A Case of Pheochromocytoma Manifested by Generalized Seizure / 대한내분비학회지

Pheochromocytoma is originated from chromaffin cells of sympathetic nervous system and clinical symptoms are caused by catecholamine released from tumor. In typical cases, periodic attacks of hypertension, palpitation, headache, and sweating are main symptoms. But, the diagnosis of pheochromocytoma is sometimes difficult since its clinical presentation is quite variable. We evaluated a 25-year-old woman who was admitted because of left flank pain and seizure. She had a history of hemoptysis and toxemia. During the hospitalization, she experienced generalized seizure once more. The clinical diagnosis of pheochromocytoma was proven by highly elevated urinary catecholamines and confirmed histologically after operation. We think it is the first case report of pheochromocytoma manifested by seizure in korea, so we report this case with literature review.

Relation of beta 3-Adrenergic Receptor Gene Polymorphism to the Patterns of Body Fat Distribution and Insulin Sensitivity in Female Nondiabetic Offspring of Patients with NIDDM / 대한내분비학회지

BACKGROUND: Obesity is an important metabolic abnormality as a pathogenesis of non-insulin dependent diabetes mellitus(NIDDM), and genetic factors have been suggested to be involved in the development of obesity and NIDDM. beta 3-adrenergic receptor gene polymorphism has been reported to be related to an earlier onset of NIDDM and increased capacity of weight gain in obesity. The purpose of this study was to investigate the relation of beta 3-adrenergic receptor gene polymorphism to body fat distribution pattern and insulin resistance in female nondiabetic offpsring of patients with NIDDM. METHODS: We assessed the patterns of body fat distribution by anthropometric measurement, bioelectric impedence analysis and computed tomogram; insulin sensitivity by using frequently sampled intravenous glucose tolerance test and the minimal model analysis. We inverstigated the beta 3 -adrenergic receptor gene polymorphism by PCR and RFLP. RESULTS: 1) The frequency of beta 3 adrenergic receptor gene polymorphism was as follows; wild type (Trp64Trp) 69.8%, Trp64Arg heterozygote 26.4%, Arg64Arg homozygote 3.8% in the offspring of patients with NIDDM. According to obesity, there was no significant difference of distribution of Arg64 allele between nonbese and obese subjects. 2) In the mutant subjects with Arg64 allele, the concentrations of total and LDL cholesterol were significantly increased (p<0.01), but fasting serum glucose and insulin, percent body fat, visceral fat area and visceral to subcutaneous fat area ratio were insignificantly increased, SI were insiginificantly decreased. 3) Multiple regression analysis showed that Arg64 allele did not significantly associated with visceral obesity and insulin resistance. CONCLUSION: The beta 3-adrenergic receptor gene polymorphism was related to dyslipidemia, but not related to visceral adiposity or insulin resistance in nondiabetic offspring women of patients with NIDDM. Further prospective studies in these subjects will be needed for the clarification of pathogenetic role of beta 3-adrenergic receptor gene polymorphism in the development of insulin resistance and NIDDM.

Relationship between Weight Change after 20 years of Age and the Risk of NIDDM In the Urban Area / 대한내과학회지

OBJECTIVE: The role of obesity in the pathogenesis of NIDDM has long been recognized. However, the relation between weight change and risk for diabetes has been less well defined and earlier studies have shown inconsistent results. We conducted a cross-sectional study to evaluate the relationship between weight change after 20 years of age and the risk of NIDDM in the Korean urban population. METHODS: From April 1997 to February 1998, we examined 642 subjects among a total of 776 persons aged over 30 years living in Mokdong apartment area selected using a random cluster sampling method for the survey of the prevalence of diabetes in urban area. After 75g oral glucose tolerance test, they were diagnosed with normal glucose tolerance or diabetes by WHO criteria. We excluded the subjects with impaired glucose tolerance. We obtained the data about weight change since 20 years of age and measured the current weight, height and waist-hip ratio. RESULTS: 1) Among 642 subjects, 46 were diabetic and the prevalence of diabetes was significantly increased with the increase of BMI in both men and women but with the increase of waist-hip ratio only in women. 2) The weight gain between 25 and 30 years of age was significantly greater in the subjects aged 30-39 than the older age groups. 3) In both men and women, weight gain of greater than 10 kg after 30 years of age increased the risk of diabetes. In women, weight gain greater than 20 kg between 20 years of age and the time of maximal obesity also increased the risk of diabetes. However, the significant risk factors for diabetes were age in men, whereas age and waist-hip ratio in women by multiple logistic regression analysis. 4) In women, weight gain less than 10kg after 30 years of age decreased the risk of diabetes, independent of age, BMI and family history of diabetes. CONCLUSION: Moderate weight gain after 30 years of age in women reduced the risk of diabetes. Extreme weight gain after 30 years of age in both men and women is related with high prevalence of diabetes. And in women, weight gain associated with pregnancy and otherwise after 20 years of age increased the risk of diabetes. However, the significance was disappeared after adjustment for age, BMI and family history of diabetes. The prospective study about the relationship between weight changes and the risk of diabetes would be needed.

Relationship of Dehydroepiandrosterone Sulfate, Sex Hormone Binding Globulin and Carotid Atherosclerosis in Women / 대한내분비학회지

BACKGROUND: Cardiovascular disease is the major cause of morbidity and mortality. It is well known that androgen and sex hormone-binding globulin(SHBG) in women were associated with risk factors for cardiovascular disease such as obesity, central fat accumulation and atherogenic lipid profile. High resolution B-mode ultrasonography can visualize directly both luminal and vessel wall characteristics, and ultrasonic measurement of carotid intima-medial thickness(IMT) can be used to investigate the atherosclerosis of coronary, cerebral and peripheral arteries. The aim of this study was to evaluate the relationship between the serum dehydroepiandrosterone sulfate(DHEA-S) and SHBG, and body fat distribution pattern, cardiovascular risk factor and carotid atherosclerosis in women. METHODS: Blood pressure, fasting serum glucose, insulin, lipid profile, SHBG and DHEA-S were measured. Body fat distribution pattern was assessed by waist to hip ratio, waist to thigh ratio and subscapular to triceps skin fold thickness ratio, faf mass measured by bioelectric impedance analyzer, subcutaneous fat area, visceral fat area, and visceral to subcutaneous fat area ratio(VSR) at the level of umbilicus using the computed tomography. The IMT of the carotid artery was measured by high resolution B mode ultrasound as a marker of atherosclerosis. RESULTS: 1) There was no significant difference of age-adjusted values of carotid IMT among subjects with NGT(0.426+/-0.09mm), IGT(0.46+/-10.09mm) and NIDDM(0.453+/-0.11mm). 2) In postrnenopausal women, carotid IMT was greater(0.484+/-0.11mm, p=0.05) than premenopausal women(0.426+/-0.08mm), but it was not significant after age adjustment. Serum SHBG and DHEA-S levels in postmenopausal women were significantly lower(p<0.05) than premenopausal women, but they were not significant after age adjustment. 3) Carotid IMT was significantly correlated with age(r=0.37, p<0.01), fasting serum glucose (r=0.32, p<0.01), total cholesterol(r= 0.25, p<0.05), LDL-cholesterol(r=0.26, p<0.05), visceral fat area(r=0.35, p<0.01) and VSR(r=0.31, p<0.05). 4) By the stepwise multiple regression analysis, carotid IMT was positively and significantly associated with age(p<0.01) and serum DHEA-S concentration(p<0.05) in dent of age, body mass index, waist to hip ratio, fasting serum glucose. CONCLUSION: Carotid IMT was associated with age and serum DHEA-S concentration in women without cardiovascular disease. Therefore, serum DHEA-S may be one of risk factors for cardiovascular disease in women. However, we could not conclude its cause-result relationship because of cross sectional nature of our study, and prospective study will be needed.

A Case of Pheochromocytoma associated with Ectopic ACTH Syndrome / 대한내분비학회지

The syndrome of ectopic production of ACTH by non-pituitary neoplasm occur with various types of tu#rnors. Pheochromocytoma is a rare, but one of the important causes of this syndrome. Recently we experienced a 36-year-old male patient with ACTH-producing pheochromocytoma. After left adrenalectomy, serum ACTH level retumed to the normal range. The patient became normotensive without antihypertensive agents and hyperglycemia resolved and insulin therapy was discontinued. Secretion of ACTH was confirmed by immunohistochemical stain.

Mechanism of Angiotensin 2-Stimulated Aldosterone Secretion in Adrenal Glomerulosa Cells of Diabetic Rats ; Normal Phospholipase Activity and Intracellular Calcium Mobilization / 대한내분비학회지

BACKGROUND: Diabetic patients develop hypoaldosteronism which frequently caused hyperkalemia and metabolic acidosis and diabetic hypoaldosteronism is associated with selective unresponsiveness of aldosterone to angiotensin A-II, but mechanism of defect in A-II stimulated aldosterone response still remain unclear. METHODS: To elucidate the mechanism of defect in A-II stimulated aldosterone response, author evaluated the responses of aldosterone production to A-II, K+, and ACTH in adrenal glomerulosa cells prepared from streptozotocin induced diabetic rats, Inositol triphosphate (IP3) generated by activation of phospholipase C (PLC) and arachidonic acid and lysophospholipids generated by activation of phospholipase A2 (PLA2) were measured in A-II stimulated glomerulosa cells. Radiocalcium efflux and aldosterone response to second messenger of A-II such as PLC, IP3, PLA, AA and protein kinase C activator, 12-o-tetradecanoylphorbol 13 acetate (TPA). RESULTS: 1. Plasma renin activity and aldosterone levels were not different among control rats, untreated and insulin treated diabetic rats. 2. Basal, ACTH and K+ -stimulated aldosterone production were similar in cells from the three groups (p0.05). 4. Aldosterone responses to PLC, IP3, AA and TPA were significantly decreased in glomerulosa cells from diabetic rats compared with control and insulin treated diabetic rats (p0.05). 45Ca efflux to PLC, IP3 PLA2 and AA were similar among the three groups (p>0.05). CONCLUSION: These results suggested that decreased A-II-stimulated aldosterone response was present in glomerulosa cells from streptozotocin induced diabetic rats and reversed by insulin treatments. The main defect of altered A-II response of zona glomerulosa might be located in the step after activation of phospholipase and increase of intracellular calcium, and activation of PKC, or distal to that could be one of the causative mechanism.

A Clinical Study of Subacute Thyoidits / 대한내과학회지

OBJECTIVES: Subacute thyroiditis is a nonsuppurative inflammation of thyroid gland and is probably caused by a cytopathic virus. Typical clinical symptoms and features of subacute thyroiditis vary widely during the course of illness. It has a clinical course, evolving from hyperthyroidism through a temporary hypothyroidism to recovery. However, the final outcome of this disease remains unpredictive in some patients. Permanet hypothyroidism occurs infrequently. METHODS: Thirty-three patients proven to have subacute thyroiditis at the Ewha Womans University Hospital from September 1993 to November 1995 were studied. We analyzed their clinical features, laboratory findings, and duration of recovery to cha- racterize the course of the disease. RESULTS: 1) Total 33 patients were studied: 31 patients were female and 2 patients were male. Their mean age was 42.6+/-8.3 years old. The peak months were August through October in this study. 2) Initial mean ESR was 73.0+/-35.2mm/hr, mean T3 was 217.3+/-73.9ng/dl, mean T4 was 15.2+/-8.5microgram/ dl, and TSH was 0.06+/-0.09microIU/ml. The positive rates of antithyroglobulin and anitmicrosomal antibodies were 31% and 6% respectively, and TSH receptor antibody was elevated in one patient. 3) In the thyroid scan, 91% showed both lobes nonvisualisation, and 9% showed one lobe nonvisualization. Radioactive iodine uptake(RAIU) at 24 hour was 2.4+/-3.3%. 4) With the predisolone therapy, 90% of patients completely recovered, 57% of these patients had no hypothyroid phase and remaining 33% of them had hypothyroid phase during course of the disease. Three of the patients had permanent hypothyroidim. 5) The average duration of recovery was 3.2+/-1.4 months and it has no correlation with initial thyroid hormone levels, antithyroid antibodies and duration of steroid administration. CONCLUSION: There was no historical, physical, laboratory findings that help us predict those patients likely to have an exacerbation of the disease.

A Clinical Study of Postpartum Autoimmute Thyroiditis / 대한내분비학회지

Background: Postpartum thyroiditis is a painless, destructive lymphocytic inflammation of the thyroid gland that occurs during the postpartum period and is associated with a high prevalence of serum thyroid autoantibodies. Clinical symptoms and laboratory fi#ndings of postpartum thyroiditis vary widely during the course of illness and the final outcome of this disease remains unpredictive in some patients. The purpose of this study is to investigate the clinical course and the predictors of the outcome of the disease. Methods: Thirty-eight patients proven to have postpartum thyroiditis at the Ewha Womans University Hospital were studied. We analyzed their clinical features, laboratory findings and duration of recovery to characterize the course of the disease. Results: Their mean age was 29.0±3.3 years and the time of diagnosis was 4.9±1.9 months after delivery. The prevailed months of delivery were November through January in this study. Twenty six patients were hypothyroid and 12 were thyrotoxic at initial thyroid function. The positive rates of antithyroglobulin and anitmicrosomal antibodies were 92%, 67% in the hypothyroid group and 75%, 67% in th thyrotoxic group respectively. TSH receptor antibodies were negative in all patients. In the hypothyroid group the titers of antimicrosomal antibodies were significantly higer than the thyrotoxic group. The titers of antimicrosomal antibodies were positively correlated with serum TSH and negatively correlated with serum T4. In all patients, the titers in thyroid function tests returned to the normal range without long-term hypothyroidism. Conclusion: The titers of antimicrosomal antibodies were significantly higher in the hypothyroid group than the thyrotoxic group. Thus the titers of antimicrosomal antibodies can help guide the physician in the care of patients with postpartum thyroiditis who will probably be hypothyroid. In this study, we were surprised that all patients became euthyroid without permanent hypothyroidism.

Endocrinologic changes during short term fasting in obese postmenopausal women / 대한내분비학회지

No abstract available.

Isocyanate-induced occupational asthma: immunologic and challenge studies / 결핵

No abstract available.

Effects of nifedipine and captopril on cisplatin induced nephrotoxity in rats / 대한신장학회잡지

No abstract available.

The Clinical Studies on Congestive Heart Failure

The author analyzed 231 patients of congestive heart failure which was confirmed by the clinical symptoms and the laboratory findings among the patients admitted to Ewha Womans University Hospital between the begining of 1974 and the end of 1978. The result were as follow; 1. In sex distribution, the female was predominant. Male to female ratio is 1:2.45. The most common incidence by age group was sixth decade. 2. Regarding the underlying disease, there were hypertensive heart disease(27.3%), post-partum heart disease(19.5%), rheumatic heart disease(16.0%) and arteriosclerotic heart disease(15.6%) in order. 3. The precipitating factors were observed in 77.5% of total cases and the order of frequency was pregnancy and delivery(26.4%), infection(19.1%), arrhythmia(12.6%) and physical exertion(12.1%). 4. On admission, patients usually complained of dyspnea, cough, right upper quadrant pain and the physical examination revealed moist rales, hepatomegaly etc. 5. The laboratory findings were anemia(19.0%), increased E.S.R.(33.8%) and leukocytosis (34.2%). 6. The blood chemistry showed increased level of creatinine(24.5%), S.G.O.T. (20.9%), B.U.N.(20.0%) and decreased albumin(15.5%), increased S.G.P.T.(15.0%) in order. 7. The X-ray films of chest on admission revealed increased vascular marking and pulmonary congestion(85.7%), cardiomegaly(80.0%) and pleural effusion(21.4) etc. 8. The E.C.G. findings showed(205 cases among 231 cases) LVH 56.6%, atrial fibrillation 26.3% etc. 9. The echocardiography perfomed in 59 cases among 231 cases gave valvular heart disease (28.9%), atrial fibrillation (11.9%) arteriosclerotic heart disease(8.5%), ventricular hypertrophy (6.8%) and atrial enlargement(5.1%) in order of frequency.

The Clinical Studies on Congestive Heart Failure

The author analyzed 231 patients of congestive heart failure which was confirmed by the clinical symptoms and the laboratory findings among the patients admitted to Ewha Womans University Hospital between the begining of 1974 and the end of 1978. The result were as follow; 1. In sex distribution, the female was predominant. Male to female ratio is 1:2.45. The most common incidence by age group was sixth decade. 2. Regarding the underlying disease, there were hypertensive heart disease(27.3%), post-partum heart disease(19.5%), rheumatic heart disease(16.0%) and arteriosclerotic heart disease(15.6%) in order. 3. The precipitating factors were observed in 77.5% of total cases and the order of frequency was pregnancy and delivery(26.4%), infection(19.1%), arrhythmia(12.6%) and physical exertion(12.1%). 4. On admission, patients usually complained of dyspnea, cough, right upper quadrant pain and the physical examination revealed moist rales, hepatomegaly etc. 5. The laboratory findings were anemia(19.0%), increased E.S.R.(33.8%) and leukocytosis (34.2%). 6. The blood chemistry showed increased level of creatinine(24.5%), S.G.O.T. (20.9%), B.U.N.(20.0%) and decreased albumin(15.5%), increased S.G.P.T.(15.0%) in order. 7. The X-ray films of chest on admission revealed increased vascular marking and pulmonary congestion(85.7%), cardiomegaly(80.0%) and pleural effusion(21.4) etc. 8. The E.C.G. findings showed(205 cases among 231 cases) LVH 56.6%, atrial fibrillation 26.3% etc. 9. The echocardiography perfomed in 59 cases among 231 cases gave valvular heart disease (28.9%), atrial fibrillation (11.9%) arteriosclerotic heart disease(8.5%), ventricular hypertrophy (6.8%) and atrial enlargement(5.1%) in order of frequency.