Diagnostic Significance of the Urine-Stick Test in Middle and High School Children in Seoul

PURPOSE: This study was performed to assess the diagnostic significance of the urine-stick test in detecting Diabetes Mellitus (DM) and to assess the clinical characteristics of adolescent diabetes. MEHTODS: A total of 926,208 middle and high school children participated. The urine-stick test was performed and those who showed glycosuria and, further studies such as evaluations of plasma glucose, triglyceride, cholesterol and C-peptide level done. We compared the clinical characteristics between the diabetes group and non-diabetes group. RESULTS: Among 926,208 students, 1,020 (0.11%) showed glycosuria. Among the 1,020 glycosuria positive subjects, 339 (33.2%) had further laboratory tests. Two hundred and sixty-eight cases (79.1%) were normal, 52 cases (15.3%) were newly diagnosed as DM, 9 cases (2.7%) were already diagnosed DM, 10 cases (2.9%) had an impaired glucose tolerance. The 52 newly diagnosed DM cases, whose postprandial 2 hour glucose level was more than 200m/dL, showed different fasting glucose levels. Thirty cases (57.7%) had a level of more than 140mg/dL, 11 cases (21.1%) were between 110 and 140mg/dL and 11 cases (21.1%) were at a level of less than 110mg/dL. Polydipsia, polyuria and polyphagia were frequent symptoms exibited by the DM group while weight loss and fatigue showed no significant difference between the DM and non-diabetes groups. Six cases were type 1 DM and 44 cases were type 2 DM. Being female, having a family history of DM and a higher BMI and higher diastolic blood pressure were significant risk factors for DM. CONCLUSION: The positive rate of glycosuria by the urine-stick test was 0.11%. Among glycosuria positive subjects 15.3% were newly diagnosed as DM. For the high risk group, an annual urine-stick test and a postprandial blood glucose test should be performed and a systematic referral system is necessary.

Diagnostic Significance of the Urine-Stick Test in Middle and High School Children in Seoul

PURPOSE: This study was performed to assess the diagnostic significance of the urine-stick test in detecting Diabetes Mellitus (DM) and to assess the clinical characteristics of adolescent diabetes. MEHTODS: A total of 926,208 middle and high school children participated. The urine-stick test was performed and those who showed glycosuria and, further studies such as evaluations of plasma glucose, triglyceride, cholesterol and C-peptide level done. We compared the clinical characteristics between the diabetes group and non-diabetes group. RESULTS: Among 926,208 students, 1,020 (0.11%) showed glycosuria. Among the 1,020 glycosuria positive subjects, 339 (33.2%) had further laboratory tests. Two hundred and sixty-eight cases (79.1%) were normal, 52 cases (15.3%) were newly diagnosed as DM, 9 cases (2.7%) were already diagnosed DM, 10 cases (2.9%) had an impaired glucose tolerance. The 52 newly diagnosed DM cases, whose postprandial 2 hour glucose level was more than 200m/dL, showed different fasting glucose levels. Thirty cases (57.7%) had a level of more than 140mg/dL, 11 cases (21.1%) were between 110 and 140mg/dL and 11 cases (21.1%) were at a level of less than 110mg/dL. Polydipsia, polyuria and polyphagia were frequent symptoms exibited by the DM group while weight loss and fatigue showed no significant difference between the DM and non-diabetes groups. Six cases were type 1 DM and 44 cases were type 2 DM. Being female, having a family history of DM and a higher BMI and higher diastolic blood pressure were significant risk factors for DM. CONCLUSION: The positive rate of glycosuria by the urine-stick test was 0.11%. Among glycosuria positive subjects 15.3% were newly diagnosed as DM. For the high risk group, an annual urine-stick test and a postprandial blood glucose test should be performed and a systematic referral system is necessary.

The Clinical Types and Characteristics of Diabetes Mellitus in Korean Children

PURPOSE: Diabetic children should be classified into type 1 or 2 for adequate diabetic control. However, there is a shortage of information of the appropriate criteria in Korea. This study is desinged to discover the clinical types and characteristics of diabetes mellitus(DM) in Korean children. METHODS: We studied the clinical characteristics and laboratory findings of 177 diabetic children. Classification was based on the serum C-peptide levels, presence of ketoacidosis, autoantibodies, and insulin dependence. RESULTS: Among 177 diabetic children, 147(83.1%) were classified as type 1 and 21(11.9%) as type 2, and 12(57.1%) children in type 2 were obese. All patients with age of onset before 9 were type 1. In cases of type 1, initial serum C-peptide levels were 1.0ng/mL (6%). All patients with initial serum C-peptide level above 1.5ng/mL were type 2. Four patients initially diagnosed as type 2 DM changed to type 1 during follow-up, and 2 patients of type 1 DM changed to type 2. Only 55.4% of type 1 DM patients had insulin autoantibody, islet cell cytoplasmic antibody or anti-glutamic acid decarboxylase antibodies. CONCLUSION: Most diabetic children in Korea were classified as type 1. Our results suggest that insulin requiring lean patients with positive autoantibody should be classified as type 1 even if their serum C-peptide levels are within normal range, and the clinical types could be changed during follow-up in a small proportion of diabetic children.

Leptin Levels and Obesity in Childhood / 대한소아내분비학회지

PURPOSE: Leptin is a hormone involved in the regulation of energy balance. Serum leptin levels are correlated with body fat. It provide information to hypothalamus on the amount of energy stored in the adipose tissue. Certain endocrine disease presents obesity in childhood, such as growth hormone deficiency, Prader- Willi syndrome and Turner syndrome. The purpose of this study is to evaluate leptin levels in obese children and to know whether it is a useful marker to differentiate the underlying cause of obesity. METHODS: One hundred sixty six obese children were included in this study. Height, weight, HTSDS, WTSDS, adjusted WTSDS to height age and BMI were measured. Serum leptin levels were measured. RESULTS :Leptin levels in simple obesity, growth hormone deficiency, Prader-Willi syndrome, Turner syndrome and control were 12.3+/-6.3ng/ml, 6.4+/-2.0ng/ml, 19.9+/-11.2ng/ml, 8.9+/-5.3ng/ml, 5.7+/-3.7ng/ml respectively. Leptin levels were significantly high in obese children, especially in Prader-Willi syndrome, simple obesity and Turner syndrome. Leptin concentration were correlated with BMI and WTSDS. CONCLUSION: Leptin can be used as an indicator of obesity but, not suitable as a differential diagnostic factor for obesity.

Pituitary Hyperplasia Secondary to Primary Hypothyroidism Mimicking Pituitary Tumor

No abstract available.

The Growth Hormone Levels and the Effect of Growth Hormone in the Children with Chronic Renal Failure / 대한소아내분비학회지

PURPOSE:Growth retardation is a serious clinical problem in children with chronic renal failure(CRF). Dialysis and renal transplantation do not provide an improvement in growth velocity. Possible causes of growth retardation are nutritional deficiency, electrolyte imbalance, uremia, renal asteodystrophy and chronic anemia. However, catch-up growth cannot be achieved after correcting these factors. There is no concordance about disturbances of growth hormone(GH)-insulin-like growth factor-I (IGF-I) axis. in CRF. This study was designed to evaluate the growth status, IGF-I, GH and the effect of GH in CRF. METHODS:Twelve children with CRF(five were treated conservative, seven were transplanted) were included. IGF-I, stimulated GH, 24 hour integrated concentration of GH (IC-GH)were measured. Six were given rhGH(0.1U/kg/day) for average one year. RESULTS: 1)Growth velocity(GV) was 3.2+/-0.8cm/yr(conservative therapy:3.3+/-0.7, transplanted:2.9+/-0.8). Height standard deveation score(SDS) was -2.4+/-1.3cm/yr(conservative therapy group:-3.3+/-1.4, transplanted group:-1.3+/-0.4). Bone age lagged 2.1+/-13yr behind chronological age. 2) IGF-I concentrations were normal. 3)Stimulated GH levels were normal(16.6+/-3.3ng/ml) except one patient. Twenty- four hour IC-GH were less than 3.2ng/ml in 4 patients. 4)After GH therapy, GV increased 3.3+/-0.7cm/yr to 5.4+/-0.8cm/yr and Ht SDS increased -3.3+/-1.4 to -2.9+/-1.5 in the conservatively treated group. GV increased 2.9+/-0.8cm/yr to 5.5+/-1.8cm/yr and Ht SDS increased -1.3+/-0.4 to -0.8+/-0.5 in the transplanted group. CONCLUSION: Stimulated GH was normal but spontaneous secretion of GH was decreased in some patients with CRF. This neurosecretory dysfunction may be one causative factor in CRF. For these patients GH replacement therapy will be effective in promoting growth.

The Effects of Growth Hormone on Pubertal Maturation / 대한소아내분비학회지

PURPOSE:The recombinant human growth hormone is widely used to improve short stature but it was reported that GH therapy might accelerate sexual maturation especially short girl. We tried to find out the effects of GH on pubertal progression in female rat. METHODS:In animal experiment, forty female Sprague-Dawley rats were treated with rhGH(1U/kg). GH was given subcutaneously daily for 5weeks since 25day of life. We measured body weight and length twice a week, vaginal opening and epithelial change were observed daily. We checked the serum estrogen and insulin-like growth factor- I concentration weekly. The results were compared to 40 control female rats. RESULTS: 1) Body weight increased significantly in GH treated group(P0.1). First diestrous phase of puberty was noted on postnatal 36.8+/-1.9day and 38.3+/-3.0day, respectively(p>0.1). 4) The difference of serum E2 concentration of two group was insignificant. CONCLUSIONS:GH administration in female rats increased body weight and length without accelerating of pubertal maturation compared to control group. So GH treatment will give a good favor on final height.

Two Cases of Pituitary Hyperplasia Secondary to Primary Hypothyroidism Mimicking Pituitary Tumor / 대한소아내분비학회지

Pituitary adenoma should be differentiated diagnostically from pituitary hyperplasia, which can be classified by primary, secondary & tertially caused by ectopic tumors. Two cases with marked pituitary enlargement secondary to primary hypothyroidism were reported. The volume of the sellar turcica correlates with circulating TSH level. The subsequent regression with thryoxine therapy indicated hyperplasia rather than adenoma. This observation emphasizes the importance of diagnosing and treating primary hypothyroidism prior to considering surgery for possible pituitary adenoma. A brief review of related literatures was also made.

Two Cases of Hyperinsulinemic Hypoglycemia / 대한소아내분비학회지

Hyperinsulinemic hypoglycemia is a relatively rare disease in childhood period except neonate, but hypoglycemia due to delicate imbalance between glucose production & consumption is evoked easily and left permanent damage to brain at these period. The definition is that serum insulin level is above 10microU/ml when blood sugar level is below the 40mg/dl and so I/G ratio is higher than 0.4. The clinical manifestations are irrtability, frequent feeding and seizures etc. and there is no specific pancreatic pathology in most cases. We experienced 2 cases of hyperinsulinemic hypoglycemia with pancreatic hyperplasia and pancreatic adenoma each other. The diagnosis was made on clinical manifestations, laboratory results, radiologic and pathologic findings. We reported these cases with brief review of literature.

Growth Promoting Factors Which Affect Final Adult Height / 대한소아내분비학회지

PURPOSE:Factors influencing postnatal growth are innumerable. It is known that genetic factors such as parental height and environmental factors such as nutrition, economic status and hormonal effects are important factors. The purpose of this study was to examine the factors affecting final adult height in normal children. METHODS:753 high school students (513 boys, 240 girls) who live in Seoul were studied. Height and body weight were measured and questionaires about sexual development were examined. We included the subjects who reached fianl adult height. The criteria of final adult height was as following: ages over 17 years in the boys and over 15 years in the girls and growth velocity was less than 1 cm per year. They had no systemic diseases and height standard deviation scores were more than -2.5. RESULTS: 1)Final adult heights were 173.1+/-.1cm in boys and 160.9+/-.7cm in girls. 2)Final adult height significantly correlated with father height(r=0.13, p<0.01), mother height(r=0.25, p<0.01), midparental height(r=0.25 p<0.01) and birth weight (r=0.16, p<0.01). 3)In short final adult height groups, birth weight and midparental height were significantly lower(p<0.05), but puberty onset age, body mass index and economic status were similar to normal stature groups. 4)Final adult height significantly correlated with target height.(r=0.43, p<0.01). In boys, the final adult height was 1.7cm taller than target height on the average. In girls, final adult height was 1.6cm taller than target height on the average. 5)In the group in which final adult height is less than target height, birth weights were significantly lower than those of the groups in which final height is greater than target height. CONCLUSIONS:Among factors affecting final adult height, parent height and birth weight were important. To predict final adult height, target height can be used simply and target height showed significant correlation with final adult height. In the case of showing differences between final adult height and target height, many factors including birth weight will influence the outcome.

Growth Status in Infants Born Intrauterine Growth Retardation / 대한소아내분비학회지

PURPOSE:In infants born intrauterine growth retardation(IUGR), there may be persistent short stature in childhood and adulthood, although most IUGR infants show some degree of catch-up growth. The purpose of this study was to describe the postnatal growth status in order to determine the incidence of catch-up growth. METHODS:This study was carried out with the 260 IUGR infants(birth weight<2,500gm) born at Inje University Sanggye Paik Hospital, from October 1989 to March 1995. RESULTS: 1)Mean gestational age was 38.3+/-.6weeks, mean birth weight was 2.3+/-.2kg and mean birth length was 46.1+/-.7cm. 2)Mean height standard deviation score(height SDS) was 0.02+/-.03. Height SDS was -0.002+/-.71 at 1 year of age, 0.03+/-.14 at 2 years of age, -0.03+/-.71 at 3 years of age, 0.01+/-.24 at 4 years of age, 0.16+/-.24 at 5 years of age, -0.08+/-.43 at 6 years of age. 3)Of the entire study group of the 260 children, 16 children (6%) were below 10 percentile in height. 1 of 36 (2.8%) was below 10 percentile in height at 1 year of age, 5 of 86(5.8%) at 2 years of age, none at 3 years of age, 6 of 44 (13.6%) at 4 years of age, 1 of 25 (4.0%) at 5 years of age, 3 of 17 (17.6%) at 6 years of age. 4)Height SDS significantly correlated with gestational age (r=0.57, p<0.01), birth weight (r=0.17, p<0.01) and midparental height (r=0.72, p<0.01). 5)Birth length and midparental height showed significant differences between catch-up group and non-catch-up group (p<0.01). Condusions:In summary, of the infants born IUGR, 94% showed catch-up growth. Birth length and midparental height were significantly lower in non- catch-up group.

The Effects of Growth Hormone on Carbohydrate and Lipid Metabolism / 대한소아내분비학회지

PURPOSE:Growth hormone stimulates longitudinal growth, and it also exerts various effects on the metabolism of carbohydrates, lipids and proteins, indirectly regulating fuel metabolism. A hallmark is the stimulation of lipolysis, suppression of glucose oxidation, and development of insulin resistance. These metabolic effects subsequently affect body composition and atherogenic risk factors. There have recently been numerous reports concerning the metabolic effects of growth hormone, but the results are conflicting and exact cellular mechanism of action is yet unknown. The aim of this study is to assess the effect of biosythetic growth hormone replacement on carbohydrate and lipid metabolism and its subsequent effect on atherogenic risk in growth hormone deficient and idiopathic short stature. METHODS:We studied 111 idiopathic short stature patients and 12 children diagnosed with growth hormone deficiency by growth hormone provocation tests. Subjects were divided into three groups on the basis of duration of treatment; those who had been receiving GH replacement for 6, 12 and 18 months. Growth hormone was adminstered in a subcutaneous dose of 0.1 units per kg 6 times a week, and levels of blood sugar, total cholesterol, triglycerides, HDL-cholesterol, free fatty acid were measured before and after treatment in each group and changes in the atherogenic index (calculated as total cholesterol/HDL-cholesterol) were compared. RESULTS: 1)Blood sugar levels showed no significant change after GH therapy in both idiopathic short stature and growth hormone deficient groups. 2)Levels of total cholesterol showed a signficant decrease 6, 12 and 18 months after GH therapy in the idiopathic short stature patients, but no signficant change was noted in the growth hormone deficient patients. 3)GrowthhormonetherapyshowednosignificanteffectoneitherHDL-cholesterol or atherogenic index in both idiopathic short stature and growth-hormone deficient children. 4)There was no significant change in triglyceride and free fatty levels in children with idiopathic short stature after growth hormone therapy. CONCLUSIONS:Growth hormone administration significantly lowered total cholesterol levels in idiopathic short stature children, but failed to have a significant effect on atherogenic risk. Despite the increasingly widespread use of growth hormone in the treatment of hypopituitarism and non-GHD short stature, data concerning the metabolic effects of growth hormone are conflicting and the precise underlying mechanism is yet to be revealed, making further research necessary to determine the long term consequences of growth hormone replacement.

Final Adult Height in Patients with Turner Syndrome / 대한소아내분비학회지

PURPOSE: Short stature is the most constant finding in Turner syndrome. Short stature in Turner syndrome has lately received considerable attention, mostly because of recent attemp to improve growth by hormonal treatments; growth hormone, oxandrolone, estrogen. The aim of this study was to find out whether growth promoting treatment would improve final height in girls with Turner syndrome. METHODS:Seventy-one girls with the clinical chracteristics Turner syndrome verified by karyotype analysis were entered into this study. The following selection criteria for final adult height were used; Chronological age of more than 14years old, bone age of more than 15years old and growth velocity of less than 0.5cm per 6months. Analysis was performed by means of multiple regression analysis between descriptive data; modality of treatment with oxandrolone and/or estrigen, parental height, karyotype and final adult height. RESULTS: 1) The final adult height of untreated Turner syndrome was 138.9+/-3.9cm. 2)The final adult height in 29 GH treated Turner girls was 143.9+/-6.5cm, significant higher value than 42 GH untreated Turner girls height, 139.8+/-5.2cm(p<0.01). 3) The final height in GH only group and combined group were 141.2+/-6.0cm, 146.2+/-6.2cm, respectively. The combined therapy was more effective than GH therapy(p<0.01). 4) The final height in 32 patients with karyotype of 45,X was 141.6+/-5.6cm, and that of 31 structural aberration group was 140.3+/-6.2cm. There was no significant difference between two groups. But in mosaicism, only numeric abnormalities, the final height 145.9+/-6.1cm was much more higher than other two groups(p<0.05). 5) The final adult height in Turner syndrome was in good correlation with target height. Final adult height(cm)= 1.01*Target height(cm)- 4.97 r=0.51, p<0.05. 6) There was positive correlation between final adult height and height SDS at start GH treatment and negative correlation with age at start GH treatment. The delta height (final height - height at start treatment) correlate with GH treatment duration. CONCLUSIONS:The final adult height in Turner syndrome in a given ethinic or national population varies in the same way as adult height in normal women. Growth hormone therapy may increase final height in Turner syndrome irrespective of ethinic or national difference. Further growth was observed in GH combined with estrogen or oxandrolone.

The Changes of the Bone Mineral Density by Treatment Modality in Patients with Turner Syndrome / 대한소아내분비학회지

PURPOSE:Decreased bone mineral density(BMD) has been reported in girls with Turner syndrome. Estrogen therapy is recommanded to improve sexual infantilism and decreased BMD. Short stature is also characteristic finding in patients with Turner syndrome. Treatment modality for short stature has included estrogen, anabolic steroids and growth hormone(GH). Recently GH therapy in GH deficient children could increase BMD in addition to improve short stature. We observed the treatment effects on bone mineral density in patients with Turner syndrome. METHODS: Bone Mineral Density in second to fourth lumbar spine area were measured by dual energy X-ray absorptiometry in 56 girls with Turner syndrome, before and after growth hormone and/or estrogen. All Turner girl was confirmed by clinical and chromosomal examination. RESULTS: 1) There was no significant difference in BMD according to karyotype. 2) The mean BMD of untreated Turner syndrome was 0.752+/-0.122g/cm2. 3) The mean BMD before and after GH treatment were 0.620+/-0.028g/cm2, 0.793+/-0.093g/cm2 respectively. The mean BMD before and after estrogen treatment were 0.761+/-0.125g/cm2, 0.918+/-0.141g/cm2 respectively. In combined group, the BMD were 0.752+/-0.087g/cm2 and 0.939+/-0.134g/cm2. Growth hormone was also effective to improve BMD as well as estrogen. But the changes of BMD were more significant in estrogen and combined group(p<0.05). 4) A significant positive correlation was found between age and BMD(p<0.05). CONCLUSIONS:Estrogen therapy can accelerate epiphysial maturation and compromise final height. Growth hormone therapy in Turner girls was effective for improvement bone mineral density as well as growth improvement. But growth hormone and estrogen combined therapy or Estrogen therapy is more effective to improve bone mineral density in Turner syndrome. Estrogen replacement can be delayed for a while on growth hormone treatment and the appropriated time of estrogen therapy should be elucidated.

Clinical Features of Adrenocortical Neoplasms

PURPOSE: Adrenocortical tumors are uncommon in children and comprise only a small proportion of primary adrenal neoplasms. The biologic behavior of these tumors may be very difficult to predict, and their rarity has hindered identification of clinical characteristics. Patients with functioning tumors have excessive steroid hormone production, and the clinical manifestation depends on the predominant hormone produced. The detection of nonfunctioning tumors is not easy and the diagnosis may be delayed. Benign tumors can be cured by complete surgical excision, but malignant cases have poor response to treatment and worse prognosis. Early diagnosis and proper management are very important because of the large proportion of functioning malignant tumors in children. We report clinical features of adrenocortical tumors in children that may be of help in the early detection, proper management, and assessment of prognosis of patients. METHODS: We reviewed the clinical characteristics of 14 cases of adrenocortical tumors, among 85 children diagnosed with adrenal tumors, who visited the Severance Hospital, College of Medicine, Yonsei University, from January 1970 to July 1996. RESULTS: 85 Patients were diagnosed with adrenal tumors. Among them, 71 cases 83.5%) were tumors of the adrenal medulla, neuroblastoma and pheochromocytoma, and 14 cases (16.5%) were adrenocortical tumors, consisting of 5 cases of adenoma, 7 cases of carcinoma, and 2 cases unspecified. The age distribution ranged from 16 months to 14 years of age, and the mean was 5 years & 11 months (median 4 years & 2 months). Sex distribution revealed a male to female ratio of 1:1.33. The left to right ratio was 3.7:1, showing a left side predominance. 13 Cases (92.9%) were functioning tumors: 12 cases (92.3%) had clinical evidence of androgen excess, among which 6 cases (46.2%) were associated with Cushing's syndrome, and 1 case was compatible with primary aldosteronism. Serum cortisol, urinary 17-ketosteroids and 17-hydroxycorticosteroids concentrations were measured in 11 cases and urinary concentrations of 17-ketosteroids were elevated in all 11 cases (100%), while 17-hydroxycorticosteroids were elevated in 4 cases (36.4%). Abnormalities of serum cortisol were found in all cases except 1: serum cortisol concentrations were abnormally elevated in 5 cases (45.5%), and the remainder (5 cases, 45.5%) showed loss of diurnal variation. Dexamethasone suppression test was performed in 9 cases, and all (100%) showed no suppression. Preoperative radiologic studies included abdominal sonograms, CT or MRI scans, and angiography. Histology showed carcinomas to be bigger and heavier than adenomas, and microscopically carcinomas had necrosis, calcifications, and invasions of vessels. Distant metastases were found in 4 cases (12.7%). Adrenalectomy with complete surgical excision was performed in 12 cases. Long-term follow-up was possible in 10 patients after operation: 3 patients initially diagnosed with adenoma survived without tumor recurrence over a year, and among 6 carcinoma patients, 4 expired within a year, and 2 survived, with one patient currently undergoing postoperative chemotherapy. Of the 10 patients currently under going follow-up, one patient was initially diagnosed with a histologically unspecified tumor, and has survived 4 years after operation. CONCLUSIONS: When adrenocortical neoplasms are suspected by clinical symptoms and laboratory findings, abdominal ultrasonogram, CT or MRI scans must be performed immediately. Early detection and proper management are important for better prognosis, but are often delayed in the majority of cases. Ultimately, pediatricians need to be familiar with clinical characteristics and laboratory findings of adrenocortical tumors, bearing in mind the possibility of diagnosis in children.

The Prevalence of Renal Malformation in Tumer Syndrome in Korea

Bone metastasis of hepatocellular carcinoma appears to be peculiar when clinical manifestation of liver disease is not apparent, and initial diagnosis of metastatic hepatocellular carcinoma by fine needle aspiration cytology is rarely obtained. We experienced a case of 45-year-old man with metastatic hepatocellular carcinoma in the sacrum, which was diagnosed by fine needle aspiration cytology. The intrahepatic mass, measuring 1.2cm in diameter and kept unchanged in size for two years, was never proved to be hepatocellular carcinoma histopathologically. The aspirated neoplastic cells were mostly in sheets, showing abundant acidophilic cytoplasm and large, round, centrally located nuclei with single, prominent acidophilic mucleoli. In the cell block section, diagnosis of metastatic well-differentiated hepatocellular carcinoma was made without difficulty, and definite trabecular fashion with sinusoidal endothelial cell lining was found.

Serial Changes of Blood Glucose Levels in IDDM Patients Using Intermediate-acting Insulin only Therapy

PURPOSE: We investigated the clinical characteristics of IDDM patients, treated with NPH only, and evaluated current problems by measurement of serial blood glucose, insulin, C-peptide for 12 hours after administration of intermediate-acting insulin. METHODS: We studied 19 IDDM patients who had been diagnosed and followed up on a regular basis at Severance hospital. They were assigned into 2 groups, one(HbA1c high group) with HbA1c above 12%, the other(HbA1c low group) showing HbA1c below 12%. Their Heights, DM durations, HbA1c, basal C-peptides were primarily measured. Using continuous withdrawal pump, samples were taken every hour for 12 hours from 7:00 am. And serial blood glucose, insulin, C-peptide were assayed. RESULTS: 1) The mean HbA1c of the high group was 16.5+/-3.5% and that of the low group was 11.0+/-0.6%. There were no differences in clinical characteristics. 2) In HbA1c high group, fasting blood glucose, and mean blood glucose levels for 3hours were 156+/-85mg%, 284+/-125mg%(8,9,10am), 250+/-133mg% 11,12am,1pm), 252+/-122mg%(2,3,4pm), and 182+/-105 mg%(5,6,7pm), respectively. In low group, fasting blood glucose, and mean blood glucose levels for 3hours were 130+/-71mg%, 275+/-109 mg%(8,9,10am), 249+/-129mg%(11,12am,1pm), 231+/-81mg%(2,3,4pm), 158+/-62mg%(5,6,7pm), respectively. 3) Fasting blood insulin level was 51+/-47 U/l in high group, 62+/-62 U/l in low group. Thereafter low HbA1c group showed higher insulin levels than high HbA1c group. 4) Fasting blood C-peptide was 0.16+/-0.20 g/l in the high group, and 0.34+/-0.14 g/l in low group. Thereafter low group developed higher C-peptide responses than high group. The curve of C-peptide showed similar change of blood glucose, and maximal response followed 1-2 hours after maximal level of blood glucose. CONCLUSIONS: We concluded that short-acting insulin should be included for good control of blood glucose. Although fasting & dinner blood sugar seemed to be under fair control, intermediate-acting insulin used alone was not effective in preventing severe blood sugar elevation after morning meal.

Growth Retardation / 대한내분비학회지

No abstract available.

Incidence and Complications of Obesity in Pubescent School Children

PURPOSE: In recent years, obesity in children has become one of the major nutritional problems, and the trend is that number of obese children is increasing. The purpose of this research is to examine the incidence of obesity in pubescent school children in Seoul and Cheju, and to analyze body fat component, complications and eating habits of those obese children in order to obtain basic information for prevention of obesity in children in the future. METHODS: The total number of 4,555 junior high school students from 4 schools consisting of 1,234 boys and 3,321 girls were examined based on their height and weight. For those children, obesity index was calculated based on the 50th percentile obtained from standard weight for height of children proposed by the Korean Pediatric Association in 1985. The body fat component was measured and compared between 275 children of 530 obese children(11.6%) and 275 children from the control group by Futrex-5000 A body fat and fitness computer. Of those children, oral glucose tolerance test, blood pressure, and biochemical studies were performed on 31 children whose follow-up was possible, and their exercise load and eating habits were examined. RESULTS: It was found that 11.6% of the subject children were obese, which consisted of 12.4% in boys and 11.4% in girls. The study showed 11.4% obesity ratio in Seoul and 13.2% obesity ratio in Cheju, but the difference was insignificant. Percents of bodyfat was 25.3+/-5.7% (mean+/-SD) for control group, 32.9+/-4.8% for mild obesity group, 35.6% for moderate obesity group, and 37.2+/-4.0% for severe obesity group. The morbidity of complications of those 31 children whose follow-up was possible showed the highest percentage of 29.0% in hyperlipidemia, and lower percentage in hypertension, elevated AST and/or ALT, glucose intolerance, diabetes, respectively. The eating habit analysis showed the total calorie intake/total energy expenditure ratio of 1.10 which is higher in calories than energy consumption, and the food intake evaluation showed that 23.3% of fat was contained in total calorie intake. CONCLUSIONS: The childhood obesity becomes the primary cause of adult obesity, hypertension and diabetes, and therefore, eating habits and exercise load should be carefully observed in order to prevent childhood obesity. In addition to the health care provided currently by schools, regular physical check-up should undertaken for early diagnosis to conduct appropriate tests and treatment.

Clinical Differences by Karyotype in Patients with Turner Syndrome

PURPOSE: The aim of this study was to evaluate clinical differences by karyotype in Turner Syndrome. METHODS: We evaluated 66 patients with Turner syndrome diagnosed at Yonsei University College of medicine from Mar.1985 to Feb.1993. We divided subproups as pure 45,X groups, mosaisism groups and structural aberration groups. Clinical features, serum estrogen, LH, FSH, concentrations, gonadotropin release after GnRH administrarion and final adult height were compared between groups. RESULTS: 1) The karyotype showed. 45,X : 30 cases(45%), mosaicism : 20cases(30%), (X/Xi(Xq) : 15%, X/XX : 7.5%, X/XY : 3%, XXq- : 1.5%, X/Xr(Y) : 1.5%, X/XXX : 1.5%) structural aberration: 16 cases(24.5%)(X, i(Xq) : 2 0%, XXq- : 3.0%, XXp- : 1.5%) 2) Clinical features were milder in Turner varinats than classical 45,X. Birth weight, body m ass index, thyroid autoantibody titers, carbohydrate intolence, peak GH levels were not significantly different between two groups. 3) Height age delay was more sighificant in 45,X karyotype than in Turner variants. 4) Although 45,X karyotype showed lower Estrogen, higher LH, FSH level than Turner variants, there was no statistically significant difference between two groups. 5) When GnRH was administered to Turner syndrome gonadotropin release were exaggerated. 6) In 25 cases who achieved their final adult height without GH therapy, mean final adult height was 140.9cm and there was no significant difference between 45,X and Turner variants. CONCLUSIONS: In Turner variants, clinical features are milder than classical 45,X and hormone secretion capacity and final adult height is not significantly different between two groups.