-2 receptor can lead to renal hypertrophy and albuminuria. Angiotensin II receptor blocker, alpha-lipoic acid, and PPAR-gamma agonist attenuated these changes in angiopoietins and/or Tie-2 expression and prevented the development of albuminuria and renal hypertrophy in vivo.

A Case of Graves' Disease Coexistent with Pulmonary Sarcoidosis / 결핵및호흡기질환

Sarcoidosis is a multisystemic granulomatous disease with an of unknown etiology, involving bilateral hilar lymphadenopathy, pulmonary, skin and eye lesions. However, involvement of the endocrine system in sarcoidosis is quite rare, and the coexistence of both diseases is extremely unusual. We describe a 60-year-old woman presenting with sarcoidosis and Graves' disease. She was admitted for evaluation of dry cough, dyspnea, palpitation and general weakness. Both thyroid glands were enlarged diffusely. The thyroid function tests showed suppressed serum thyrotropin and an increased thyroid hormone level. The levels of the TSH receptor antibody, anti-thyroglobulin antibody and anti-microsomal antibody were higher than normal. The radionuclide scan(131I) showed increased iodine uptake. The chest X-ray revealed pulmonary hilar enlargement and high resolution CT showed both hilar lymph nodes enlargement and tiny parenchymal nodules. The transbronchial lung biopsy showed a noncaseating granuloma without necrosis. We report this case of pulmonary sarcoidosis plus Graves' disease with a review of the relevant literatures.

A case of Hashimoto's thyroiditis coexisting with thyroid papillary and follicular carcinoma / 대한내과학회지

We report here on a rare case of papillary and follicular carcinoma of the thyroid gland that developed in a 31 years old woman who was previously diagnosed with Hashimoto's thyroiditis. Her chief complaint was a palpable neck mass. The antimicrosomal and antithyroglobulin antibody levels were elevated. Ultrasonography of the left thyroid gland revealed a 2.5x2.0 cm sized thyroid nodule. Fine needle aspiration biopsy of the thyroid nodule was done and this was diagnosed as Hashimoto's thyroiditis. There was no evidence of thyroid cancer. After 1 year, thyroid ultrasonography and biopsy were repeated for examining an enlarged thyroid nodule. Total thyroidectomy was then performed. The histopathologic examination revealed that the right and left thyroid glands were in accordance with the diagnosis of papillary and follicular cancer, respectively. Until now, no known case of simultaneous papillary and follicular carcinoma in Hashimoto's thyroiditis has been reported. This case suggests that adequate follow up for Hashimoto's thyroiditis patients with thyroid nodule may help the early detection and management of thyroid cancer.

A Case of Acute Perithyroiditis with Transient Thyrotoxicosis in Childhood / 대한내분비학회지

Acute thyroiditis is a rare disease because of the sufficient supply of blood vessels and lymphatics in thyroid tissue, the high concentration of iodide in the thyroid tissue and the nearly completely isolated structure of the thyroid gland from the surrounding tissue via its capsule. The most common route of infection is from a pyriform sinus fistula and then the inflammation spreads from the sinus to the perithyroidal space. Computed tomography (CT) and magnetic resonance imaging (MRI) can show a low echogenic mass encircling thyroid gland and swelling of the perithyroidal tissue in acute suppurative thyroiditis. We experienced a case of acute perithyroiditis with thyrotoxicosis that developed in a 13-year old boy and he was diagnosed by the CT findings. The patient had complained of a low graded fever and neck swelling. The laboratory diagnosis and clinical course was like that of subacute thyroiditis, but the CT finding showed a show low echogenic mass encircling the thyroid glands and swelling of the perithyroidal tissue. Therefore, we diagnosed this patient with acute perithyroiditis. After treatment with antibiotics, he displayed clinical improvement and was discharged.

A Case of Adrenocortical Adenoma Causing Subclinical Cushing's Syndrome Mistaken for Liddle's Syndrome / 대한내분비학회지

Subclinical Cushing's syndrome is defined as an autonomous cortisol hyperproduction without specific clinical signs of cortisol excess, but detectable biochemically as derangements of the hypothalamic-pituitary-adrenal axis function. We report a case of a 33-year-old woman with subclinical Cushing's syndrome caused by left adrenocortical adenoma, mistaken for Liddle's syndrome. The patient complained of fatigue. Laboratory findings showed metabolic alkalosis, hypokalemia, high TTKG (transtubular K concentration gradient), low plasma renin activity, and low serum aldosterone level, that findings implied as Liddle's syndrome. So we performed further study. Hormonal and radiologic studies revealed subclinical Cushing's syndrome with a left adrenal mass. The adrenal mass was resected and pathologically diagnosed as adrenocortical adenoma. After the resection of the left adrenal mass, patient's hormonal levels showed normal range.

A Case of Iodine-induced Thyrotoxicosis with Acromegaly / 대한내분비학회지

Hyperthyroidism is seen in 3.5-26% of subjects with acromegaly. Hyperthyroidism can be developed by thyroid stimulating hormone (TSH) dependent mechanism in TSH-secreting adenomas with acromegaly or by TSH independent mechanism through the stimulation of thyroid cells by growth hormone (GH). So, confirming the cause of hyperthyroidism is important to treat that. We report a case of a 56-year-old man who had acromegaly with iodine-induced thyrotoxicosis. He took the sea tangle for 4 years because he had constipation. His face and hands indicated acromegaly. Thyroid function test showed that T3 and free T4 were increased and TSH was decreased. Ultrasonography of neck showed diffuse enlargement of thyroid gland and thyroid scan showed decreased uptake of thyroid gland. So we could confirm iodine-induced thyrotoxicosis due to excessive iodine intake. Serum GH and insulin-like growth factor (IGF)-1 were markedly increased and brain MRI showed heterogenous 1 cm sized pituitary mass in right side. Acromegaly was confirmed by brain MRI, pituitary stimulation test and increased level of GH, IGF-1. He stopped iodine intake. After 6 months, T3, free T4 and TSH were normalized and he is waiting for the surgical removal of pituitary adenoma.

A Case of Drug Induced Nephrogenic Diabetes Insipidus and Hyperprolactinemia in Schizophrenia Simultaneously / 대한내분비학회지

In schizophrenia, when treatment using antipsychotics fails, lithium, which is known as an antimanic drug, can also be administered. It is reported that 12~20% of patients taking lithium develop nephrogenic diabetes lactotrophs. Hyperprolactinemia is induced by typical antipsychotics, as they block the dopamine-2 receptors of latotrophs in the pituitary gland. Therefore, atypical antipsychotics for decreasing the side effect, such as hyperprolactinemia, can be used. However, hyperprolactinemia can be induced by risperidone, one of the atypical antipsychotics. Here, a case of drug induced nephrogenic diabetes insipidus and simultaneous hyperprolactinemia, which occurred in a patient with schizophrenia, is reported.

A case of two consecutive deliveries in a woman with acromegaly / 대한내과학회지

Acromegaly is a rare pituitary disorder and usually results from GH hypersecretion by a somatotroph adenoma. Disturbed pituitary function might lead to infertility or early pregnancy termination. Pregnancy in acromegaly is very rare. GH is a potent insulin antagonist, and pregnant patients with GH hypersecretion are prone to added glucose intolerance and diabetes. Pregnancy itself may impact the course of a pituitary tumor. In our case, pregnancy was uneventful and normal full-term infant was delivered at 1993 by vaginal delivery after transsphenoidal surgery and bromocriptine therapy. After delivery, GH and IGF-I level wasn't normalized. Postoperative pituitary MRI scan showed residual tumor. Therefore she received subsequent postoperative pituitary radiation (total dose : 5000 cGy). Next year, despite elevated GH and IGF-I, she delivered normal full-term infant. We report a case of two consecutive deliveries in a woman with acromegaly despite elevated GH and IGF-I levels after transsphenoidal surgery and radiation therapy.

A Case of Pseudopseudohypoparathyroidism with Partial Empty Sella / 대한내분비학회지

Pseudohypoparathyroidism (PHP) is a rare endocrine syndrome, which is characterized by Albright's hereditary osteodystrophy (AHO). Pseudopseudohypoparathyroidism (PPHP) presents with AHO features, but does not show clinical symptoms or the same laboratory finding as hypoparathyroidism. A 54 aged woman visited our department with lower abdominal pain. She had a history of a total hysterectomy due to persistent uterine bleeding 30 years previously. She showed abnormal physical findings, including a round face, short stature and brachydactyly. Her hormonal data were within normal limits, as follows: PTH 40.72 pg/mL, calcium 8.6 mg/dL, phosphorus 4.0 mg/dL and 24 hour urine cAMP 3.2 nmol/mg. On a pituitary challenge test, the basal levels and response rates of FSH and LH were low, and a sella CT scan showed partially empty sella. Herein is reported a case of PPHP, with partial empty sella, with a review of the literature

A Case of Pseudopseudohypoparathyroidism with Partial Empty Sella / 대한내분비학회지

Pseudohypoparathyroidism (PHP) is a rare endocrine syndrome, which is characterized by Albright's hereditary osteodystrophy (AHO). Pseudopseudohypoparathyroidism (PPHP) presents with AHO features, but does not show clinical symptoms or the same laboratory finding as hypoparathyroidism. A 54 aged woman visited our department with lower abdominal pain. She had a history of a total hysterectomy due to persistent uterine bleeding 30 years previously. She showed abnormal physical findings, including a round face, short stature and brachydactyly. Her hormonal data were within normal limits, as follows: PTH 40.72 pg/mL, calcium 8.6 mg/dL, phosphorus 4.0 mg/dL and 24 hour urine cAMP 3.2 nmol/mg. On a pituitary challenge test, the basal levels and response rates of FSH and LH were low, and a sella CT scan showed partially empty sella. Herein is reported a case of PPHP, with partial empty sella, with a review of the literature

A case of parathyroid carcinoma with meningioma / 대한내과학회지

Parathyroid carcinoma is a very rare disease which comprising 0.1~5% of hyperparathyroidism, and it usually presents with marked hypercalcemia. Clinically, it shows hypercalcemia due to the effect of excessive secretion of parathyroid hormone, bone disease, renal involvement and palpable neck mass. It is known that hyperparathyroidism is induced mostly by parathyroid adenoma but it can be seen in parathyroid hyperplasia, hyperparathyroid carcinoma, rarely associated with familial or multiple endocrine neoplasia. Parathyroid carcinoma can be diagnosed with distant metastasis or local invasion. Treatment is complete resection of primary cancerous lesion and local tissue. Since recurrence or distant metastases are frequent, radiological studies should be done when hypercalcemia is recurred. Sometimes, other tumors can causes hypercalcemia. There are several reports of parathyroid cancer associated with multiple endocrine neoplasia, but has never been reported of parathyroid carcinoma associated with meningioma. We experienced a parathyroid carcinoma with meningioma in 68 year old woman and report the case with the review of literatures.

A case of parathyroid carcinoma with meningioma / 대한내과학회지

Parathyroid carcinoma is a very rare disease which comprising 0.1~5% of hyperparathyroidism, and it usually presents with marked hypercalcemia. Clinically, it shows hypercalcemia due to the effect of excessive secretion of parathyroid hormone, bone disease, renal involvement and palpable neck mass. It is known that hyperparathyroidism is induced mostly by parathyroid adenoma but it can be seen in parathyroid hyperplasia, hyperparathyroid carcinoma, rarely associated with familial or multiple endocrine neoplasia. Parathyroid carcinoma can be diagnosed with distant metastasis or local invasion. Treatment is complete resection of primary cancerous lesion and local tissue. Since recurrence or distant metastases are frequent, radiological studies should be done when hypercalcemia is recurred. Sometimes, other tumors can causes hypercalcemia. There are several reports of parathyroid cancer associated with multiple endocrine neoplasia, but has never been reported of parathyroid carcinoma associated with meningioma. We experienced a parathyroid carcinoma with meningioma in 68 year old woman and report the case with the review of literatures.

Effect of chronic alcohol ingestion on bone mineral density in males without liver cirrhosis / 대한내과학회지

BACKGROUND: Osteoporosis in men is an important public health problem. Because of the incremental tendency of elderly population and age-specific incidence of fracture, it is inevitable that the health burden of fracture will increase. Also, the mortality of fracture in men is higher than in women. Alcohol consumption is a risk factor for osteoporosis based on the frequent finding of a low bone mass decreased bone formation rate and increased fracture incidence in alcoholics. Chronic alcohol consumption may reduce bone density but also increase bone density. It has been well established that liver cirrhosis also induces bone density changes and thus it is difficult to distinguish the role of liver disease from that of alcohol itself in bone alterations occurring in patients with chronic alcohol consumption. So we studied male chronic alcoholics which did not have liver cirrhosis to assess the effect of chronic alcohol consumption on bone mineral density. METHODS: We studied 18 chronic heavy drinkers of more than 40 g/day for at least 5 years and age-matched 18 control groups who had drunk alcohol less than 20 g/day. Serum and urinary parameters of bone and mineral metabolism were determined. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry at four axial sites (lumbar spine, femoral neck, ward's triangle and trochanter). RESULTS: Alcoholic patients drank alcohol 97.7 g/day. Osteocalcin, a marker of bone formation, was slight decreased in alcoholic patients and deoxypyridinoline, a marker of bone resorption, was slight increased but not statistically significant (p > 0.05). The levels of 25-(OH)-vit D, parathyroid hormone, free testosterone, estradiol were not different between the two groups. Ward's triangle and trochanter BMD of femur were significantly lower than controls and L-spine BMD decreased parallel with total alcohol intake amount in the alcoholics (r=-0.62, p < 0.05). CONCLUSION: We suggest that chronic alcohol consumption induced low bone density on femur ward and trochanter. And there was significant inverse correlation between L-spine BMD and total alcohol consumption amount. The large scaled randomized and prospective studies are needed to clarify the pathogenesis of alcohol-induced male osteoporosis.