The Relationship between Oral Health-Related Factors and Grip Strength in the Elderly / 치위생과학회지

Background@#Among the health problems in old age, oral health is closely related to nutrition intake and digestion, so although it is an important factor in the well-being of the elderly along with general health, studies examining the relationship between oral health-related factors and grip strength of the elderly are insufficient. Therefore, this study intends to examine the relationship between oral health-related factors and grip strength, which are closely related to the general health of the elderly. @*Methods@#This study used data from the 7th period of Korea National Health and Nutrition Survey (2016∼2018) approved by the Research Ethics Review Committee of the Korea Centers for Disease Control and Prevention. Complex sample frequency analysis and descriptive statistics were performed, and general linear model analysis was performed to confirm the relationship between demographic characteristics, oral health -related factors and grip strength. The statistical analysis was performed using IBM SPSS Statistics for Windows, Version 23.0, and the significance test was based on type I error level of 0.05. @*Results@#Grip strength was higher in the case of no discomfort than in the case of discomfort in relation to mastication discomfort and grip strength (B=0.927, p＜0.001). In addition, the grip strength was decreased by 1.348 times when not using dental floss (p＜0.001) and when not using mouth wash was 1.480 times (p＜0.001). @*Conclusion@#In this study, in the relationship between oral health-related factors and grip strength, grip strength was found to be high in the absence of mastication discomfort. and in the case of using dental floss and mouthwash the elderly showed high grip strength. Therefore, it is suggested to present a lifestyle to improve hand function and grip strength in the elderly and develop a program to increase grip strength and provide them at the same time during oral health education.

Gender Sensitivity and Gender Equality Consciousness of Dental Hygiene Students / 치위생과학회지

Background@#This study was conducted to identify the level of gender sensitivity and gender equality consciousness among dental hygiene students and to confirm the necessity of gender equality programs in the curriculum. @*Methods@#A self-report questionnaire was conducted with some dental hygiene students using the Gender Sensitivity tool and Korean Gender Egalitarianism Scale for Adolescents (KGES-A). @*Results@#First, the gender equality consciousness of the students who took women’s studies was high in the areas of educational life and socio-cultural life, and that of the subjects of grandparent families and Catholic was found to be high in the domestic life area. Second, the gender sensitivity of the subjects who took women’s studies was found to be high in all sub-areas. In addition, the gender sensitivity of females was higher in the areas of sexual identity, non-violence, and self-reflection than that of males. That of 4-year college students was higher in the areas of sexual identity, openness to gender roles, and non-violence than that of 3-year college students. In addition, the gender sensitivity of Catholic students was high in the areas of sexual identity and openness to gender roles. Third, gender equality consciousness was found to have an effect depending on whether subjects took women’s studies, family type, family type, and religion, and gender sensitivity was found to have an effect depending on whether subjects took women’s studies or gender. @*Conclusion@#Since dental hygienist is a profession that targets humans, education that can instill equal awareness and values of humans is important. To inspire gender sensitivity and gender equality consciousness in a prospective professional, it is necessary to conduct programs and education related to gender intelligence within dental hygiene curriculum.

Factors Affecting Scaling Experiences of Adolescent Children from Multicultural and Native Families / 치위생과학회지

Background@#Multicultural families are constantly on the rise as marriage migrants and foreign workers increase. Multicultural families appear to record poor health levels compared to native families. As health is a social issue, children of surviving generations of multicultural families are also a growing interest. This study was conducted to confirm the effect of multicultural families and parents’ educational level on the scaling experience of children. @*Methods@#For this study, the 2016∼2018 Korea Youth Risk Behavior Web-based Survey data were used. In order to make the two groups of adolescents belonging to multicultural and native families similar, a total of 5,362 people were included in the survey, consisting of 2,681 individuals each from multicultural and native families using the propensity score matching method. Logistic analysis was performed to identify factors influencing the scaling experience of adolescent children. @*Results@#The results confirm that, even after controlling for factors such as parents’ educational level, household income, and children’s oral health behavior, parents’ nationality appeared to have a statistically significant effect on their children’s scaling experience. In addition, it was confirmed that the experience of oral health education had a significant effect. @*Conclusion@#Cultural heterogeneity and the lack of adequate language ability of immigrants affects health behavior and medical accessibility. Therefore, children from multicultural families are more likely to be exposed to unhealthy environments compared to the children of native Korean families. Based on an understanding of the socioeconomic multicultural background of individuals, education and public policy should be prepared to improve the awareness for the need for preventive oral health and provide unhindered accessibility to dental services.

Serum alanine aminotransferase levels are closely associated with metabolic disturbances in apparently healthy young adolescents independent of obesity / 소아과

PURPOSE: Liver metabolism plays a pivotal role in the development of metabolic disorders. We aimed to investigate the clinical and laboratory risk factors associated with alanine aminotransferase (ALT) levels in young adolescents from an urban population in Korea. METHODS: A population of 120 apparently healthy adolescents aged 12–13 years was included in the cross-sectional design study; 58 were overweight or obese and 62 were of normal weight. We estimated anthropometric and laboratory measurements, including waist-to-height ratio, blood pressure, insulin sensitivity, aspartate aminotransferases (AST), ALT, and lipid profiles. RESULTS: The mean ages of the overweight or obese and normal weight participants were 12.9±0.3 and 13.0±0.3 years, respectively. Height, weight, body mass index, waist circumference, waist-to-height ratio, systolic and diastolic blood pressure, AST, ALT, total cholesterol, low-density lipoprotein-cholesterol, triglyceride, insulin, and the homeostatic model assessment of insulin resistance (HOMA-IR) score were significantly higher and the high-density lipoprotein-cholesterol and quantitative insulin-sensitivity check index were significantly lower in the overweight/obese participants in comparison to the normal-weight participants (all P < 0.05). In multivariate linear regression analysis, waist-to-height ratio, systolic blood pressure, and HOMA-IR score were independently and positively associated with serum ALT levels. CONCLUSION: Screening for ALT levels in adolescents may help to differentiate those at risk of metabolic abnormalities and thus prevent disease progression at an early age.

Interventions for Dysphagia following Stroke: A Systematic Review of Randomized Controlled Trials / 대한연하장애학회지

OBJECTIVE: Dysphagia is a major complication of stroke and causes serious problems, such as lung aspiration. Previous reviews of dysphagia treatments for stroke were limited due to a dearth of available studies. More trials have been published recently warranting a re-examination of the evidence. The purpose of this systematic review was to examine the effectiveness of interventions for dysphagia in adults following stroke. METHODS: The PRISMA Statement with a 27-item checklist was used as a general guide to conduct and report a quality systematic review. Five electronic databases were searched for randomized controlled trials published in English between 2008 and 2017 examining the effectiveness of dysphagia interventions following stroke. The search terms were entered by combining the keywords related to dysphagia, stroke, interventions, and randomized controlled trials. RESULTS: Fifteen articles were included; the most commonly used interventions were Transcranial Magnetic Stimulation (4 articles), Neuromuscular Electrical Stimulation (4 articles), and Pharyngeal electrical stimulation (4 articles). CONCLUSION: This review provides evidence of the effectiveness of interventions for people with dysphagia following stroke, but there were some mixed results. The heterogeneity of the outcome measures as well as the mixed results highlight the need for further research.

Comparison of Factors Affecting Perceived and Objective Dental Needs / 치위생과학회지

BACKGROUND: With increased interest in oral health, several efforts have been made to improve oral health conditions. To achieve this, needs for oral health must be precisely determined and accurately measured. Therefore, factors influencing both objective unmet dental needs, which were determined by experts, and perceived unmet dental needs, which were determined by patients, were examined in this study. METHODS: Responses of 17,735 respondents aged greater than 19 years from the Korean National Health and Nutrition Survey collected using the fifth (2010~2012) rotation sample survey were analyzed. Based on the information collected from the survey and dental examination, we determined the associations between the independent (sex and socioeconomic level) and dependent variables using a chi-squared test. Moreover, ordinal logistic regression analyses on multiple categorical values were performed using perceived and objective dental needs as the dependent variables. RESULTS: Generally, factors influencing both perceived and objective dental needs were similar. These included sex, household income, educational level, private insurance, and subjective oral health status. However, the high-income groups had lesser perceived and objective dental needs compared to the low-income groups. Furthermore, factors such as sex, educational level, and marital status had different influence on both needs. CONCLUSION: Generally, factors that affect perceived and objective dental needs were similar. To minimize unmet dental needs, factors influencing both perceived and objective dental needs should be examined for a broad dental insurance coverage, and efforts to prevent oral diseases are also required.

Treatment of Auricular Deformities with the EarWell System in Three Newborns

Auricular deformities occur frequently in newborn infants. Typically, most pediatricians explain to parents that these deformities will get better as child grows older. But, only about 30% of auricular deformities are known to be self-correcting, and there is no reliable model to predict them. If ear molding is initiated during the first days of life with the EarWell System, successful treatment could be possible without pain in a non-surgical way. We present 3 cases of auricular deformities treated with the EarWell System. 2 infants were born with auricular deformities at Gangnam Cha Medical Center and 1 infant visited the outpatient clinic for the treatment of auricular deformities. 5 ears in 3 infants underwent ear molding using the EarWell System. They had it placed on the 20th day after birth. Average treatment time was 18.7 days, and all of them were corrected. Complications were redness, oozing, erosion and mild pressure ulcerations. Early recognition and treatment of the auricular deformity ensure the great prospect of success. Also, it is important for both the parents and the pediatricians to know that auricular deformities could be successfully treated with Earwell System.

Cultural Competence and Influencing Factors of Dental Hygiene Students / 치위생과학회지

The purpose of this study was to investigate the level of cultural competence and its influencing factors among 530 dental hygiene students. The analysis was performed using PASW Statistics ver. 18.0, and the following conclusions were drawn. Cultural knowledge levels showed a significant difference according to general characteristics in four components of cultural competence levels. Cultural competence and its four components were higher in subjects who have a religion (p<0.05). The differences in cultural competence levels according to culture-related characteristics are as follows. In individuals with experience of taking foreign culture-related classes, intention to work overseas, or fluency in a foreign language, cultural competence levels and its four components such as cultural comfort, knowledge, awareness, and behavior intent were higher (p<0.05). Intention of overseas employment was the factor most strongly influencing the level of cultural competence of the subjects. The more intention the subjects have to work overseas, the more they have experienced foreign culture-related lessons, the more fluently they speak a foreign language, and the higher level of cultural competency they reached (p<0.05). As the research results show, it is necessary to establish a continuing plan to understand and communicate with individuals of other cultures through foreign language and foreign culture classes in schools in order to improve the level of cultural competence. This education would reduce the fear and stress that subjects might make a mistake in meeting with people from other cultures, and it could be a preparatory process to actively carry out dental hygiene practice with foreigners.

A boy with 46,X,+mar presenting gynecomastia and short stature

A 15-year-old boy was referred due to gynecomastia and short stature. He was overweight and showed the knuckle-dimple sign on the left hand, a short fourth toe on the left foot, and male external genitalia with a small phallus. His levels of estradiol and follicle-stimulating hormone were increased, and his testosterone concentration was normal. Other hormonal tests were within the normal range. Radiographs showed short fourth and fifth metacarpals and fourth metatarsal bones. The karyotype was reported as 46,X,+mar, and the marker chromosome was shown to originate from the Y chromosome, which was identified by fluorescence in situ hybridization. Polymerase chain reaction and direct sequencing were used to clarify the deleted loci of the Y chromosome by making use of Y-specific sequence-tagged sites (STSs). The sex-determining region Y and centromere were verified, and there were microdeletions on the long arm of the Y chromosome. The azoospermia factor (AZF) b region was partially deleted, and AZFa and AZFc were completely deleted. Two STS probes of sY143 and the Y chromosome RNA recognition motif in AZFb showed positive signals corresponding to Yq11.223. The karyotype of the patient was interpreted as 46,X,der(Y)del(Y)(q11.21q11.222)del(Y)(q11.23qter). Herein, we report a rare case of a boy presenting with gynecomastia and short stature with 46, X, +mar, which originated from the Y chromosome, which was identified to have Yq microdeletions.

A patient with Cushing disease lateralizing a pituitary adenoma by inferior petrosal sinus sampling using desmopressin: a case report

A 14-year-old girl was referred for evaluation of the etiology of Cushing syndrome. During the previous 2 years, she had experienced weight gain, secondary amenorrhea, growth retardation, and back pain. Random serum cortisol level, 24-hour urinary free cortisol excretion, and overnight and low-dose dexamethasone suppression tests suggested Cushing syndrome. Midnight adrenocorticotropic hormone (ACTH) level and high-dose dexamethasone suppression test confirmed Cushing disease. Pituitary magnetic resonance imaging was suspicious for microadenoma. To eliminate ectopic ACTH syndrome, and lateralize the pituitary tumor, inferior petrosal sinus sampling (IPSS) was performed by desmopressin use to stimulate ACTH. Finally, the patient was diagnosed with Cushing disease due to ACTH-secreting pituitary microadenoma, lateralized to the left side; subsequently underwent transsphenoidal surgery. Here we report a case of a 14-year-old girl diagnosed with Cushing disease with a pituitary tumor lateralized by IPSS using desmopressin, which is very rare in pediatric Cushing disease.

Male patients presenting with rapidly progressive puberty associated with malignant tumors

In males, precocious puberty (PP) is defined as the development of secondary sexual characteristics before age 9 years. PP is usually idiopathic; though, organic abnormalities including tumors are more frequently found in male patients with PP. However, advanced puberty in male also can be an important clinical manifestation in tumors. We report 2 cases of rapidly progressive puberty in males, each associated with a germ-cell tumor. First, an 11-year-old boy presented with mild fever and weight loss for 1 month. Physical examination revealed a pubertal stage of G3P3 with 10-mL testes. Investigations revealed advanced bone age (16 years) with elevated basal luteinizing hormone and testosterone levels. An anterior mediastinal tumor was identified by chest radiography and computed tomography, and elevated α-fetoprotein (AFP) and β-human chorionic gonadotropin (β-hCG) levels were noted. Histopathologic analysis confirmed a yolk-sac tumor. Second, a 12-year-old boy presented with diplopia, polydipsia, and polyuria for 4 months. Physical examination revealed a pubertal stage of G3P3 with 8-mL testes. Bone age was advanced (16 years) and laboratory tests indicated panhypopituitarism with elevated testosterone level. A mixed germ-cell tumor was diagnosed with elevated AFP and β-hCG levels. Of course, these patients also have other symptoms of suspecting tumors, however, rapidly progressive puberty can be the more earlier screening sign of tumors. Therefore, in male patients with accelerated or advanced puberty, malignancy should be considered, with evaluation of tumor markers. In addition, advanced puberty in male should be recognized more widely as a unique sign of neoplasm.

Lipopolysaccharide-binding protein plasma levels as a biomarker of obesity-related insulin resistance in adolescents / 소아과

PURPOSE: Lipopolysaccharide-binding protein (LBP) is a 65-kDa acute phase protein, derived from the liver, which is present in high concentrations in plasma. Data regarding the association between circulating plasma LBP levels and obesity-related biomarkers in the pediatric population are scarce. We aimed to determine whether there was a difference in plasma LBP levels between overweight/obese and normal-weight adolescents and to assess the correlation of circulating LBP levels with anthropometric measures and obesity-related biomarkers, including insulin resistance, liver enzyme levels, and lipid profiles. METHODS: The study included 87 adolescents aged 12-13 years; 44 were overweight/obese and 43 were of normal-weight. We assessed anthropometric and laboratory measures, including body mass index (BMI), blood pressure, insulin resistance, liver enzyme levels, and lipid profiles. Plasma LBP levels were measured using an enzyme-linked immunosorbent assay. RESULTS: The mean age of the participants was 12.9±0.3 years. Circulating plasma LBP levels were significantly increased in overweight/obese participants compared with those in normal-weight participants (7.8±1.9 µg/mL vs. 6.0±1.6 µg/mL, P<0.001). LBP levels were significantly and positively associated with BMI, systolic blood pressure, aspartate aminotransferase, alanine aminotransferase, total cholesterol, low density lipoprotein-cholesterol, fasting glucose and insulin, and insulin resistance as indicated by the homeostatic model assessment of insulin resistance (HOMA-IR) (all P<0.05). In multivariate linear regression analysis, BMI and HOMA-IR were independently and positively associated with plasma LBP levels. CONCLUSION: LBP is an inflammatory biomarker associated with BMI and obesity-related insulin resistance in adolescents. The positive correlation between these parameters suggests a potentially relevant pathophysiological mechanism linking LBP to obesity-related insulin resistance in adolescents.

A 2-month-old boy with hemolytic anemia and reticulocytopenia following intravenous immunoglobulin therapy for Kawasaki disease: a case report and literature review / 소아과

Herein, we report a rare case of hemolytic anemia with reticulocytopenia following intravenous immunoglobulin therapy in a young infant treated for Kawasaki disease. A 2-month-old boy presented with fever lasting 3 days, conjunctival injection, strawberry tongue, erythematous edema of the hands, and macular rash, symptoms and signs suggestive of incomplete Kawasaki disease. His fever resolved 8 days after treatment with aspirin and high dose infusion of intravenous immunoglobulin. The hemoglobin and hematocrit decreased from 9.7 g/dL and 27.1% to 7.4 g/dL and 21.3%, respectively. The patient had normocytic hypochromic anemia with anisocytosis, poikilocytosis, immature neutrophils, and nucleated red blood cells. The direct antiglobulin test result was positive, and the reticulocyte count was 1.39%. The patient had an uneventful recovery. However, reticulocytopenia persisted 1 month after discharge.

Correlation between Oral Health Condition and Life Quality Related to General Health Using EuroQol-5 Dimension / 치위생과학회지

With change in the pattern of disease occurrence and increase in the interest in health, efforts to assess the health status on patients covering their subjective awareness at the same time as clinical and objective evaluation on health are continued. To measure health-related quality of life can be one of these efforts. This study was performed to evaluate the relevance of the quality of overall health-related-life and oral health condition. Also the second year (2014) materials in the 6th the National Health and Nutrition Survey were applied to this study. The factors affecting general health related quality of life measured by EuroQol-5 dimension (EQ-5D) have been confirmed by gender, age, education level, income level, private health insurance, perceived health status, toothache experience during the last 1 year, remaining tooth number. As oral health plays an important role in determining the overall health conditions, objective oral health state influences the whole body health. Hence, it can be regarded that oral health is ultimately related to the general health-related quality of life.

Correlation among Halitosis, Xerostomia and Stress in Adults / 치위생과학회지

This study is conducted to provide a basis for effective management of bad breath with a poll in 155-scaling patients visiting the dental hygiene department of a university located in Gyeong-gi province after grasping the relevance among halitosis, xerostomia, and stress from them. Analysis was performed using PASW Statistics 18.0. The results of the halitosis measurements based on the general properties showed a significant difference in the hydrogen sulfide (H₂S) level depending on the patient's age; the highest level of 355.61 was observed in patients in their twenties followed by 227.85 in the fifties (p<0.001). The level was higher in cases with sinusitis or rhinitis (p=0.034). The H₂S and (CH₃)₂S levels showed are levant (r=0.492, p<0.01) correlation with the components of halitosis. Further, among other factors affecting breath odor, (CH₃)₂S was shown to increase with increased stress. These results indicate that emotional factors, such as stress, should be considered when diagnosing patients with halitosis, and systematic and standardized diagnostic tools should be developed.

Ultrasound measurement of pediatric visceral fat thickness: correlations with metabolic and liver profiles

PURPOSE: Abdominal obesity is a fundamental factor underlying the development of metabolic syndrome. Because of radiation exposure and cost, computed tomography or dual-energy X-ray absorptiometry to evaluate abdominal adiposity are not appropriate in children. Authors evaluated whether ultrasound results could be an indicator of insulin resistance and nonalcoholic fatty liver disease (NAFLD). METHODS: We enrolled 73 subjects (aged 6-16 years) who were evaluated abdominal adiposity by ultrasound. Subcutaneous fat thickness was defined as the measurement from the skin-fat interface to the linea alba, and visceral fat thickness (VFT) was defined as the thickness from the linea alba to the aorta. Anthropometric and biochemical metabolic parameters were also collected and compared. The subjects who met 2 criteria, radiologic confirmed fatty liver and alanine aminotransferase >40, were diagnosed with NAFLD. RESULTS: There was a strong positive correlation between VFT and obesity. VFT was highly correlated with the homeostasis model assessment for insulin resistance score (r=0.403, P<0.001). The area under the curve for VFT as a predictor of NAFLD was 0.875 (95% confidence interval [CI], 0.787-0.964). VFT of 34.3 mm was found to be the discriminating cutoff for NAFLD (sensitivity, 84.6%; specificity, 71.2%, respectively). CONCLUSION: Ultrasound could be useful in measuring VFT and assessing abdominal adiposity in children. Moreover, increased VFT might be an appropriate prognostic factor for insulin resistance and NAFLD.

Ultrasound measurement of pediatric visceral fat thickness: correlations with metabolic and liver profiles

PURPOSE: Abdominal obesity is a fundamental factor underlying the development of metabolic syndrome. Because of radiation exposure and cost, computed tomography or dual-energy X-ray absorptiometry to evaluate abdominal adiposity are not appropriate in children. Authors evaluated whether ultrasound results could be an indicator of insulin resistance and nonalcoholic fatty liver disease (NAFLD). METHODS: We enrolled 73 subjects (aged 6-16 years) who were evaluated abdominal adiposity by ultrasound. Subcutaneous fat thickness was defined as the measurement from the skin-fat interface to the linea alba, and visceral fat thickness (VFT) was defined as the thickness from the linea alba to the aorta. Anthropometric and biochemical metabolic parameters were also collected and compared. The subjects who met 2 criteria, radiologic confirmed fatty liver and alanine aminotransferase >40, were diagnosed with NAFLD. RESULTS: There was a strong positive correlation between VFT and obesity. VFT was highly correlated with the homeostasis model assessment for insulin resistance score (r=0.403, P<0.001). The area under the curve for VFT as a predictor of NAFLD was 0.875 (95% confidence interval [CI], 0.787-0.964). VFT of 34.3 mm was found to be the discriminating cutoff for NAFLD (sensitivity, 84.6%; specificity, 71.2%, respectively). CONCLUSION: Ultrasound could be useful in measuring VFT and assessing abdominal adiposity in children. Moreover, increased VFT might be an appropriate prognostic factor for insulin resistance and NAFLD.

Clinical risk factors associated with the development of wheezing in children less than 2 years of age who required hospitalization for viral lower respiratory tract infections / 소아과

PURPOSE: Wheezing following viral lower respiratory tract infections (LRTIs) in children <2 years of age is an important risk factor for the development of asthma later in life; however, not all children with viral LRTIs develop wheezing. This study investigated risk factors for the development of wheezing during viral LRTIs requiring hospitalization. METHODS: The study included 142 children <2 years of age hospitalized for LRTIs with at least one virus identified as the cause and classified them into children diagnosed with LRTIs with wheezing (n=70) and those diagnosed with LRTIs without wheezing (n=72). RESULTS: There were no significant differences in the viruses detected between the two groups. Multivariate logistic regression analysis showed that, after adjusting for potentially confounding variables including sex and age, the development of wheezing was strongly associated with parental history of allergic diseases (adjusted odds ratio [aOR], 20.19; 95% confidence interval [CI], 3.22-126.48), past history of allergic diseases (aOR, 13.95; 95% CI, 1.34-145.06), past history of hospitalization for respiratory illnesses (aOR, 21.36; 95% CI, 3.77-120.88), exposure to secondhand smoke at home (aOR, 14.45; 95% CI, 4.74-44.07), and total eosinophil count (aOR, 1.01; 95% CI, 1.01-1.02). CONCLUSION: Past and parental history of allergic diseases, past history of hospitalization for respiratory illnesses, exposure to secondhand smoke at home, and total eosinophil count were closely associated with the development of wheezing in children <2 years of age who required hospitalization for viral LRTIs. Clinicians should take these factors into consideration when treating, counseling, and monitoring young children admitted for viral LRTIs.

Clinical manifestations of testicular adrenal rest tumor in males with congenital adrenal hyperplasia

PURPOSE: In male patients with congenital adrenal hyperplasia (CAH), the presence of testicular adrenal rest tumors (TARTs) have been reported, however their prevalence and clinical manifestations are not well known. Untreated TARTs may lead to testicular structural damage and infertility. This study was conducted to investigate the prevalence of TARTs in male patients with CAH, and characterize the manifestations to identify contributing factors to TART. METHODS: Among 102 CAH patients aged 0-30 years, 24 male patients have been regularly followed up in our outpatient clinic at Severance Children's Hospital from January 2000 to December 2014. In order to reveiw the characteristics of TART patients, we calculated the mean levels of hormones during the 5 years before the time of investigation. Five patients underwent follow-up scrotal ultrasonography (US) after adjusting the dosage of glucocorticoids. RESULTS: TARTs were detected in 8 of the 13 patients (61.5%). The median age of TARTs diagnosis was 20.2 years with the youngest case being 15.5 years old. The mean serum level of adrenocorticotropic hormone (ACTH) was higher in the TARTs patient group compared to the non-TARTs group (P<0.05). The tumor size decreased in 3 cases, slightly increased in 1 case, and had no change in another case. CONCLUSION: The serum ACTH level might be associated with the growth promoting factor for TARTs, but the exact mechanism has not been clearly identified. Screening for TARTs using US is important in male patients with CAH for early-detection and prevention of ongoing complications, such as infertility.

Hypotonic hyponatremia by primary polydipsia caused brain death in a 10-year-old boy

Hypotonic hyponatremia by primary polydipsia can cause severe neurologic complications due to cerebral edema. A 10-year-and-4-month-old boy with a psychiatric history of intellectual disability and behavioral disorders who presented with chief complaints of seizure and mental change showed severe hypotonic hyponatremia with low urine osmolality (serum sodium, 101 mmol/L; serum osmolality, 215 mOsm/kg; urine osmolality, 108 mOsm/kg). The patient had been polydipsic for a few months prior, and this had been worse in the previous few days. A diagnosis of hypotonic hyponatremia caused by primary polydipsia was made. The patient was in a coma, and developed respiratory arrest and became brain death shortly after admission, despite the treatment. The initial brain magnetic resonance imaging showed severe brain swelling with tonsillar and uncal herniation, and the patient was declared as brain death. It has been reported that antidiuretic hormone suppression is inadequate in patients with chronic polydipsia, and that this inadequate suppression of antidiuretic hormone is aggravated in patients with acute psychosis. Therefore, hyponatremia by primary polydipsia, although it is rare, can cause serious and life-threatening neurologic complications.