A Case of Incidentally Discovered Subclinical Cushing Syndrome in a Patient with Chronic Fatigue and Anxiety / 가정의학회지

Subclinical Cushing syndrome (SCS) is a hypothalamic-pituitary-adrenal axis abnormality characterized by autonomous cortisol secretion in patients with no typical signs or symptoms of Cushing syndrome. SCS patients may have adverse metabolic and cardiovascular effects due to slight, but continuous glucocorticoid secretion. Glucocorticoids also affect behavior, mood, neural activity, and a number of specific biochemical processes in the central nervous system. Here, we report a case of SCS due to an adrenal incidentaloma in a hypertensive diabetic patient who presented with chronic fatigue and anxiety that disappeared after the removal of the adrenal adenoma.

Association of Inter-arm Blood Pressure Difference with Atherosclerosis in Patients without Cardiovascular Diseases

BACKGROUND: Previous studies showed that great difference of inter-arm blood pressure (IABP) was associated with adverse cardiovascular outcomes. However, these studies had measurement bias because blood pressure (BP) was measured sequentially for each arm. Then, the aim of present study, using simultaneous BP measurement, is to investigate the association between ankle brachial index (ABI), brachial ankle pulse wave velocity (baPWV) and IABP difference in patients without cardiovascular disease. METHODS: We conducted cross sectional study from medical data and selected 153 (116 men, 37 women) patients aged 18 years or older. Simultaneous BP measurements were recorded using automatic oscillometric monitor equipped with dual arm cuffs in both arms. At the same day, ABI, baPWV, and physical parameters were evaluated. RESULTS: The mean age of the subjects was 52.8 +/- 9.9 and the difference of inter-arm systolic BP (SBP) and diastolic BP (DBP) were 5.6 +/- 4.3 and 4.5 +/- 3.7 mm Hg. Compared with group with an inter-arm SBP difference less than 5 mm Hg, group with an inter-arm SBP difference more than 5 mm Hg was more older (p = 0.012), more higher proportion of patient whose left arm SBP was higher than right (p = 0.004), higher left arm SBP (p = 0.044) and higher baPWV (p = 0.025). However, the difference of IABP in SBP and DBP had no significant correlation with the age (r = 0.152, p = 0.06 and r = 0.03, p = 0.715), ABI (r = 0.021, p = 0.801 and r = 0.131, p = 0.105) and baPWV (r = 0.115, p = 0.158 and r = 0.068, p = 0.403). CONCLUSIONS: There were no significant correlation between the differences of IABP in simultaneous BP measurements and ABI, baPWV.

Health Care Behavior of People 60 Years and Older in Korea According to Family Type and Sociodemographic Factors - The 5th Korea National Health and Nutrition Examination Survey

BACKGROUND: This study evaluated the effects of family type and sociodemographic factors on medical treatment, health behavior, and subjective health status in Koreans 60 years and older. METHODS: This study was based on data from the 5th Korea National Health and Nutrition Examination Survey (KNHANES), a nationwide health interview survey using a rolling sampling design involving complex, stratified, multistage, probability cluster. Our subjects included those > or =60 years of age (n=1,946) participating in the KNHANES 2010. Family type was categorized into 7 groups according to cohabitation: alone, couple cohabitation (living with a spouse), parent(s) cohabitation (couple living with parent(s)), offspring cohabitation (no spouse, living with offspring), couple offspring cohabitation (couple living with offspring), couple offspring parents cohabitation (couple living with parent(s) and offspring), and others. Logistic regression analyses were used to examine the association of family type and sociodemographic factors with health care. RESULTS: The most common family type was couple cohabitation (38.26+/-1.8%). In this group, the percentage of non-receipt of needed medical care (odds ratio [OR], 0.60; 95% confidence interval [CI], 0.42 to 0.87) and current smoking rate (OR, 0.32; 95% CI, 0.20 to 0.50) were significantly lower than those living alone. Among the sociodemographic charicteristics, male gender, apartment dwelling, high middle household income, 2 member family, education higher than middle school, and possessing own house were associated with good health care behavior. CONCLUSION: This study shows that couples have better health care behavior than other family types, in particular, limited smoking, appropriate medical treatment, and positive subjective health status. Those living alone visit medical clinics less often and have a negative subjective health status.