A Case of Acute Renal Failure Caused by Hyperosmolar Hyperglycemic State Induced-Rhabdomyolysis / 대한신장학회잡지

Acute renal failure is the most common complication of rhabdomyolysis. However, hyperosmolar hyperglycemic state (HHS) induced-rhabdomyolysis rarely causes acute renal failure (ARF) because HHS induces osmotic diuresis and prevents tubular necrosis. Here we report a case of acute renal failure caused by HHS-induced rhabdomyolysis in a patient with poorly controlled diabetes mellitus. A 59-year-old male was admitted with comatose mentality. He had been diagnosed with diabetes mellitus 6 months ago but had not been treated. Physical examination showed severe dehydration of oral mucosa. His laboratory findings demonstrated severe HHS, rhabdomyolysis and acute renal failure (plasam glucose 1,543 mg/dL, osmolarity 329 mOsm/L, creatine phophokinase 15,395 IU/L, lactate dehydrogenase 1,046 IU/L, creatinine 2.4 mg/dL). With adequate hydration and insulin therapy, HHS improved but rhabdomyolysis and ARF were more aggravated. With early hemodialysis treatment, he finally improved without sequale.

Clinical characteristics of the diabetic patients managed at the different medical institutions in Seoul and Gyeonggi province / 대한내과학회지

BACKGROUND: In spite of various types of medical supports, many diabetic patients have not been cared adequately. This study was performed to investigate the clinical characteristics and the patterns of management according to the types of the medical institutions. METHODS: Seven private clinics as primary care institutions, 3 hospitals as secondary care institutions, and 2 medical centers as the tertiary care institutions located in Seoul and Gyeonggi province were the targets of investigation for three months from December 2000 to February 2001. The survey included demographic information, biochemical tests and the pharmacological agents used concomitantly. The subjects who have completed the entire tests were respectively 321, 343 and 1830 patients in the primary, secondary and tertiary care centers. RESULTS: There were no significant differences in age and sex distribution among the study groups. The fasting and postprandial blood glucose levels were highest in secondary and primary institutions, respectively. The glycated hemoglobin levels were higher in primary care institutions than in others. In tertiary care institutions, blood pressure and lipid profile (total cholesterol, triglyceride and HDL-cholesterol) were better controlled compared with the other study groups. CONCLUSIONS: In spite of the limited data from the selected medical institutions, the overall status of the blood glucose, hypertension and hyperlipidemia management for the diabetic patients in Korea were inadequate in all types of medical institutions. For the better management of the diabetic patients, more efforts will be required including the standard management protocol as well as the education program for the primary physicians.

The Effect of Cilostazol on Glucose Tolerance and Insulin Resistance in a Rat Model of Non-insulin Dependent Diabetes Mellitus

BACKGROUND: It has been reported that many peripheral vasodilating drugs might improve insulin resistance. Cilostazol, a antithrombotic agent, increases peripheral blood flow in non-insulin dependent diabetic patients. The effect of cilostazol treatment on insulin resistance in streptozotocin (STZ)-induced non-insulin dependent diabetic Wistar rats was examined. METHODS: About a half of two-day old neonate siblings were injected intraperitoneally with STZ and maintained for six months, at which time they were compared with age-matched control rats for intraperitoneal glucose tolerance test (IPGTT) and for glucose infusion rate (GINF) in a euglycemic hyperinsulinemic glucose-clamp study. After that, these studies were also performed after feeding rat chow containing cilostazol (100 mg/kg/day) to rats with STZ-induced non-insulin dependent diabetes mellitus for four-weeks and compared with those of age-matched control rats. RESULTS: In the intraperitoneal glucose tolerance test studies, plasma glucose levels of STZ-induced non-insulin dependent diabetic rats were significantly higher and plasma insulin levels significantly lower than those of age-matched control rats in the age of six months. Glucose infusion rate was lower in STZ-induced non-insulin dependent diabetic rats than those of age-matched control rats. However, after a four-week cilostazol treatment, glucose infusion rate of STZ-induced non-insulin dependent diabetic rats was not significantly different from that of control rats. CONCLUSION: These findings suggested that cilostazol may improve insulin resistance in STZ-induced non-insulin dependent diabetic rats.

A case of primary empty sella syndrome combined with Cushing's disease / 대한내과학회지

Empty sella is defined as a sella which, regardless of its size, is completely or partly filled with cerebrospinal fluid (CSF), and is divided into two groups, primary or secondary. Secondary empty sella syndrome is associated with a prior surgery, radiation therapy or medical treatment of pituitary gland, and otherwise primary. The endocrine function of primary empty sella syndrome is usually normal, but sometimes, this syndrome is associated with complete or partial pituitary insufficiency and rarely pituitary hypersecretion. In the cases of hypersecretion of pituitary hormones, hyperprolactinemia, acromegaly and hypersecretion of adrenocorticotrophin (ACTH) has been reported. but, hypersecretion of ACTH is rarely reported. We describe a patient of primary empty sella syndrome combined with Cushing's disease. So we present this case with a review of the literature.

The role of hypoalbuminemia as a marker of the severity of disease in patients with tsutsugamushi disease / 대한내과학회지

BACKGROUND: Although hypoalbuminemia is common in patients with tsutsugamushi disease, acute rickettsial infectious disease, its impact on the severity of disease is not reported. Therefore, we studied the role of hypoalbumiemia as a marker of the severity of disease in patients with tsutsugamushi disease. METHODS: We retrospectively reviewed clinical data of 95 patients with tsutsugamushi disease who were admitted between January 1994 and December 1999 at Uijongbu St. Mary's hospital. We compared clinical and laboratory findings, complications, and mortality between hypoalbuminemic group (serum albumin or = 3.0 g/dL). RESULTS: Of the total 95 patients, 50 patients (52.6%) had hypoalbuminemia. In hypoalbuminemic group, the incidence of hypotension was higher (20.0% vs 2.2%, p=0.006) and the duration of admission was longer (12.0+/-4.5 vs 8.8+/-2.7 days, p<0.001), compared to control. The degree of thrombocytopenia in hypoalbuminemic group was severer than that in control (84,000+/-46,000 vs 138,000+/-75,000/mm3, p<0.001). Hypoalbuminemic group showed higher incidence of interstitial pneumonia (64.0 vs 13.3%, p<0.001), hypoxia (40.0 vs 6.6%, p<0.001), metabolic acidosis (12.0 vs 0%, p=0.018), and acute renal failure (18.0 vs 4,4%, p=0.038), compared to control. Four patients who had hypoalbuminemia died due to septic shock and multiorgan failure. CONCLUSION: This study shows that hypoalbuminemia could be used as a marker of the severity of disease in patients with tsutsugamushi disease.

Changes of Glucose Tolerance in Acromegaly Patients with 24 Hour Continuous Subcutaneous Infusion of Octreotide / 대한내분비학회지

BACKGROUND: An important metabolic feature of acromegaly is a reduced action of insulin on hepatic gluconeogenesis and peripheral glucose disposal which mediated by growth hormone hypersecretion. Octreotide, a synthetic octapeptide somatostatin analogue exerts complex effects on hormonal and metabolic regulations affecting glucose homeostasis. This study was designed to ascertain the shorterm effect of octreotide on glucose tolerance in acromegaly. METHODS: 10 patients (five men and five women, age 47.9+/-11.8) were injected subcutaneously with octreotide, 100 micrograms for 24 hours. Patients were assessed with respect to growth hormone, glucose, and insulin response to a standard 100 g oral glucose tolerance test (OGTT) before and during the last 2 hour of octreotide infusion. RESULTS: During the therapy, there was significant decrease in mean blood glucose response to OGTT (678.4+/-51.9 vs 581.9+/-47.3 mg/dL/2hr: mean areas under the glucose curve, p=0.01) and mean serum insulin response to oral glucose load was significantly reduced in all patients (339.2+/-106.2 vs 256.7+/-111.3 U/mL/2hr: mean areas under the insulin curve, p=0.01). Using glucose tolerance test criteria three patients of 10 had normal glucose tolerance, four and three had impaired glucose tolerance and diabetes, respectively, at base line. While on octreotide these composition was changed to six patients of NGT, three of IGT and one diabetes. CONCLUSION: We conclude that insulin resistance mediated by GH hypersecretion was improved by shorterm octreotide treatment.

Effects of pertussis and cholera toxin on oxidized low density lipoprotein induced apoptosis in cultured bovine aortic endothelial cells / 대한내과학회지

OBJECTIVES: Oxidized LDL is thought to play a key role in atherogenesis. Among their wide variety of biological properties, oxidized LDL injures the endothelium as an early event of atherogenesis. However, the mechanisms by which oxidized LDL injures endothelial cells are not definitely known. In order to evaluate the involvement of GTP-binding protein on the mechanism of apoptosis, we studied the effects of pertussis and cholera toxin on oxidized LDL-induced apoptosis in bovine aortic endothelial cells(BAECs). METHODS: Oxidized LDL elicited apoptosis in cultured BAECs as shown by characteristic morphological and biochemical changes. Chromatin condensation and nucleus fragmentation were visualized by using fluorescence microscopy of intact cells staining by acridine orange/ ethidium bromide. DNA fragmentation was quantified by an ELISA with specific antibody for bromodeoxyuridine- labelled DNA fragments and confirmed with DNA ladder formation. RESULTS: Studies using a combination of bacterial toxins which change the function of GTP-binding protein suggest that oxidized LDL-induced apoptosis was regulated by GTP-binding protein. Oxidized LDL-induced apoptosis was not changed by pretreatment of BAECs with pertussis toxin. In contrast, pretreatment with cholera toxin completely prevented the oxidized LDL- induced apoptosis. CONCLUSION: These results show that oxidized LDL induces apoptosis of BAECs and suggest that cholera toxin-sensitive G-proteins are involved in signal transduction of oxidized LDL-induced apoptosis of BAEC.

A Clinical Study on Surgically Managed Thyroid Diseases: Trend of Thyroid Operation in Catholic Medical Center, Korea from 1988 to 1992 / 대한내과학회지

OBJECTIVES: The thyroid disease is the common form of endocrine diseases, which often requires surgical management. Recently, fine needle aspiration biopsy is widely used preoperatively. As a result, some studies show that numbers of thyroid operation have decreased significantly. We performed this study to analyze the clinical features of thyroid diseases and the trend of thyroid operation in Korea. METHODS: We reviewed medical records of 1787 cases with thyroid diseases who were managed surgically in Catholic Medical Center, Korea from 1988 to 1992. RESULTS: 1) The percentage of thyroid diseases in total cases undergoing operation in Department of General Surgery was 3%, which tended to decrease with time.2) 72.9% of thyroid diseases was benign. Among them, the frequency of nodular hyperplasia and follicular adenoma were 67.5% and 18.4%, respectively.3) The percentage of thyroid cancers in thyroid diseases was 27.1%, which tended to increase with time. The frequency of papillary adenocarcinoma was 78.6%, follicular adenocarcinoma 18.2% and medullary carcinoma 1.5%.4) Thyroid cancers were most commonly found in the forty and sixty decades. Male:female ratio was 1:8.5.5) 7.6% of thyroid cancers was accompanied by benign thyroid diseases which were mostly nodular hyperplasia and follicular adenoma.6) The most common type of operation was lobectomy (82.5%) in benign thyroid diseases, and total thyroidectomy (47.1%) and lobectomy (41.1%) in thyroid cancers.7) Fine needle aspiration biopsy was performed in 51.7% of thyroid nodules, the frequency of which tended to increase with time. The sensitivity, specificity, false negative rate and false positive rate of this test were 78.3%, 89.4%, 13.7% and 17.2%, respectively. CONCLUSION: With the use of fine needle aspiration biopsy, numbers of thyroid operation decreased and the percentage of thyroid cancers in thyroid operation increased.

A Case of Pituitary Feedback Adenoma Caused by Primary Hypothyroidism / 대한내분비학회지

A 14-year-old girl presented with severe headache and grand mal seizure. A magnetic resonance imaging(MRI) of brain showed a pituitary mass(1.0X1.5X1.3cm) incidentally during seizure evaluation. On physical examination, nodular goiter was detected on her anterior neck. The hormone study showed markdly increased basal thyroid stimulating hormone(TSH) level compared to thyroid hormone level, hyperprolactinemia and decreased basal growth hormone level. TSH and prolactin showed exaggerated response to thyrotropin releasing hormone(TRH) and the growth hormone showed delayed and blunted response to insulin-induced hypoglycemia. With the results of thyroid autoantibody and thyroid scan, the diagnosis of Hashimoto's thyroiditis was possible. Thyroid hormone and anticonvulsant drug were started with close observation of clinical status under the impression of pituitary feedback adenoma caused by hypothyroidism. After 3 months replacement therapy of levothyroxine sodium, she achieved euthyroid state with disappearance of headache and nodular goiter. After continuous replacement therapy for 9 months more, the pituitary mass was successfully regressed on follow up MRI with normalization of basal prolactin level. Grand mal seizure was developed after withholding anticonvulsant drug even though continuous admmistration of thyroid hormone. Because of similarity among pituitary adenoma discovered incidentally, careful hormonal study and high index of suspicion should be maintained to achieve correct diagnosis in order to avoid unnecessary pituitary surgery in these patients.

Two Cases of Cryptococcosis in Patients with Cushing's Syndrome and Diabetes Mellitus / 대한내분비학회지

Although cryptococcosis complicated with steroid therapy is well described, cryptococcosis has been rarely reported in the presence of Cushing's syndrome characterized by endogenous steroid excess. We experienced two cases of cryptococcosis in patients with Cushing's syndrome and diabetes mellitus. We describe a case of cryptococcal meningitis complicatiog Cushing's syndrome, secondary to pituitary adenoma. And another case of cryptococcal pneumonia complicatiog Cushing's syndrome, secondary to bilateral nodular adrenal hyperplasia. Before Cryptococcosis, two patients were suffered from diabetes mellitus, and they have got both adrenalectomy.

Expression of Epidermal Growth Factor Receptor mRNA by In Situ Hybridization in Normal and Abnormal Thyroid Tissue / 대한내분비학회지

Growth factors are polypeptide molecules that regulate cell growth and function by binding with high affinity to specific receptor molecules in the plasma membrane and stimulating receptor mediated action of intracellular signal transduction pathway.Epidermal growth factor(EGF) and their receptors(EGFR) regulate normal cellular growth, proliferation, and differentiation of various cells in vivo and in tissue cultures. And also may contribute directly to oncogenesis.Overexpression of EGFR and autocrine stimulation of growth involving this receptor system has been identified in several types of human neoplasia. There is evidence that the EGF and receptor system is involved in the regulation of follicular cell growth in the thyroid gland especially with immunohistochemical technic. But there was a challenge about the validity of previously performed immunohistochemical studies.In the study we investigated the relationship between EGFR mRNA expression and tumorigenesis by rapid in situ hybridization method. Formalin-fixed, paraffin embedded tissue sections of 10 normal, 17 nodular hyperplasia, 6 follicular adenoma, and 15 papillary cancer were examined. The results were as follows:1) EGFR mRNA positivity were 20%(2/10) in normal thyroid, 70%(12/17) in nodular hyperplasia, and 100% in follicular adenoma and papillary cancer.2) There was a significantly increased EGFR mRNA expression in papillary cancer compare to normal and nodular hyperplasia(p<0.05). But no difference was found with papillary cancer and follicular adenoma.3) There was a significantly increased EGFR mRNA expression in follicular adenoma compare to normal (p<0.05). But no difference was found with follicular adenoma and nodular hyperplasia. These results suggest that an overexpression of EGFR mRNA may play an important role in the tumorigenesis of thyroid tissue.

Analysis of HLA-DQA1 genotype in Korea autoimmune thyroid disease and IDDM patients / 대한내분비학회지

No abstract available.

Relationship between magnesium and calcium to glucose stimulated insulin secretion in the perfused rat pancreas

No abstract available.

A case of multiple endocrine neoplasia type 3 / 대한내분비학회지

No abstract available.