Pigment Dispersion Syndrome and Reverse Pupillary Block after Implantable Collamer Lens with Central Hole Implantation

PURPOSE: To report a case of pigment dispersion syndrome and reverse pupillary block secondary to the implantation of implantable collamer lens (ICL) with a central hole (AQUA ICL®) that was treated with ICL removal and laser peripheral iridotomy (LPI). CASE SUMMARY: A 29-year-old woman with myopia in both eyes underwent implantation of AQUA ICL®. Four weeks postoperatively, the intraocular pressure (IOP) increased to 34 mm Hg and the patient showed pigment dispersion syndrome in both eyes. Since the IOP did not reduce with the maximum tolerable medical therapy, the ICLs were removed 8 weeks after implantation. The pigment dispersion subsided and IOP reduced shortly after ICL removal. However, 4 weeks after removal of ICL, posterior iris bowing and reverse pupillary block occurred in the right eye and the IOP increased to 46 mm Hg. LPI was performed in the right eye, and the reverse pupillary block was dissolved after a reduction in pigment dispersion. The IOP subsequently normalized to 13 mm Hg. Two weeks later, prophylactic LPI was performed in the left eye. Four weeks after prophylactic LPI, selective laser trabeculoplasty was performed on both eyes. As a result, the IOP was 11 mm Hg in the right eye and 12 mm Hg in the left eye after 4 weeks of treatment with topical IOP-lowering medications. CONCLUSIONS: The present case indicates that implantation of ICL with a central hole can lead to early postoperative pigment dispersion syndrome. When this condition persists and is accompanied by reverse pupillary block after ICL removal, LPI can be partially effective.

A Case of Malignant Glaucoma in a Vitrectomized Eye

PURPOSE: To report a case of malignant glaucoma in an eye vitrectomized 5 years previously due to endophthalmitis. CASE SUMMARY: A 55-year-old male visited clinic due to a painful right eye 2 days in duration. Five years ago, he suffered endophthalmitis in his right eye and underwent pars plana vitrectomy. On slit-lamp examination, shallow anterior chamber depth of 2 central corneal thickness and corneal edema were observed along with remnant cortical lens material behind the intraocular lens. Intraocular pressure was 68 mm Hg measured using applanation tonometry. Maximal medical treatment failed to lower the intraocular pressure on the first day of visit. The very next day, anterior chamber became shallower less than 0.5 central corneal thickness and intraocular pressure was 70 mm Hg. Posterior capsular syndrome was suspected on anterior optical coherence tomography and neodymium:yttrium-aluminum-garnet laser posterior capsulotomy was performed, however, normal anterior chamber could not be restored. Despite continuous medical therapy for 3 weeks, the patient's symptoms worsened and intraocular pressure increased over 99 mm Hg and therefore, the Ahmed glaucoma valve was implanted. One day after the operation, intraocular pressure decreased to 10 mm Hg and anterior chamber depth became deeper with the depth of over 5 central corneal thickness. At the final visit 4 months postoperatively, intraocular pressure and normal anatomy of the anterior segment were well maintained. CONCLUSIONS: Malignant glaucoma syndrome can occur even in vitrectomized eyes and capsular block syndrome can initiate this. Malignant glaucoma syndrome in a vitrectomized eye resistant to maximal medical treatment can be treated with Ahmed valve implantation.

Risk Factors for Neovascular Glaucoma after Vitrectomy in Patients with Proliferative Diabetic Retinopathy

PURPOSE: The use of pre- and intraoperative vitreous bevacizumab injection and combined lens extraction with vitrectomy in patients with proliferative diabetic retinopathy (PDR) is increasing. In this study we analyzed the incidence and risk factors of neovascular glaucoma (NVG) after vitrectomy for PDR. METHODS: Patients who underwent vitrectomy for PDR from January 2004 to June 2011 were retrospectively reviewed. The minimum follow-up was 12 months. The cumulative incidence of NVG was calculated using the Kaplan-Meier survival analysis. The patients were divided into 4 groups according to lens status (preoperative pseudophakic group, simultaneous cataract surgery group, sequential cataract surgery group, non-cataract surgery group). The differences in incidence between the groups were determined by the Chi-square test. Finally, to analyze the risk factors associated with the occurrence of NVG, the Cox's regression model was used. RESULTS: Of the 614 eyes (402 patients), 284 were males and 330 were females. The mean age was 55.8 +/- 10.46 years (range 30-81 years) and the mean follow-up period was 36.6 months (range 1-93 months). Thirty-four of 614 patients (5.5%) developed postoperative NVG after vitrectomy. The probability of NVG occurrence at 6 and 12 months after vitrectomy was 0.7% and 2.5%, respectively. The incidence between the 4 groups did not show a statistically significant difference. The risk factors for postoperative NVG were male gender (RR = 3.01 p = 0.004), preoperative intravitreal bevacizumab injection (RR = 7.20, p < 0.001), and reoperation (RR = 3.18, p = 0.0037). CONCLUSIONS: The frequency of NVG after vitrectomy in patients with PDR was 5.5%. Lens status was not associated with NVG occurrence. The risk factors related to NVG were male gender, preoperative intravitreal bevacizumab injection, and reoperation.

Diverse Types of Glaucoma in Patients with Pseudoexfoliation Syndrome: Normal Pressure Glaucoma

PURPOSE: To evaluate the types of glaucoma in patients with pseudoexfoliation syndrome (PXS) and analyze the glaucomatous changes in patients with normal intraocular pressure (IOP). METHODS: A retrospective chart analysis of patients diagnosed with PXS was performed. The types of glaucoma were classified based on the IOP, optic disc examination, visual field test results, and optical coherence tomography (OCT) results. Other than those with pseudoexfoliative glaucoma (PXG), the normal IOP patients with PXS were divided into glaucomatous and non-glaucomatous groups. Later, the glaucomatous group was clinically compared to the non-glaucomatous group. RESULTS: The records of 40 patients with PXS were evaluated. Among the 48 PXS eyes, high pressure glaucoma was found in 21 eyes (43.75%), low pressure glaucoma in 5 eyes (10.42%), and non-glaucoma in 19 eyes (39.58%). However, in the 32 fellow eyes without PXS, 2 eyes (6.25%), 8 eyes (25%), and 20 eyes (62.5%) showed the above diseases, respectively. In result, PXS affected the glaucomatous change (odds ratio = 2.544, p = 0.045). By contrast, in PXS patients with normal IOP, PXS did not affect the glaucomatous change (p = 0.519). CONCLUSIONS: Diverse types of glaucoma including low pressure glaucoma may exist in patients with PXS. Considering the possibility of low pressure glaucoma in patients with PXS is necessary.

The Volume of Tumor Mass and Visual Field Defect in Patients with Pituitary Macroadenoma

PURPOSE: We used the Swedish interactive threshold algorithms (SITA) standard strategy of Humphrey perimetry, to analyze the pattern of visual field (VF) defects and evaluate the quantitative correlation between the tumor volume and severity of VF defects in patients with pituitary macroadenoma. METHODS: We reviewed 50 patients with pituitary macroadenoma who received VF test and 11 patients were excluded. VF analysis was performed with Humphrey perimeter using the SITA standard strategy. The tumor volume was assessed radiologically via brain magnetic resonance images and was calculated using Cavalieri's principle. We used the mean deviation (MD) and pattern standard deviation (PSD) of the Humphrey parameter to measure VF defect severity, and then analyzed the correlation of tumor volume with VF defects. RESULTS: Twenty nine patients (74%) showed abnormal VF and bitemporal field changes, which were the most common field defects on presentation. Seven patients (18%) had unilateral VF defects, 22 patients (56%) had bilateral VF defects. The tumor volume of the patients with VF defects was significantly larger than that of patients with normal VF (p = 0.006). The tumor volume exhibited significant negative correlation with MD (r = -0.693; p < 0.001) and significant positive correlation with PSD (r = 0.589; p < 0.001). CONCLUSIONS: In patients with pituitary macroadenoma, there was a variety of VF defects and a high correlation between the tumor volume and the severity of VF defects. SITA standard strategy can be a fast and quantitative method for evaluating central VF defects.

Comparison of Total Deviation of Standard Automated Perimetry and Matrix FDT in Preperimetric Glaucoma Patients

PURPOSE: To compare the results of total deviation (TD) as measured by standard automated perimetry (SAP) and measured with of Matrix Frequency-doubling Technology (FDT) in patients with preperimetric glaucoma. METHODS: Fifty-two eyes of 52 patients with preperimetric glaucoma were included. Subjects were examined with Matrix FDT and Stratus optical coherence tomography (OCT), and the results of each examination were analyzed. The proportions of abnormal results in SAP TD, Matrix TD, and Matrix pattern deviation (PD) were calculated. Among the results of tests, the following correlations were evaluated: SAP TD and Matrix, and visual fields and OCT. In addition, the differences in peripapillary retinal nerve fiber layer thickness (RNFL) according to the result of SAP TD in preperimetric patients with abnormal Matrix PD were analyzed. RESULTS: A abnormalities in SAP TD, Matrix TD and Matrix PD were found in 22 (42.3%), 34 (65.4%), 41 (78.9%) eyes, respectively. There was marginal correlation between SAP TD and Matrix PD (p=0.07). No significant correlation was found between SAP TD and OCT, although Matrix PD and OCT did show significant correlation (p<0.05). In preperimetric patients with abnormal Matrix PD, RNFL thickness was significantly lower in the abnormal SAP TD group than in the normal SAP TD group on average, in the superior quadrant, and at the 12 o'clock and 5 o'clock positions (p<0.05). CONCLUSIONS: In patients with preperimetric glaucoma, 42.3% and 78.9% had glaucomatous VF defects in SAP TD and Matrix PD, respectively. These results were higher than expected, especially those of SAP TD.

Analysis of Retinal Nerve Fiber Layer Thickness in Patients With Superior Segmental Optic Hypoplasia

PURPOSE: To analyze the thickness of the peripapillary retinal nerve fiber layer (RNFL) in patients with superior segmental optic hypoplasia (SSOH) using optical coherence tomography (OCT). METHODS: Ten eyes of 10 patients with SSOH and 20 eyes of 20 subjects as normal control were evaluated. The peripapillary RNFL thickness measured by Stratus OCT was compared between the two groups. RESULTS: The mean RNFL thickness was significantly different between SSOH patients (72.35+/-14.77 micrometer) and normal subjects (111.61+/-6.62 micrometer) (p<0.001). The extent to which the RNFL thickness was below 5 percentile of normal subjects on the TSNIT graph was from the 41.7+/-15.53 to 110.1+/-7.47 scan number, which corresponded mainly with the superior nasal region. Moreover, in a clock-hour analysis, the peripapillary RNFL thic kness of the SSOH patients decreased significantly from 10 o'clock to 6 o'clock compared to normal subjects (p<0.01). CONCLUSIONS: Peripapillary RNFL thickness in patients with SSOH was reduced in the superior, nasal, and inferior regions. Further studies involving larger populations of patients should be performed to verify these findings.

Retinal Nerve Fiber Layer Thickness Analysis in Early Glaucoma

PURPOSE: To investigate the difference between superior and inferior peripapillary retinal nerve fiber layer (RNFL) thickness in early glaucoma patients who have RNFL defect in either superior quadrant or inferior quadrant and to determine if it can be useful to detect early glaucomatous change. METHODS: Eighty eight patients with early glaucoma who have RNFL defect in either the superior quadrant or the inferior quadrant as confirmed by red free photograph (40 eyes with normal standard automated perimetry and 48 eyes with early glaucomatous visual field loss) were divided into the superior RNFL defect group and the inferior RNFL defect group. The average RNFL thickness was measured in the superior and inferior quadrants using optical coherence tomography and the thickness differences between the superior and the inferior quadrants (S-I difference) were compared among early glaucoma eyes and 59 normal controls. Then, discriminative power of the S-I difference was assessed by area under ROC (AUROC). RESULTS: The average thickness of the RNFL showed a statistically significant difference between early glaucoma eyes and normal controls (P<0.05). S-I differences of the superior RNFL defect group and inferior RNFL defect group in preperimetric patients and in early perimetric patients were -20.5+/-16.4 micrometer and 15.0+/-14.2 micrometer, -24.0+/-17.2 micrometer and 18.4+/-16.7 micrometer, respectively, which were significantly greater than that of the normal control group (-8.2+/-17.1 micrometer). AUROC of S-I difference in the superior and inferior defect groups of preperimetric patients were 0.691, 0.872, respectively. CONCLUSIONS: The difference in RNFL thickness between the superior and inferior quadrants (S-I difference) in early glaucoma patients was larger than in normal controls. We expect that this parameter of RNFL analysis using OCT can be useful in detecting early glaucoma.

The Relationship between Optical Coherence Tomography and Scanning Laser Polarimetry Measurements in Glaucoma

PURPOSE: To investigate the relationship between optical coherence tomography (OCT) and scanning laser polarimetry (SLP) in measuring peripapillary retinal nerve fiber layer (RNFL) thickness in glaucomatous eyes. METHODS: Fifty glaucomatous eyes were evaluated in this study. Evaluations were analyzed two ways. First, parameters of the Stratus OCT (average thickness, superior/ inferior average) and GDx VCC (TSNIT average, nerve fiber indicator (NFI), superior/ inferior average) were correlated using the Pearson's correlation coefficient (r). Secondly, comparison (r) of these parameters was completed using the mean deviation (MD) of visual field defect. RESULTS: The following parameters were found to be significantly correlated (P<0.005). TSNIT average/average thickness (r=0.673), NFI/average thickness (r=-0.742), superior average (r=0.841), and inferior average (r=0.736). In the correlation analysis using the severity of visual field defect, all these parameters had statistically meaningful correlations (P<0.005). CONCLUSIONS: GDx VCC and Stratus OCT are highly correlated in glaucomatous eyes. Therefore, peripapillary RNFL thickness measured by Stratus OCT and GDx VCC may be equally helpful in the diagnosis of glaucoma.

Diagnostic Outcomes of Patients Suspicious for Glaucoma Referred from The Company Health Screening

PURPOSE: To evaluate the diagnostic outcomes of patients suspicious for glaucoma referred from the company health screening. METHODS: In this prospective study, 147 (87 male, 60 female) patients for glaucoma suspicious referred from the company health screening were enrolled. They underwent slit-lamp examination, Goldmann applanation tonometry, gonioscopy, optic disc examination, visual field examination and peripapillary retinal nerve fiber layer (RNFL) thickness measurement using optical coherence tomography (StratusOCT) and scanning laser polarimetry (GDx VCC). We analyzed their diagnostic outcomes. RESULTS: The mean age of patients was 43.8 9.6 years. Reasons for glaucoma suspicion and the number of referred patients were 111 (75.5%) high cup/disc ratio, 23 (15.6%) high intraocular pressure and 13 (8.8%) both of these. The diagnostic outcome was as follows: glaucoma, 26 (17.7%); glaucoma suspect, 4 (2.7%); ocular hypertension (OHT), 14 (9.5%); no glaucoma and no ocular hypertension, 89 (60.5%); and normal, 18 (12.2%). CONCLUSIONS: Glaucoma, glaucoma suspect and ocular hypertension were confirmed in 27.2% of patients suspicious for glaucoma referred from the company health screening. Thus, the company health screening appears to be relatively sensitive to detecting glaucoma patients.

A Case of Conjunctival Melanoma

Primary malignant melanoma of the conjunctiva represents less than 2% of ocular melanomas and less than 1%of malignant tumors of the eye and usually derives from PAM(Primary acquired melanosis). Conjunctival melanoma spreads initially via lymphatics to the regional lymph nodes and eventually to the other organs in the body. Recently, except for advanced unresectable cases, conjunctival melanoma is treated by excision of the mass combined with cryotherapy. We report a case of conservative treatment in a patient who presented recurred conjunctival melanoma, along with the review of literatures.

Factor Analysis of Refractive Outcome in LASIK

We intended to identify preoperative factors associated with refractive outcome of LASIK.We have performed LASIK for correction of 3.25 to 19.00 diopter of myopia using Aesculap-Meditec, Mel 60.Three principal outcomes of LASIK on 75 patients (104 eyes)were examined : (1)Efficacy (2)Predictability (3)Stability.Multiple logistic regression was used to test for independent associations of multiple preoperative factors with each of three outcomes. Lesser astigmatism was associated with increased efficacy (odds ratio=0.580).Greater optical zone was associated with increased efficacy (0.289) and with lesser likelihood of instability of refraction (0.272).Greater attempted correction was associated with decreased predictability, specifically with undercorrection (4.545 :8.25-14.75D / 21.430 :> or=15.00D).Greater average SimK was associated with decreased likelihood of instability of refraction (0.602). In conclusion.preoperative factors associated with postoperative uncorrected visual acuity are amount of astigmatism and optical zone size.Predictability is associated with attempted correction.Stability is associated with average SimK and optical zone size.Such information may help guide patient selection, determine timing of fellow eye treatment, and suggest changes in the laser treatment algorithm for individual patients.

One Family of Familial Combined hyperlipidemia Associated with Various Metabolic Abnormalities / 대한내분비학회지

Familial combined hyperlipidemia is one af the manogenic disorders frequently found in humans and is seen in 0.5~2% of the general populatian, accounting for at least 10% of persons with pemature atlmmcletusis. The distinguishing feature of familial combined hyperlipidemia, in camparison with other single-gene abnarmalities of lipoprotein metabolism, is that not all affected members have the same plasma lipid phenotype; some individuals have an elevation of cholesterol concentration alane(type IIa lipoprotein pattern), while some athers have an elevation of triglyceride concentration alone(type IV pattem), and still others have elevations of both values(type IIb pattem). In any one persan, the lipid phenotype can change as a result of dietary or drug treatment. Familial combined hyperlipidemia should be suspected in those subjects with moderate hypertriglyceridemia and/or moderate hypercholestaolemia (lipoprotein types IIa, Ilb, IV), especially when premature coronary heart disease is evident in the family histary. Low plasma HDL-cholesterol, obesity, insulin resistance and hyperuricemia are often . Family members affected by familial combined hyperlipidemia should be identified and be treated, since tbe condition is associated with premature caronary heart diasease. We have found one family of familial combined hyperlipidemia with one member(case 1) associated with insulin resistance, hyperuricemia and gout, and another member(case 2) associated with diabetes mellitus and infertiTity.

Antibody-dependent Cell-mediated Cytotoxitity as a Prognostic Indicator in the Medical Treatment of Graves' Disease / 대한내분비학회지

BACKGROUND: The several forms of treatment of Graves disease-thyroidectomy, antithyroid drugs and radioiodide therapy-are in wide use now. But which therapy is best is a matter of debate. Some authors reported that in patients who underwent thyroidectomy, higher titers of serum antimicrosomal antibody were associated with 1) higher formation rates of germinal centers, 2) more lymphocyte infiltration in the thyroid tissue, 3) higher incidence of hypothyroidism, and 4) lower incidence of recurrence. We were interested in the relationship of thyroid autoantibody titers, ADCC(antibody-dependent cell-mediated cytotoxicity) activity and the clinical response to antithyroid medication. METHODS: We measured ADCC activities from patients in Graves disease(n-48), Hashimoto thyroiditis(n=17) and normal control(n=9). The patients of Graves disease were followed up for more than 1 year, and they were grouped into A(n=17, well responsed group to antithyroid medication) and B(n=31, poorly responsed group). We examined ADCC activities of patients' sera by chromium release assay. RESULTS: 1) Mean age of patients with Graves disease was 34.4210.4 years and 15 patients were male(31%). 2) Results of thyroid function tests of the Graves' patients were T 585.9 +/- 255.3 ng/dL, T4 21.3 +/- 12.2 mg/dL, TSH 0.11 +/- 0.06mIU/mL. Concentrations of antimicrosomal antibody, antithyroglobulin antibody and thyrotropin binding inhibitory immunoglobulin were 1279.1 +/- 1486.7 IU/mL, 488.1 +/- 751.1 IU/mL, and 38.5 +/- 33.4U/L respectively. 3) There was no significant difference between levels of thyroid hormones or concentrations of thyroid autoantibodies and ADCC activities in graves patients. 4) The ADCC activity of the Graves patient group(24.49%) was significantly higher than that of the normal control group(3.76%), and significantly lower than that of the Hashimotos thyroiditis group(36.34%). 5) There was no significant difference in ADCC activity between group A(18.24 +/- 13.44%) and B(27.91 +20.02%). CONCLUSION: From this results, we suggested that ADCC activity seems to be no value as a prognostic factor in predicting the response to antithyroid drugs in Graves disease patients. But, further studies, larger number of patients and long-term follow up, are needed.

A Case of Methimazole Induced Agranulocytosis Complicated with Deep Neck Abscess / 대한내분비학회지

The thiourea derivatives, propylthiouracil and methimazole are in widespread use for the treatment of hyperthyroidism. The untoward side effects of these drugs are not infrequent and agranulocytosis is the most serious side effect them. We observed one case of methimazole induced agranulocytosis complicated by deep neck abscess. A 54-year-old woman was admitted because of fever, chilling and sore throat for 1 week. The symptom was developed after receiving methimazole 30mg daily day due to hyperthyroidism during last 3 months. Physical examination revealed hyperemic, enlarged tonsils and tender swelling of the right lower neck The peripheral blood total leukoeyte count was 1,500/mm' (absolute neutrophil count, ANC 9) and a peripheral blood smear revealed few neutrophil. The patient was administered G-CSF 2 mg/kg daily, and on the fifth day of hospitalization, fever subsided and ANC increased to 3,431. On the 11th day, fever developed again and the tenderness and swelling in both lower neck area were aggrevated. Computed tomography of the neck was performed, and revealed a large deep neck abscess. After pus aspiration and antibiotics therapy, the neck abscess was disappeared.

A Case of Surgically Treated Insulinoma in Pregnancy / 대한내분비학회지

Insuliin secreting tumor is 70% prevalent disease in female and predoadnant in forth and sixth deeade. The incidence of insulinoma is one case per 250,000 patient-years. Insulinoma in pregnancy was extremely rare, and the prevalence was not reported. The diagnosis of an insulinoma is depend on demonstration of hypoglycemia with high insulin and C-peptide levels. Immunoreactive insulin/plasma glucose ratio0.3 in particular support the diagnosis of an insulinoma. Fetal complication would be developed because of hypoglycemia. In approximately half of the cases reported, surgical exploration was done during pregrancy, the remainder were treated after delivery. Insulinoma poses serious diagnostic and therapeutic problems when she is pregnant. We experienced a case of insulinoma in pregnancy that represented Whipples triad and was treated by surgical intervention.

Two Cases with Squamous Cell Carcinoma of the Thyroid Gland / 대한내분비학회지

Primary squamous cell carcinoma of the thyroid is rare, presenting much less than one percent of all primary thyroid malignancies. Most cases have been reported in elderly patients with a history of goiter. It is necessary to differentiate between primary squamous cell carcinoma and secondary involvement from other sites. Secondary involvement of the thyroid may be more amenable to palliation or cure. The treatment of choice in primary squamous cell carcinoma is radical surgery in resectable cases, but the squamous cell carcinoma behaves aggressively and carries a uniformly poor prognosis regardless of the treatment. We had an experience of a primary squamous cell carcinoma of the thyroid in two elderly patients. These patients presented a typical feature of a primary squamous cell carcinoma of the thyroid, which has been rarely reported in Korea.

Three Cases of Primary Hypothyroidism with Down Syndrome in Adult / 대한내분비학회지

Down syndrome is perhaps the most common genetic condition associated with mental retardation. In cytogenetic examination, trisomy 21 is in 95% of Down syndrome, and the others are mosaicism, translocation or deletion. There are many associated diseases with Down syndrome such as, thyroid function abnormality, congenital heart disease, intestinal blockage, and so on. Hypothyroidism appeared in 15% before adolescent in Down syndrome patients. In Korea, there were several reports of Down syndrome with hypothyroidism in childhood but not in adulthood. And we had three cases of hypothyroidism with Down syndrome in adulthood. Cytogenetic examination revealed trisomy 21 in the 2 cases and 1 case of mosaicism. Antithyroid antibody was positive in one case. None of these cases was admitted due to symptoms of hypothyroidism. It is very difficult to make the diagnosis of hypothyroidism in Down syndrome because of similarity in symptoms between Down syndrome and hypothyroidism. Thus, periodic thyroid function test should be made in Down syndrome, and this could be a part of improving quality of life in Down syndrome.

A Case with Multifocal Langerhans Cell Granulomatosis Involving the Thyroid Gland / 대한내분비학회지

Langerhans cell granulomatosis(LCG), previously termed 'Histiocytosis-X', is one of the rare disease. LCG is characterized by proliferation of Langerhans cells in a unifocal or multifocal pattern. And LCG may be manifested in a variety of way, ranging from a spontaneously regressing solitary lesion to a multisystem life-threatening disorder. This disease usually involves the bone, lung, skin and lymph node. The most common endocrinologic abnormalities in LCG are diabetes insipidus and growth hormone deficiency. LCG involving the thyroid gland is extremely rare and only a small numbers of cases have been reported worldwide. A 41-year-old diabetic female visited the hospital due to the neck swelling for 3 months and she also complained of polyuria, polydipsia and easy fatigue. LCG involving multiple organs included thyroid gland was diagnosed by high-resolution CT of lung, by characteristic histological findings of the thyroid lesion and by the immunohistochemical staining for S-100 protein and OKT 6(CD la). She is followed at OPD without any medication.

Impaired Glucose Tolerance Associated with Klinefalter Syndrome / 대한내분비학회지

Klinefelter syndrome is one of the most common forms of primary hypogonadism and infertility in males. It is a clinical syndrome consisting of gynecomastia, azoospermia, and increased urinary excretion of follicle-stimulating hormone. Fequency of diabetes mellitus, emphysema, asthma, breast cancer increase in Klinefelter syndrome. We report a 16-year-old male patient with impaired glucose tolerance in association with Klinefelter syndrome, which was confirmed by chromosome analysis. The mechanism of impaired glucose tolerance in this patient was peripheral insulin resistance which clarified by euglycemic hyperinsulinemic clamp test.