Diabetic Ketoacidosis in a Patient with Acromegaly / 대한내분비학회지

Acromegaly is a chronic, debilitating condition caused by excessive secretion of growth hormone (GH). Impaired glucose tolerance is present in about 20-40% of acromegaly, with diabetes mellitus developing in about 10~15% of patients, but diabetic ketoacidosis is a rare association. Herein is reported a case of diabetic ketoacidosis in a 33 year-old female, with a 4 year history of typical acromegaly features. She presented with severe hyperglycemia and ketoacidosis, but with no other cause for this metabolic derangement. She had elevated plasma GH (50 ng/mL) and IGF-1 (1533 ng/mL) levels, and a pituitary macroadenoma. About 200 units of insulin per day were required for her glycemic control. However, the serum IGF-1 level and daily insulin requirement were significantly tapered after a transsphenoidal adenomectomy and long acting somatostatin analogue treatment. There was a good correlation with the daily insulin requirement and plasma IGF-1 level. This case demonstrates that severe GH excess can cause diabetic ketoacidosis, and that its successful treatment improves glucose metabolism.

Diabetic Ketoacidosis in a Patient with Acromegaly / 대한내분비학회지

Acromegaly is a chronic, debilitating condition caused by excessive secretion of growth hormone (GH). Impaired glucose tolerance is present in about 20-40% of acromegaly, with diabetes mellitus developing in about 10~15% of patients, but diabetic ketoacidosis is a rare association. Herein is reported a case of diabetic ketoacidosis in a 33 year-old female, with a 4 year history of typical acromegaly features. She presented with severe hyperglycemia and ketoacidosis, but with no other cause for this metabolic derangement. She had elevated plasma GH (50 ng/mL) and IGF-1 (1533 ng/mL) levels, and a pituitary macroadenoma. About 200 units of insulin per day were required for her glycemic control. However, the serum IGF-1 level and daily insulin requirement were significantly tapered after a transsphenoidal adenomectomy and long acting somatostatin analogue treatment. There was a good correlation with the daily insulin requirement and plasma IGF-1 level. This case demonstrates that severe GH excess can cause diabetic ketoacidosis, and that its successful treatment improves glucose metabolism.

A case of Salmonella enterica serovar Typhi endocarditis with multiple splenic infarctions / 대한내과학회지

Infective endocarditis is a very rare cardiac manifestation of salmonella infection, and splenic infarction is a rare noncardiac complication. We describe a case of Salmonella enterica serovar Typhi bacteremia which was complicated by infective endocarditis with multiple splenic infarctions in a previously healthy 47-year-old female. She didn't have any history of foreign travel. The isolate of Salmonella enterica serovar Typhi was susceptible to cephalosporins, aminoglycosides, quinolones but resistant to ampicillin. After 3 weeks of intravenous and oral therapy with ciprofloxacin, follow up transthoracic and transesophageal echocardiography showed no vegetation. In addition, follow up abdominal CT showed decreased size of splenic infarctions. The patient was treated with 2 weeks of intravenous and 4 weeks of oral ciprofloxacin, and was cured without sequelae or relapse for 6 months follow-up.

Common Bile Duct Varices: MR Cholangiography and MR Angiography Demonstration / 대한소화기내시경학회지

Extrahepatic obstruction of the portal vein, resulting in portal hypertension, may cause extensive collateral circulation at the porta hepatis. These collateral veins may compress and narrow the common bile duct, sometimes causing obstructive jaundice. Until recently, ERCP and percutaneous angiography have been used to diagnose choledochal varix. Now, MR cholangiography is replacing the diagnostic role of ERCP. This imaging has the advantage of obtaining angiography at the same time. We present a 62-year-old male patient, in whom choledochal varix accompanying choledocholithiasis, was diagnosed by MR cholangiography and contrast-enhanced MR angiography.

Papillary Stenosis and Cholangitis Caused by Endoscopic Mucosal Resection of Ampullary Adenoma / 대한소화기내시경학회지

Adenomas of the major duodenal papilla are rare but clinically important since they are a premalignant condition. Endoscopic mucosal resection has emerged as the first line therary for ampullary adenoma. However, various complications such as pancreatitis, bleeding or duodenal perforation have been reported after endoscopic mucosal resection. To our knowledge, cholangitis has not been reported as a complication of the procedure in the literature. We report a case of papillary stenosis and cholangitis caused by endoscopic mucosal resection of ampullary adenoma. We performed the endoscopic biliary spincterotomy followed by biliary stenting and cholangitis was successfully controlled.

Papillary Stenosis and Cholangitis Caused by Endoscopic Mucosal Resection of Ampullary Adenoma / 대한소화기내시경학회지

Adenomas of the major duodenal papilla are rare but clinically important since they are a premalignant condition. Endoscopic mucosal resection has emerged as the first line therary for ampullary adenoma. However, various complications such as pancreatitis, bleeding or duodenal perforation have been reported after endoscopic mucosal resection. To our knowledge, cholangitis has not been reported as a complication of the procedure in the literature. We report a case of papillary stenosis and cholangitis caused by endoscopic mucosal resection of ampullary adenoma. We performed the endoscopic biliary spincterotomy followed by biliary stenting and cholangitis was successfully controlled.

A Case of Acute Recurrent Pancreatitis Whose Etiology was Diagnosed by Endoscopic Ultrasonography / 대한소화기내시경학회지

Acute recurrent pancreatitis results most commonly from gallstone disease. Although transabdominal ultrasound is a common procedure for evaluating biliary tract, it may not be effective in minilithiasis. We here report a case of acute recurrent pancreatitis, in which endoscopic ultrasonography revealed minilithiasis in the gallbladder with a review of the literature. A 57-year-old woman had suffered from idiopathic recurrent pancreatitis four times for the past 4 months. While transabdominal ultrasonography and abdominal computerized tomography revealed no evidence of bliary stones, but EUS exhibited minilithiasis in the gallbladder. After laparoscopic cholecystectomy, no further events of pancreatitis happened.

A Case of Acute Recurrent Pancreatitis Whose Etiology was Diagnosed by Endoscopic Ultrasonography / 대한소화기내시경학회지

Acute recurrent pancreatitis results most commonly from gallstone disease. Although transabdominal ultrasound is a common procedure for evaluating biliary tract, it may not be effective in minilithiasis. We here report a case of acute recurrent pancreatitis, in which endoscopic ultrasonography revealed minilithiasis in the gallbladder with a review of the literature. A 57-year-old woman had suffered from idiopathic recurrent pancreatitis four times for the past 4 months. While transabdominal ultrasonography and abdominal computerized tomography revealed no evidence of bliary stones, but EUS exhibited minilithiasis in the gallbladder. After laparoscopic cholecystectomy, no further events of pancreatitis happened.