A Case of Thyrotropin - Secreting Pituitary Adenoma with Normal alpha-subunit / TSH Molar Ratio / 대한내과학회지

Thyrotropin(TSH)-secreting pituitary adenoma is a rare disorder causing hyperthyroidism, which is one of the syndrome of inappropriate secretion of TSH. It is characterized by high serum T4, T3 as well as elevated serum TSH. Generally serum free alpha-subunit concentration is also increased and alpha- subunit/TSH molar ratio is more than 1. This alpha- subunit/TSH molar ratio is a clue of diagnosis as well as a useful marker of therapeutic response. We experienced a case of 29-years old man with hyperthyroidism due to TSH-secreting pituitary adenoma. He was underwent 1.5cm sized pituitary tumor removal via transsphenoidal approach in our neurosurgery department. In immunohistochemical stain monotonous tumor cells showed strong positive reaction to antihuman TSH antibody and equivocal reaction to ACTH antibody. After operation, goiter size was progressively decreased and also serum T4, T3 and TSH were decreased in nearly normal range. However, he showed elevated serum T4, T3 and TSH after 1 month due to residual tumor. So he received radiation therapy thereafter. In this case the alpha-subunit and alpha-subunit/TSH molar ratio were not increased. So we report a case of TSH-secreting pituitary macroadenoma which had low alpha-subunit/TSH molar ratio with a literature review.

Expression of Mucin Carbohydrate Antigen, sTn and Tn in Patients with Ulcerative Colitis(UC) / 대한내과학회지

OBJECTIVES:Long standing observation, which may relate either to the causes or the effects of UC, reveals that there is a pronounced alteration of mucin such as quantitative and qualitative abnormalities of mucin glycoprotein. But recently in situ hybridization technique showed no specific difference in the expression of apomucin mRNA in UC. Therefore we investigated whether abnormality of mucin was originated from defect in glycosylation. And we also tried to find differences in the expression of Tn and sTn antigens between Korean and Jewish patients with UC. METHODS: We performed the immunohistochemical staining using the monoclonal antibody of mucin carbohydrate antigens Tn and sTn in 19 patients with UC. RESULTS: Tn and sTn antigens were not expressed throughout the crypt and surface epithelium in normal colon but both of mucin carbohydrates antigens were well expressed in mild UC, Tn antigen was seen in the surface epithelium with perinuclear pattern and sTn antigen was shown not only in surface but also in crypt epithelium. In severe UC, Tn antigen was well expressed, but sTn antigen was not expressed. Tn antigen seemed to be ex-pressed more frequently than sTn antigen with severity of inflammation. These results were similar in Korean and Jewish patients with UC. CONCLUSION: These results suggest that inflammatory bowel disease has some deterioration in the step of glycosylation in the cytoplasm and there was no racial difference in the expression of Tn and sTn antigen in Korean and Jewish patients with UC.

Heart Rate Adjustment of ST Segment Depression as a Myocardial Ischemia Index of Coronary Artery Disease

BACKGROUND: Exercise testing is an importnat diagnostic and prognostic procedure in the assessment of patients with ischemic heart disease. But standard ST-segment depression criteria was not high enough to estimate coronary srtery disease. Recently, the heart rate adjustment of ST segment depression, ST segment/heart rate slope and index, have been proposed as a more accurate criteria for diagnosing significant coronary artery disease. The objective of this study was to compare the discriminating power of proposed ST segment/heart rate slope and index with that of a standard method of assessing exercise-induced ST segment depression for estimating coronary artery disease. METHODS: Sixty nine patients with ischemic heart disease were studied with exercise treadmill testing and coronary angiography. Computer-measured ST-segment amplitudes were obtained and analysis of the heart rate-adjusted ST segment depression(ST/HR slope and big up tri, Delta ST/HR index) was done. The sensitivity, specificity, and extent of coronary artery disease on each criteria were compared. RESULTS: 1) The sensitivity of big up tri, Delta ST/HR index partition of 1.6uV/beats/min was slightly higher(83%) and the specificity of ST/HR slope partition of 2.4uV/beats/min was higher(87%) than the standard exercise electrocardiographic criteria. 2) Early onset of ischemic ST-segment depression, profound ST-segment depression(> or =2mm), and downsloping ST-segment were associated with more extensive coronary artery disease. 3) On ST/HR slope, no CAD was 1.7+/-0.26uV/beats/min, one vessel disease was 2.6+/-0.34 uV/beats/min, two vessel disease was 2.7+/-1.36uV/beats/min, one vessel disease was 2.8+/-0.35uV/beats/min, and on big up tri, Delta ST/HR index, no CAD was 1.8+/-0.38uV/beats/min, one vessel disease was 2.8+/-1.36uV/beats/min, two vessel disease 3.4+/-1.44uV/beats/min, and three vessel disease was 3.7+/-2.95uV/beats/min. The increment of ST/HR slope and big up tri, Delta ST/HR index were associated with the coronary artery disease and its severity, but the correlations were not high enough. CONCLUSION: The heart rate adjustment of ST segment depression was not high enough for improved detection of coronary artery disease, compared with standard ST-segment depression criteria. But these indexes can be improved the clinical usefulness of the treadmill exercise test for coronary aretry disease.