Therapeutic efficacy and factors that affect response of rosiglitazone in insulin-resistant type 2 diabetes / 대한내과학회지

BACKGROUND: Rosiglitazone, an insulin sensitizer of thiazolidinedione class, is known as a highly selective and potent agonist for the peroxisome proliferator-activated receptor-gamma. This study was performed to evaluate the antidiabetic activity and insulin sensitizing effect of rosiglitazone combination therapy in insulin-resistant type 2 diabetic patients who were poorly controlled with oral agents such as metformin and/or sulfonylurea. The factors affecting response of rosiglitazone were also evaluated on the basis of the degree of glycemic control. METHODS: One hundred twenty insulin-resistant (glucose disposal rate, Kitt < 2.5%/min) type 2 diabetic patients (M:F=42:78, mean age 58.6+/-9.2 years, body mass index 24.2+/-2.8 kg/m2) were enrolled and randomly divided into two groups. For 12 weeks, the treated group daily received 4 mg of rosiglitazone and the control group had diet and exercise therapy in addition to previous medications. The responders were defined as more than 20% decrease of fasting plasma glucose level or more than 1% decrease of HbA1c. As for the indices of insulin resistance and insulin secretory function, Kitt (Kitt=0.693/t1/2 X 100) by insulin tolerance test, HOMA(IR) and HOMA(beta-cell) function by 'HOMA index (Homeostasis model assessment)' were evaluated. RESULTS: In rosiglitazone treated group (60 patients, M:F=19:45), 12 weeks of rosiglitazone treatment decreased fasting plasma glucose (28.2%), postprandial 2-hour glucose (23.2%), and HbA1c (12.2%). Rosiglitazone also significantly decreased HOMA(IR) (41.2%), and increased Kitt (53.3%) and HOMA(beta-cell) function (46.9%). Forty-five patients (75%) satisfied responder. Females and those who had higher body mass index and waist-hip ratio showed better response. The basal fasting plasma glucose, HbA1c, and systolic blood pressure were also higher in responders. The responders showed significantly higher fasting serum insulin level and HOMA(IR), and also higher tendency of fasting serum C-peptide level and HOMA(beta-cell) function than nonresponders. CONCLUSION: From these results, rosiglitazone treatment can improve not only hyperglycemia and insulin resistance but also insulin secretory function in uncontrolled insulin-resistant type 2 diabetes. The factors that affect response of rosiglitazone are female, obesity (especially central obesity), high insulin secretory function, and severe insulin resistance. As a conclusion, the therapeutic efficacy or response of rosiglitazone is likely to depend on the degree of preserved pancreatic beta-cell function and the severity of insulin resistance.

Changes of allergenecity of salted and fermented shrimp / 천식및알레르기

BACKGROUND AND OBJECTIVE: Shrimp is one of the most common food allergens. The salted and fermented shrimp (S/F shrimp) is a traditional food and ingested frequently in the daily life of many Korean people. But few studies have been investigated on the allergenicity of S/F shrimp. The aim of our study is to observe the allergenicity of S/F shrimp and to compare it with the allergenicity of shrimp. MATERIAL AND METHODS: Crude extracts were made from three kinds of S/F shrimps and four kinds of shrimps after boiling. The extracts were used for SDS-PAGE, ELISA, ELISA inhibition test, immunoblotting, and immunoblotting inhibition test with sera from 10 subjects who have shrimp specific IgE by radioallergosorbent (RAST) (3+ or 4+). RESULTS: The protein concentrations of S/F shrimp extracts were less than half of the extracts of shrimps (1.9 mg/ml, 1.2 mg/ml, 1.1 mg/ml vs 4mg/ml, 3.83 mg/ml, 6.8 mg/ml, 6.6 mg/ml). The extracts of S/F shrimp showed weaker and more diffusely distributed protein bands in SDS-PAGE and showed less than half of the O.D. value in IgE-ELISA compared to those of shrimp extracts. The specific IgE immunoblotting of S/F shrimp extracts showed 9 bands (36, 33, 30, 29, 28, 26, 23, 20, 19 kDa). Dose dependent inhibition was observed between shrimps and S/F shrimp in ELISA-inhibition and immnunoblotting inhibition test. The allergen concentration of S/F shrimp needed to inhibit 50% of shrimp-lgE ELISA was five times higher than that of shrimp. CONCLUSION: The crude extracts of S/F shrimps showed less than half the amount of protein compared to crude extracts of shrimps have and also showed reduced allergenicity by salting and fermentation.

A Case of Metastatic Pulmonary Calcification in Primary Hyperparathyroidism / 대한내분비학회지

Metastatic calcification is the deposition of calcium, in previously normal tissue, as a result of elevated plasma calcium and phosphorus product levels and has been reported in patients with parathyroid adenoma, parathyroid carcinoma, hyperparathyroidism due to chronic renal failure, vitamin D intoxication, and osteolytic bone tumors, such as multiple myelomas. The lungs are the most common site of metastatic calcification. We have experienced metastatic pulmonary calcification in a case of primary hyperparathyroidism. A 55-year old woman was admitted due to general weakness. From the laboratory evaluation, hypercalcemia and excess production of parathyroid hormone (PTH) were noted. technetium-99m-labelled sestamibi scintigraphy indicated an intense uptake in the lower pole area of the left thyroid gland, suggestive of a parathyroid adenoma. A technetium-99m phosphate (99mTc-MDP) bone scan showed increased uptakes in both lungs. A parathyroid lobectomy was performed, and primary hyperparathyroidism, due to a parathyroid adenoma, was finally diagnosed. A follow-up 99mTc-MDP bone scan showed the disappearance of the metastatic pulmonary calcification, with the clinical symptoms and biochemical parameters normalizing after 6 months.

A Case of Bilateral Macronodular Adrenal Hyperplasia with Cushing's Syndrome Treated by Unilateral Adrenalectomy / 대한내분비학회지

In order to differentiate the causes of Cushing's syndrome; whether it is pituitary or adrenal-dependent, a high dose dexamethasone suppression test is usually performed but this does not always correlated with the imaging diagnosis. We report a case of bilateral macronodular adrenal hyperplasia, which was thought to be independent to adrenocorticotrophin (ACTH) stimulation. At first we thought it was pituitary-dependent Cushing's syndrome, due to its suppression by high dose dexamethasone. However, we found no abnormal findings on the brain sella magnetic resonance image (MRI). A significant finding, however, we found bilateral adrenal masses on the abdominal computed tomography (CT). We performed percutaneous selective adrenal venous sampling (PSAVS), and confirmed hypercortisolism of the left adrenal mass only. Therefore, we decided to remove the left adrenal gland to preserve the residual function of the right adrenal gland. After the left adrenalectomy, the patient became normotensive, and their buffalo hump disappeared, and her 24 hour urinary free cortisol level returned to normal.

Insulin resistance can predict the risk of metabolic syndrome / 대한내과학회지

BACKGROUND : This study was initiated to evaluate the prevalence of metabolic syndrome and its components as risk factors for cardiovascular disease according to insulin resistance in the Korean adult population. METHODS : This study was conducted as a branch of the Korean Metabolic Syndrome (KMS) Study: 1,091 individuals aged 30 79 years participating in medical check-up in Korea Association of Health (KAH) were included in this study. We checked fasting blood sugar, fasting insulin, proinsulin, lipid profiles (total cholesterol, triglyceride, LDL-cholesterol, HDL-cholesterol), body mass index, waist circumference, blood pressure, carotid intima-media thickness (IMT) and abdominal ultrasonography. We divided all of the examinees into three groups (insulin sensitive, intermediate, resistant tertiles) according to their degree of insulin resistance and correlated this with the prevalence of metabolic syndrome. RESULTS : The relative risk of metabolic syndrome was 84.1-fold higher in the insulin resistant tertile group compared to the insulin sensitive tertile group. Diabetes mellitus or impaired fasting glucose (IFG) was 10.2-fold; hypertension, 1.8-fold; dyslipidemia, 2.8-fold; hypercholesterolemia, 2.5-fold; fatty liver, 3.0-fold. Abdominal obesity rather than general obesity was more contributory to insulin resistance. CONCLUSION : Although this is a cross-sectional study, we can show that insulin resistance is one of the most-striking risk factors in metabolic syndrome and can be used as a predictor of cardiovascular diseases. Furthermore, we should monitor the healthy insulin-resistant population to prevent ongoing cardiovascular diseases. More prolonged data should be gained to refine the correlations of insulin resistance to metabolic syndrome.

Metabolic significance of non-alcoholic fatty liver disease in non-obese adults / 대한내과학회지

BACKGROUND: It is well known that non-alcoholic fatty liver disease is associated with metabolic syndrome such as obesity, type II diabetes mellitus, dyslipidemia. Non-alcoholic fatty liver disease is frequently found in non-obese adults, but the meaning of it is unknown. So we studied the association of non-alcoholic fatty liver disease in non-obese adults and metabolic abnormalities. METHODS: We examined 779 Korean adults above 30 years old (274 men, 505 women) participating in medical check-up in Health Promotion Center. Hepatitis B and C serologies were negative, and average weekly alcohol intake was or=25 kg/m2, n=348) group (65.5 vs 32.3%, p<0.05). Compared with obese group, waist circumference, waist hip ratio, body fat, impaired fasting serum glucose, total cholesterol, HDL-cholesterol, total cholesterol to HDL-cholesterol ratio, fasting insulin, proinsulin, HOMA-IR and HOMA-beta were significantly different in non-obese, non-alcoholic fatty liver group. After multiple regression analysis, waist circumference was associated with non-alcoholic fatty liver disease in non-obese individuals. Odd ratios of insulin resistance in non-obese, non-alcoholic fatty liver group were 5.8 (CI: 3.1~10.9). CONCLUSION: The frequency of non-alcoholic fatty liver disease was very high in non-obese adults and well associated with central obesity and insulin resistance.

Effect of Yellow sand on respiratory symptoms and diurnal variation of peak expiratory flow in patients with bronchial asthma / 천식및알레르기

BACKGROUND: It is known that air borne particulates are closely related with the respiratory symptoms and peak expiratory flow (PEF) in patients with respiratory diseases. In Korea, concentrations of airborne dust and inhalable particulates are dramatically increased by the Yellow sand phenomenon, especially in springtime. OBJECTIVE: This study was performed to evaluate the effect of Yellow sand-related airborne dust on the respiratory symptoms and pulmonary function of patients with bronchial asthma. METHOD: 21 non-smoking, tree pollen non-sensitized subjects with bronchial asthma in Seoul were included in this study. For each subject, asthma and rhinoconjunctivitis symptoms were recorded by self-administered standardized questionnaire and by monitoring PEF between April and May 2000. Symptom score and diurnal variability of PEF were compared with the levels of inhalable particulate matter (PM10) checked in that time at 25 points in Seoul. RESULTS: 15 (71.4%) of the enrolled subjects successfully finished this study. There was no statistically significant relationship between the increment of Yellow sand-related PM10 and respiratory symptom or PEF variability. Of the 15 subjects, there were increased symptoms for the eye in 2 (13.3%) subjects, nose in 3 (20.0%), and sinus in 1 (6.7%), which were associated with Yellow sand-related increase of airborne dust levels. 5 (33.3%) subjects showed changes of PEF variability proportional to the change of PM10. CONCLUSION: Meteorological phenomenon related with Yellow sand has a potential risk of aggravating the upper respiratory tract symptoms and of deteriorating pulmonary functions in patients with asthma.