Hypertensive Complications in Patients with Primary Aldosteronism / 대한내분비학회지

BACKGROUND: Primary aldosteronism (PA) is believed to be a benign form of secondary hypertension due to the low incidence of hypertensive complications. Recently, several studies have shown that hypertensive complications were common in patients with PA. Therefore, we investigated hypertensive complications in 46 PA patients. METHEODS: Clinical and laboratory features of 46 46 patients were retrospectively analyzed. Hypertensive complications of this group were left ventricular hypertrophy, cerebrovascular accidents, hypertensive nephropathy and hypertensive retinopathy. RESULTS: Hypertensive complications were found in 30 (65.2%) of the 46 patients. The incidence of severe hypertension (higher than or equal to 110 mmHg in diastolic blood pressure) was 17.6%. Left ventricular hypertrophy was found in 26 (56.7%) of the 46 patients. Cerebrovascular accidents were found in 6 patients, and hypertensive nephropathy in 4 patients. The incidence of severe hypertensive retinopathy (higher than or equal to grade 3 in the Keith-Wagener Barker classification) was 17.6%. Of the 35 PA patients who underwent surgical treatment hypertension was found in 18 (51.4%). CONCLUSION: These results indicate that hypertensive complications are common in patients with PA, suggesting that early detection, treatment and close follow-up are necessary in PA.

Influence of Early Age at Menopause on Bone Mineral Density and Biochemical Bone Marker / 대한내분비학회지

BACKGROUND: Among the various factors affecting bone mass and bone metabolism, aging and menopause play a major role. After the disappearance of the menstrual cycle, estrogen deficiency is the most important factor in bone loss. It is still unclear whether women with early menopause have a rate of bone loss different from women whose menopause has occurred later. Various biochemical bone markers are increased after menopause but it is still unclear whether women with early menopause have biochemical bone markers different from women whose menopause has occurred later. The aim of this study was to establish whether healthy women with early or normal menopause have different bone mass, biochemical bone markers and rates of bone loss. METHODS: Postmenopausal healthy women were divided into two groups according to their age at menopause(AAM): one group with AAM > 43 years, and the other group with AAM 50 years. Bone mass was measured using a dual energy X-ray absorptiometry(DEXA) in the lumbar, femur neck, femur trochanter, and Wards triangle. Serum levels of bone alkaline phosphatase and osteocalcin, and urine levels of calcium, deoxypyridinoline and type I collagen N-telopeptide were measured using a commercial kit. RESULTS: Age and body mass index in the early menopause group were different from those in the normal menopause group. All the bone mass and the biochemical bone markers in the early menopause group were not different from those in the normal menopause group. We selected 15 subjects from the two groups matched by age and BML Bone mass of femur neck in the early menopause group was lower than in the normal menopause group matched by age and BMI. Bone mass in lumbar, femur trochanter, and Wards triangle was lower in the early menopause group than in the normal menopause group, but the difference between the two groups was not significant. After adjusting years since menopause, we didnt find the difference of bone mass between the two groups. All the bone biochemical markers were not different in the two groups matched by age and BMI. CONCLUSION: Our data suggest that women with early menopause dont lose bone faster than women with normal menopause.

Serum Leptin in Cord Blood and Its Relation with Birth Weight and Metabolic Parameters / 대한내분비학회지

BACKGROUND: Leptin, produced in the adipose tissue, is involved in the regulation of body weight. The release of the leptin is increased in obese adults even in children. This study investigated whether the serum leptin in cord blood was related to babys birth weight and metabolic parameters. METHODS: 71 pairs of singleton pregnancy babies and their mother were studied. Babies are classified in LGA (large for gestational age), AGA (appropriate for gestational age), SGA (small for gestational age) three groups. After delivery, cord blood and maternal venous blood samples were drawn. We measured the plasma leptin, insulin-like growth factor (IGF)-1, insulin and proinsulin in cord and maternal serum. RESULTS: The concentration of leptin from cord blood was increased in LGA babies and decreased in SGA babies compued with the level in AGA babies. There was positive correlatian (r=0.55, p<0.01) between the plasma leptin level in cord and birth weight. There were positive correlatian between both the plasma proinsulin (r=0.37, p<0.01) and IGF-1 (r=0.32, p<0.01) and birth weight, too. But there was no difference between female and male baby's cord blood leptin level. In multiple regression analysis, cord blood leptin level was found independent factor related to birth weight ( p=0.001) CONCLUDION : The plasma leptin, proinsulin and IGF-1 is correlates to the birth weight. These data provide evidence that leptin and proinsulin are highly related to the nutritional status already during the fetal periods, and effect on the intrauterine fetal growth.

A Case of Black Adrenocortical Adenoma Causing Cushing's Syndrome with Contralateral Nonfuncioning Adenoma / 대한내분비학회지

We report herein the case of a 38-year-old woman with Cushings syndrome caused by bilateral adrenocortical adenomas. The adrenal tumor on the left side hypersecreted cortisol and no findings of cortisol hypersecretion from the adrenal tumor on the right side were observed on bilateral adrenal vein samplings. Both adrenal tumors were resected and histologically without any findings of nodular hyperplasia. The left adrenal tumor was histologically diagnosed as a so-called black adenoma. These data imply that the adrenal adenomas developed primarily from the adrenal gland itself, and that one of the tumors was well differentiated and secreted excess hormones, while the other remained in cell proliferation without hypersecretion.

The Incidence of Postpartum Thyroiditis and Effect of High Iodine Intake on it in Korean Women / 대한내분비학회지

BACKGROUND: Postpartum thyroiditis(PPT) is one of syndromes of thyroid dysfunction that occurs in the first year after parturition. Reported incidence of PPT is 3.9-8.2% of postpartum women in several studies from different countries. The fact that 52-100% of patients with PPT have thyroid autoantibodies, and that lymphocytic infiltration of thyroid gland is the characteristic pathological feature of PPT suggest that PPT is an autoimmune disease. High iodine intake in short term period is known to aggrevate the experimental autoimmune thyroiditis. This study was performed to investigate the incidence and clinical features of PPT in Korean postpartum women who usually ingest excessive amount of idine in immediate postpartum period and to investigate the predictive value of thyroid autoantibodies in the development of PPT in them. METHOD: Between March 1996 and February 1997, 99 women without previous history of any thyroid disease who delivered babies at Boramae hospital were enrolled. Thyroid function parameters(T3, T4, free T4, TSH), thyroid autoantibodies(anti-microsomal antibody, anti-thyroglobulin antibody) and urinary iodine excretion were measured prospectively before and 1, 3 months after delivery. Dietary iodine intake during postpartum period was evaluated by questionnaire, and clinical parameters were followed up. RESULTS: During 3 months of observation, PPT developed in 8.1%(8/99) of postpartum women. Five cases had typical course having thyrotoxic phase and the other 3 cases had hypothyroid phase without toxic phase. However, only one of those required thyroid hormone replacement therapy in the latter group. There were no differences in age, baseline thyroid function parameters, parity, percent cases with family history of thyroid disease between those developed PPT (n=8) and those did not develop PPT(n=91). Duration of high iodine intake(3.8 +- 0.5 wk. vs. 3.7 +- 0.8 wk., p>0.05), total ingested amount of high iodine diet(77 +- 28 vs. 79 +- 24 bowels of miyokguk, p)0.05), and the urinary iodine excretion(1.9 +- 1.4 mg/g creatinine vs. 3.7 +- 3.7mg/g creatinine, p0.05) at 1 month postpartum were not different between two groups. Of 99 total subjects, anti-microsomal antibody(AMA) was present in 13.1%(13/99) before delivery in their sera. Positive predictive value of the presence of AMA before delivery in predicting the development of PPT was 30.8%. CONCLUSION: The fact that incidence of PPT in normal Korean postpartum women who usually have high iodine intake in immediate postpartum period is not higher than those of other countries, and that there was no difference in the amount of iodine intake between those developed PPT and those did not suggest that high iodine intake in immediate postpartum period do not influence on the incidence of PPT. The presence of AMA before delivery had low specificity in prediction of development of PPT, so the measurement of AMA seems not to be a useful screening test.

Prevalence Thyroid Cancer in Patients with Cold Thyroid Nodules in Relation to Sex, Age, And Multinodularity / 대한내분비학회지

BACKGROUND: We evaluated the prevalence of thyroid cancer in patients with cold thyroid nodules and the impact of sex, age, hardness of nodule, and multinodularity as factors able to predict the probability of malignancy in patients with nodular thyroid diseases. METHODS: We examined a 728 patients who visited Seoul National University Hospital with one or more cold thyroid nodules between Jan. 1996 and Dec. 1997. After clinical evaluations including medical history, physical examinations(size, hardness and multiplicity of nodule), fine needle aspiration biopsies and cytologic examinations were carried out. RESULTS: Among the 728 cases, 76 cases(10.4%) were diagnosed as cancer and 602 cases (82.6%) were diagnosed as benign nodule. The prevalence of cancer was significantly lower in female patients with cold nodules(9.4%, 62/662) than in males(17.5%, 11/63)(p=0.041). Age was an important factor in both sexes. The proportion of nodules that were malignant was lower in patients of 20-60 years old(8,9%, 56/632) than patients younger than 20 years old(1S.1%, 2/11) or older than 60 years old(18.3%, 15/82)(p=0.019). The prevalence of cancer was significantly higher in hard nodules(36.3%, 41/113) than firm(5.2%, 30/574) or soft nodules(5.3%, 2/38)(p= 0.001). There was no size difference between malignant(25.2 +- 13.7mm) and benign nodules(25.3 +- 8.9mm)(p=0.9425). The prevalence of thyroid cancer in solitary nodule(10.6%, 63/593) was not different from that in multiple nodules(7.6%, 10/132)(p=0.293). CONCLUSION: Our data suggest that thyroid nodules of the patients who are younger than 20 years old or older than 60 years old, male, as well as hard nodule require more careful evaluation for the risk of thyroid malignancies.

Usefulness of Immunoglobulin Fraction Precipitated with Polyethylene Glycol in Assay for TSH Receptor Antibodies using Chinese Hamster Overy Cells Expressing Human TSH Receptors / 대한내분비학회지

BACKGROUND: Graves' disease and primary myxedema are thought to be caused by the action of TSH receptor autoantibodies(thyroid stimulating antibody; TSAb & thyroid stimulation blocking antibody; TSBAb). Thus, detection of these antibodies is crucial in diagnosis and in follow up of those patients. Recently, a sensitive method using human TSH receptor transfected Chinese Hamster Ovary(CHO) cells has been developed. However, the complexity of IgG purification procedure is considered as a limitation for its clinical application as a routine test. The aim of this study is to determine whether polyethylene glycol(PEG)-precipitated immunogiobuIin fraction could substitute for purified IgG. METHODS: We developed optimal conditions for TSAb and TSBAb assays using crude, PEG precipitated immunoglobulin fraction; and evaluated the correlation of TSAb and TSBAb activities between thase measured using crude immunoglobulin fraction and purified IgG to clarify the usefulness of PEG-precipitated immunoglobulin fraction. TSH receptor expressing wild type CHO cells were used in TSAb and CHO cells expressing chimeric TSH receptor(Mc2; 90-165 amino acid residues were substituted by those of rat LH/CG receptar) were used in TSBAb assay to minimize the possible disturbing effects of TSAb in serum. RESULTS: The optimal serum amount for TSAb and TSBAb assay using PEG-precipitated immunoglobulin fraction were 250mL serum equivalent/well and 50mL serum equivalent/well, respectively. The optimal incubation time for both assays were 2 homs, and aptimal ccrncentration of bTSH for TSBAb assay was 0.1U/L. TSAb activities measured with PEG-precipitated immunoglobulin were significantly correlated with those measured with purified IgG in 26 patients with Graves diseases(r=0.93, p<0.001). Although TSBAb activities measured using PEG-precipitated imrnunoglobulin were conelated with those measured using purified IgG in 20 patients with primary myxedema(r=0.86, p<0.001), the positive rate in TSBAb assay using PEG-precipitated immunoglobulin was lower than that of usmg purified IgG(20% v.s. 65%) because of negative conversion of TSBAb activities in samples with weakly positive TSBAb activities measured using purified IgG. CONCLUSION: PEG-precipitated immunoglobulin fraction could be used instead of purified IgG in TSAb assay using hTSHR-tranasfected wild type CHO cells with equal sensitivity and specificity. This simple and practical TSAb assay using PEG-precipitated immunoglobulin in hTSHR-transfected CHO cells would be useful in clinica1 practiee.

A Case of Cughing's Disease which Responded to the Combined Treatment of Ketoconazole and Octreotide / 대한내분비학회지

The treatment of choice for Cushing's disease is surgical removal of tumor, the source of ACTH overproduction. In occasional patients in whom a surgical approach including total adrenalectomy is not feasible or surgical removal of tumor is not complete, medical treatment may be necessary because pituitary irradiation requires a long 1ag time to remission. Although ketoconazole, an imidazole derivative with inhibitory activity on adrenal steroidogenesis has been reported to be effective in the treatment of Cushing's disease, the limited effectiveness in lowering very high level of cortisol and occasional hepatotoxicity restrains its wide use. In this report, we describe a woman with Cushing's disease due to pituitary microadenoma. Transsphenoidal pituitary adenomeetomy followed by ketoconzole treatment had been unsuccessful in achieving remission of the disease, but combined treatment with ketoconazole and octreotide accomplished successful reduction in cortisol production.

Ablation of Remnant Thyroid Tissue with I-131 in Well Differentiated Thyroid Cancer After Surgery / 대한핵의학회잡지

To evaluate the effectiveness of I-131 in ablation of residual thyroid tissue, we analyzed 350 patients with thyroid cancer who were treated with various doses of I-131 after surgery for thyroid cancer. Two hundred fifty five patients were treated with l.lGBq(30mCi) of I-131 for ablation of remnant thyroid and one hundred seventeen patients received more than 2.8GBq(75mCi) of I-131. We determined the effectiveness of ablation by following I-131 whole body scan. Absent visible uptake or minimal uptake in thyroid tissue were considered as successful ablation. Of 255 patients who received doses of 30mCi I-131 therapy, 131 patients(51%) showed successful ablation of residual thyroid tissue with 2.6+/-1.7 times of I-131 therapy. Of 117 patients who received doses of the more than 75mCi I-131, 84 patients(72%) had successful remnant thyroid ablation with 1.6+/-1.1 times of I-131 therapy. According to the extent of surgery, successful ablation rates were 78%, 62%, 54%, 33% in patients who underwent total thyroidectomy, subtotal thyroidectomy, lobectomy and isthmectomy, lobectomy or tumorectomy, respectively. This study showed that ablation of remnant thyroid after surgery with 30mCi I-131 was successful only in 50%. Therefore, in cases of patients with high risk for recurrence, we recommend high dose I-131 for ablation of remnant after total thyroidectomy.

Changes of blood pressure and RBC membrane Na+ transport in thyroid disease / 대한내분비학회지

No abstract available.

The Relationship between Plasma Level of Immunoreactive Atrial Natriuretic Factor and Hemodynamic Function in Man

To evaluate the relationship between plasma level of immunoreactive atrial natriaretic factor(IR-ANF) and atrial functional index, we studied 28 cardiac patients undergoing cardiac catheterization.Plasma level of IR-ANF in aorta or pulmonary artery was significantly correlated with mean pulmonary capillary wedge pressure, right atrial mean pressure and pulmonary arterial mean pressure, but not with left artrial dimension. To evaluate the relationship between plasma level of IR-ANF and ventricular function index, we selected 13 patients who had normal artrial pressure and no mitral valular disease among 28 patients.Among ventricular functional indices, only left ventricualr end diastolic pressure was significantly correlated with plasma level of IR-ANF in aorta or pulmonary artery. Other indices, such as cardiac index, ejection fraction and aortic systolic blood pressure were not correlated with plasma level of IR-ANF in aorta or pulmonary artery. We concluded that increase in either left atrial pressure may trigger ANF release in man, although ventricles may not be involved in ANF release significantly.

The Role of Pulmonary Circulation in the Metabolism of Atrial Natriuretic Factor in Man

To evaluate the role pulmonary capillary in the metabolism of atrial natriuretic factor(ANF), we measured plasma level of immunoreative(IR) ANF in pulmonary artery, pulmonary vein, left atrium and aorta simultaneously in 7 cardiac patients with patent with foramen ovale without shunt and 8 cardiac patients with atrial septal defect(ASD) with only left to right shunt during cardiac catheterization. Plasma level of IR-ANF in pulmonary vein was significantly lower to be involved in the metabolism of ANF and that ANF secreted by left atrial myocardium is mainly drained through coronary sinus into right atrial cavity rather than directly into left atrial cavity through thebesian vein.

An experimental study on radionuclide imaging of bowel infarction using (99m)Tc-pyrophosphate

99m Tc-pyrophosphate was investigated for use as an indicator of intestinal infarction in intussusceptedbowel. Irreducible intussusceptions were created in 18 rabbits by surgery. 99mTc-pyrophosphate was then injectedintravenously 6-12, 18, 24 and 30-40 hours later for external scanning. In 15 of the rabbits, infaractiondeveloped with intussusception, and 13 of them demonstrated increased uptake of 99m Tc-pyrophosphate on externalinvivo scintiscans. The remained 2 of them showed no evidence of increased uptake. So false negative cases were2(sensitivity 86.7%). The 3 rabbits without infarction showed no increased uptake of radionuclide. Specimenscanning confirmed increased uptake of radionuclide in the infarcted segments. These observations suggest that 99mTc-pyrophosphate is a reliable indicator of the intestinal infarction that sometimes occures with intestinal intussusception.