Therapeutic Drug Concentrations of Teicoplanin in Clinical Settings

BACKGROUND: Teicoplanin is a glycopeptide antibiotic that is widely used in clinical practice for the treatment of infections caused by drug-resistant Gram-positive bacteria. The aim of this study was to analyze plasma teicoplanin concentrations to determine the percentage of patients in whom therapeutic concentrations of teicoplanin were achieved in clinical practice. MATERIALS AND METHODS: The plasma teicoplanin concentrations of hospitalized patients receiving treatment at a teaching hospital were retrospectively analyzed. The target level was defined as a plasma teicoplanin concentration of 10 mg/L or greater, since this was generally regarded as the lower limit of the optimal concentration range required for the effective treatment of a majority of infections. RESULTS: Patients with sub-optimal (< 10 mg/L) plasma teicoplanin concentrations constituted nearly half of the total study population. The majority of these patients received the recommended loading dose, which were three 400 mg doses administered every 12 hours. Sub-group analysis showed a trend that the group receiving loading dose was more likely to reach the optimal teicoplanin concentration. CONCLUSIONS: The data revealed that a significant proportion of patients in clinical practice achieved only sub-optimal teicoplanin concentrations, which emphasizes the importance of the mandatory use of loading dose and routine therapeutic drug monitoring. Treatment reassessment and simulation of individual dose regimens may also be necessary to achieve optimal drug concentrations.

Effect of ICV Corticosterone on hypothalamic NPY mRNA Expression in food-restricted, Adrenalectomized Rats / 대한내분비학회지

BACKGROUND: Adrenalectomy does impair the expression of hypothalamic NPY gene in the rat and replacement of glucocorticoid by intracerebroventricular(ICV) route resulted in a normalization of refeeding hyperphagia and weight gain in adrenalectomized(ADX), food-deprived rats. The purpose of this study was to assess the direct effect of CNS glucocorticoid on hypothalamic NPY gene expression which occurs following food deprivation in ADX rats. METHODS: Adult male Wistar rats were fitted with ICV cannulae and restricted the food intake for 14 days. Adrenalectomy and sham operation were done on the 10th day and single ICV corticosterone acetate(100ug/2uL) was given in one ADX group(ADX+CORT, n=9) and vehicle (2uL) was given in another ADX group(ADX+VEH, n=9) and sham rats(SHAM+VEH, n=7). After experiment, we measured NPY mRNA on arcuate nucleus by in situ hybridization. RESULTS: The rate of weight loss of ADX rats closely parallded that of sham-operated rats. Plasma glucose and insulin levels were not significantly different in three groups. Hybridization density on the ARC in ADX+VEH rats(0.42+/-0.02uCi/g: p<0.05) was significantly reduced compared to that in sham controls(0.68+/-0. 11uCi/g). ICV corticosterone injection increased the hybridization density in ADX+CORT rats(0.53+/-0.04uCi/g) compared to vehicle alone, although this did not reach that of controls. NPY gene expression was 40% in ADX+VEH rats and 62% in ADX+CORT rats compared to control rats. CONCLUSIONS: These results are consistent with the hypothesis that CNS glucocorticoid deficiency appears to be responsible for the impairment of refeeding hyperphagia in ADX rats and the effect of CNS glucocorticoid deficiency is a manifestation of impaired activation of hypothalamic NPY gene expression in the ARC.

A Case of Hyponatremin Encephalopathy Developed after Transsphenoidal Pituitary Sergery in Menstruant Woman / 대한내분비학회지

A 41-year-old female complaining of easy fatigue, headache, thickened extremities and deepened facial folds was admitted to the hospital. As early as 6 years ago, she had been told by family members that her voice was changed and both hands was thickened. Cranial plain radiography indicated ballooning of sella turcica. Sella MRI disclosed 2.2cm sized pituitary tumor with suprasellar extension. The pituitary tumor with hypothalamic extension was removed via a transsphenoidal approach. The postoperative course was uneventful until hyponatremia with sudden headache and respiratory arrest was developed. The case was due to hyponatremic encephalopathy on the basis of the clinical course and symptoms, and 3% hypertonic saline was infused for 12 hours until the hyponatremia was corrected. We have experienced a mortality case of hyponatremic encephalopathy in which surgieal removal of a pituitary tumor from a female acromegalic patient in menstruant period was followed by the sudden occurrence of hyponatremia, which in turn was later associated with marked brain edema.

A Case of Aldosteronoma Complicated with Hyperthyroidism / 대한내분비학회지

Primary aldosteronism is characterized by hypokalemic metabolic alkalosis, low plasma renin activity, elevated plasma aldosterone level and can be suspected in the patients with hypertension and unexplained hypokalemia. Small adrenal cortical adenomas are responsible for this syndrome in most cases. The incidence of thyrotoxic periodic paralysis ranges from 1.9 to 6.2 % in Japan. Thyrotoxic periodic paralysis usually subsides following treatment of hyperthyroidism and has good prognosis. A 56 year-old man presented with hyperthyroidism, hypertension and recurrent hypokalemia. During the treatment of hyperthyroidism, he repeatedly experienced weakness of both lower extremities. Hormonal evaluation was performed and he was found to have a 2*2*1.5 cm sized right adrenal tumor by abdominal computerized topography(CT). After right adrenalectomy, hypokalemic periodic paralysis was improved. Both thyroid and adrenal function should be comprehensively investigated in periodic paralysis. In conclusion, physicians must be aware of the possibility of primary aldosteronism in hyperthyroid patients with hypokalemic periodic paralysis. We report a case of aldosteronoma complicated with hyperthyroidism and literatures are reviewed.

A Case of Partial Hypopituitarism after Recovery from Korean Hemorrhagic Fever / 대한내분비학회지

Heorrhage and infarct-like necrosis of anterior lobe of the pituitary gland is one of the characteristic pathologic findings of the autopsied cases of Korean Hemorrhagic Fever (KHF) patients, but there has been rare reports of hypopituitarism in patients with KHF. Recently we have experienced a patient with hyponatremia who had recovered from KHF. He was admitted to our hospital due to nausea, vomiting, and epigastric discornfort. To determine the function of the anterior pituitary gland, hormonal levels of target galnds and pituitary gland were measured, and combined pituitary stimulation test was performed. ACTH, GH, and prolactin deficiency were confirmed by combined pituitary stimulation test in this patient. There was no evidence of hypothalamic or other pituitary diseases by brain MRI. Our experience shows that KHF can be a cause of hypopituitarism and these findings should alert physicians the possibility of hypopituitarisrn in patients who had recovered from KHF.