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.

A Case of Sheehan's Syndrome Presenting Central Diabetes Insipidus / 대한내분비학회지

Sheehan's syndrome occurs as a result of ischemic pituitary necrosis due to severe postpartum hemorrhage. The manifestations of this clinical syndrome are most often caused by a deficiency in the hormones produced by the anterior pituitary gland, whereas the neurohypophysis is usually preserved but can be involved in severe cases that manifest as diabetes insipidus. This is a report of Sheehan's syndrome that manifested with diabetes insipidus as presenting symptom 2 month's after delivery. The patient suffered massive bleeding, so received a blood transfusion. A combined pituitary stimulation and water deprivation test revealed deficiencies of not only anterior pituitary hormones, such as growth hormone and prolactin, but also of anti-diuretic hormone. We report this case, with a review of the literature.

A Case of Sheehan's Syndrome Presenting Central Diabetes Insipidus / 대한내분비학회지

Sheehan's syndrome occurs as a result of ischemic pituitary necrosis due to severe postpartum hemorrhage. The manifestations of this clinical syndrome are most often caused by a deficiency in the hormones produced by the anterior pituitary gland, whereas the neurohypophysis is usually preserved but can be involved in severe cases that manifest as diabetes insipidus. This is a report of Sheehan's syndrome that manifested with diabetes insipidus as presenting symptom 2 month's after delivery. The patient suffered massive bleeding, so received a blood transfusion. A combined pituitary stimulation and water deprivation test revealed deficiencies of not only anterior pituitary hormones, such as growth hormone and prolactin, but also of anti-diuretic hormone. We report this case, with a review of the literature.

Clinical Study of Adrenal Incidentaloma in Korea

BACKGROUND: This study was designed to evaluate the clinical, endocrinological and histological characteristics of adrenal incidentalomas. METHODS: Eighty patients (41, males; 38, females; age range 17-80 years) who were diagnosed with adrenal incidentaloma at Korea University Hospital from 1992 to 2003 were studied retrospectively. RESULTS: Endocrinological investigation revealed 16 pheochromocytomas (20%), nine Cushing's syndromes (11%), eight primary aldosteronism (10%) and 46 non-functioning tumors (58%). Forty-four patients received operations, and biopsies were performed on two patients. Pathologic examination revealed 16 adrenocortical adenomas (20%), five carcinomas (6%), 13 pheochromocytomas (16%), three metastatic cancers (4%), and other tumors (10%). The diameter of the carcinomas (mean: 10.8 cm, range: 5-19 cm) were significantly larger than the diameter of benign adenomas (mean: 2.84 cm, range: 1-6 cm) (p=0.002). According to the receiver operating charactenstic (ROC) curve analysis, the cut-off value of tumor size for discriminate malignant tumor was 4.75 cm (sensitivity 90%, specificity 58%). Twenty-four patients with non-functioning tumors were followed up for a period of 3 to 72 months. During the follow up period, two patients showed an increase in tumor size of more than 1 cm, and one patient developed Cushing's syndrome. Changes in mass size and function were observed only between 10 and 26 months after the initial diagnosis. CONCLUSIONS: These data show that an endocrine evaluation should be performed in all adrenal incidentalomas, and an adrenalectomy is recommended for tumors 5 cm or greater or tumors with adrenocortical hyperfunction. In addition, these tumors should be monitored for changes in mass size and function for a follow up period of approximately 26 months.

A Case of Primary Hyperparathyroidism Caused by Cystic Parathyroid Adenoma, Diagnosed during Intra-Operative PTH Monitoring / 대한내분비학회지

Primary hyperparathyroidism is the most frequent cause of hypercalcemia, and its prevalence is increasing due to the routine examination of serum calcium levels. Primary hyperparathyroidims is most commonly caused by an adenoma or hyperplasia of the parathyroid gland. A cystic parathyroid adenoma is an extremely rare cause of primary hyperparathyroidism. In our case, a-79-year old female presented with lower back pain and constipation. Her serum calcium, phosphate and immunoreactive parathyroid homone levels were 15.6, 1.8mg/dL and 371.8pg/mL, respectively. Neck CT revealed a cystic mass and a contour bulging heterogeneous mass in the left inferior right thyroid gland, respectively. These mass lesions were removed, and the intra-operative parathyroid hormone levels monitored, to confirm the complete resection. After removing the left cystic mass to the inferior thyroid, the serum calcium and immunoreactive parathyroid hormone levels quickly returned to normal. We report a case of primary hyperparathyroidism, caused by a cystic parathyroid adenoma, with a brief review of the literature

A Case of Primary Hyperparathyroidism Caused by Cystic Parathyroid Adenoma, Diagnosed during Intra-Operative PTH Monitoring / 대한내분비학회지

Primary hyperparathyroidism is the most frequent cause of hypercalcemia, and its prevalence is increasing due to the routine examination of serum calcium levels. Primary hyperparathyroidims is most commonly caused by an adenoma or hyperplasia of the parathyroid gland. A cystic parathyroid adenoma is an extremely rare cause of primary hyperparathyroidism. In our case, a-79-year old female presented with lower back pain and constipation. Her serum calcium, phosphate and immunoreactive parathyroid homone levels were 15.6, 1.8mg/dL and 371.8pg/mL, respectively. Neck CT revealed a cystic mass and a contour bulging heterogeneous mass in the left inferior right thyroid gland, respectively. These mass lesions were removed, and the intra-operative parathyroid hormone levels monitored, to confirm the complete resection. After removing the left cystic mass to the inferior thyroid, the serum calcium and immunoreactive parathyroid hormone levels quickly returned to normal. We report a case of primary hyperparathyroidism, caused by a cystic parathyroid adenoma, with a brief review of the literature

Relationship between nonalcoholic fatty liver disease, metabolic disorders and pulse wave velocity / 대한내과학회지

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is frequently associated with type 2 diabetes mellitus, obesity and dyslipidemia. Also, it is recognized to be one of component of the insulin resistance syndrome. But both its pathogenesis and clinical implication associated with cardiovascular disease as an important outcome of insulin resistance have not been well known. We investigated the relationship between NAFLD, metabolic disorders, and brachial-ankle pulse wave velocity (baPWV) as a risk marker of atherosclerosis. METHODS: A total of 213 nonalcoholic subjects (67 males, 146 females) participated in this study. Subjects were divided into NAFLD or normal group based on the existence of fatty liver seen by sonography. RESULTS: The prevalence of hypertension, impaired fasting glucose, hypertriglyceridemia, low HDL-C level and central obesity were higher in NAFLD group than those in normal group. After controlling for age, sex and body mass index, serum ALT, AST, ALP and GGT levels were significantly associated with homeostatis model assessment of insulin resistance (HOMA-IR) (p<0.05). baPWV in NAFLD group was significantly higher than those in normal group in females (p=0.005). After adjusting for age, NAFLD had positive correlation with baPWV (p=0.039). In addition, the positive correlation was stronger in NAFLD with elevated liver enzymes (p=0.011). Individual levels of serum ALT, AST, ALP and GGT were positively correlated with baPWV after adjusting for age, sex, body mass index, HOMA-IR and systolic blood pressure (p<0.05). A multiple regression analysis showed baPWV was significantly associated with age, systolic blood pressure, body mass index and various liver enzymes, respectively. CONCLUSION: baPWV was significantly associated with NAFLD, especially in females. baPWV also had significant positive correlation with various liver enzymes. NAFLD showed more strong correlation with baPWV when it was combined with abnormal liver function. NAFLD, especially combined with abnormal liver function, may be associated with increased risk of cardiovascular disease.

A Case of Congenital Adrenal Hyperplasia due to 11beta-Hydroxylase Deficiency / 대한내분비학회지

Congenital adrenal hyperplasia refers to a group of autosomal recessive disorders that is defective in the synthesis of cortisol. The enzymes most often affected are 21-hydroxylase and 11beta hydroxylase. The low levels of cortisol stimulate the pituitary gland to release ACTH. Chronic elevation of the ACTH level causes bilateral adrenal hyperplasia and a secondary increase in androgen formation. We examined a 19 year-old woman presented with clitoral hypertrophy and vaginal spotting. The subjects basal level of serum cortisol was low, but the serum levels of ACTH, 17a-hydroxyprogesterone, deoxy-corticosterone were elevated. The urinary excretions of 17-ketosteroids and 17-hydroxycorticosteroids were also increased. The karyotyping study and transrectal ultrasonography showed normal findings. The patient underwent clitoris reduction surgery and received hydrocortisone. To the best of our knowledge, this is the first case of 11beta-Hydroxylase deficiency in Korea.

The change of prevalence of diabetes mellitus for 3 years and incidence of diabetes in Koreans over 60 years old / 대한내과학회지

BACKGROUND: As elderly people increasing, prevalence of diabetes will increase but there was paucity of data on the epidemiology of diabetes in Korean elderly population. In this study (Southwest Seoul, SWS study) we investigated the change of prevalence of diabetes mellitus for two points in time (the years 1999 and 2002) and 3-year incidence of diabetes in elderly Korean population of southwest area of Seoul. METHODS: A sampling of 1,652 subjects in 1999 and 1,214 subjects in 2002 who are over 60 years old in southwest area of Seoul were investigated. All subjects underwent a 75 g oral glucose tolerance test (OGTT), biochemical study and anthropometric measurements. Among the 1,652 subjects in 1999, 350 subjects were followed up for 3 years and 294 subjects without diabetes at baseline examination participated in retrospective cohort study. RESULTS: Prevalence of diabetes in 1999 was 20.5% [previous diagnosed people (11.9%), newly diagnosed people (8.6%)] and in 2002 was 22.1% [previous diagnosed people (15.2%), newly diagnosed people (6.9%)]. Prevalence of impaired fasting glucose (IFG) or impaired glucose intolerance (IGT) was 22.8% in 1999 and 27.8% in 2002. In 350 subjects were followed up for 3 years, prevalence of diabetes was 16.0% in 1999 and increased to 23.4% in 2002 (p=0.014). In retrospective cohort study, the annual incidence rate of diabetes was 2.9% (age and sex adjusted rate 2.5%). CONCLUSION: Prevalence of diabetes in elderly Korean population of southwest area of Seoul was 20.5% in 1999 and increased to 22.1% in 2002. Prevalence of IFG or IGT was 22.8% in 1999 and increased to 27.8% in 2002. This report supports that impaired glucose regulations and diabetes mellitus of elderly Korean population will increase in the future as aged Korean population increases.

A Case of Rectal Varix Bleeding Treated with Endoscopic Variceal Ligation / 대한소화기내시경학회지

Esophagogastric varices are considered to be the most common complication in patients with portal hypertension. Among ectopic varices, rectal varices are infrequent but potentially serious complication. The etiology and pathogenesis of rectal varices remains controversial. Several kinds of treatment have been performed but standard treatment for rectal varices has not been established. Herein we report a case of rectal varix bleeding treated with endoscopic variceal ligation (EVL) and then evaluated by transrectal color doppler ultrasonography.

A Case of Multiple Endocrine Neoplasia 2A with Germ Line Mutation of RET Gene / 대한내분비학회지

Multiple endocrine neoplasia 2A (MEN 2A) is an autosomal dominantly inherited disease, composed of medullary thyroid carcinoma, pheochromocytoma and hyperparathyroidism. The activation of germ-line mutations in the RET proto-oncogene are responsible for MEN 2. The analysis of the RET mutations has replaced the measurement of the calcitonin level in the diagnosis of the MEN carrier state. Specific RET codon mutations correlate with the MEN 2 syndromic variant, the age at onset of the medullary thyroid carcinoma (MTC) and the aggressiveness of the MTC. Herein, our experience of a 47-year-old woman, who had a bilateral pheochromocytoma and MTC, and MEN 2A confirmed by the detection of an RET proto-oncogene mutation at axon 10 on codon 618, is reported. Her sister was found to have the same mutant gene. After a total thyroidectomy and bilateral adrenalectomy, the calcitonin and catecholamine levels were normalized, and the patient discharged without problems. This case is reported, with a review of the literature.

Treatment with Embolization of Cobb's Syndrome Causing High-output Heart Failure

High-output heart failure may occur in anemia, thyrotoxicosis, Beriberi heart disease, arteriovenous fistula, congenital arteriovenous malformation, Paget's disease of the bone, fibrous dysplasia, polycythemia vera, multiple myeloma, and renal diseases such as glomerulonephritis, carcinoid syndrome, pregnancy and obesity. Among these conditions, reports on heart failure resulting from an arteriovenous malformation are rare. We report a case of high-output heart failure resulting from Cobb's syndrome (cutaneomeningospinal angiomatosis), which improved with spinal artery embolization.

Human Cytomegalovirus Pneumonia and Pulmonary Aspergillosis in a Patient with Acute Myelogenous Leukemia following Chemotherapy / 감염

Cytomegalovirus (CMV) pneumonia is one of the major causes of morbidity and mortality in immunocompromised patients such as transplant recipients. But CMV pneumonia is unusually reported among adults with leukemia who have not undergone transplantation. Because it is a cause of life-threatening pneumonia in adults with leukemia receiving potent immunosuppressive therapies, CMV has emerged as an important pathogen. We report a case of CMV pneumonia and invasive pulmonary aspergillosis in a patient with acute leukemia who have not undergone transplantation. A 31-year-old man with acute myelogenous leukemia developed high fever on day 9 of second consolidation chemotherapy. Six days later, chest radiography showed patchy consolidation with central cavity on right upper lung. Considering fungal pneumonia, amphoterin B was started, then fever was subsided. Chest CT showed necrotizing pneumonia with cavity formation in posterior segment of right upper lobe. Because of several episodes of hemoptysis, lobectomy was performed. Grossly, the area of focal necrosis with central cavity formation and multiple small interstitial nodules were observed. In the area of interstitial nodules, giant cells with intranuclear inclusion and perinuclear halo were found. In the area of focal necrosis, fungal hyphae with acute branching and septation were found. Ganciclovir and immunoglobulin were administered for CMV pneumonia. On day 62 of the chemotherapy, the patient discharged with improved symptoms. After several weeks, unrelated HLA-matched allogeneic stem cell transplantation was performed. On day 14 of transplantation, the patient died due to septic shock of unknown cause.

Species and antimicrobial susceptibility of enteropathogenic bacteria isolated in 1986-1991 / 감염

No abstract available.