A Case of Hyperglycemic Hyperosmolar State Associated with Graves' Hyperthyroidism: A Case Report

Hyperglycemic hyperosmolar state (HHS) is an acute complication mostly occurring in elderly type 2 diabetes mellitus (DM). Thyrotoxicosis causes dramatic increase of glycogen degradation and/or gluconeogenesis and enhances breakdown of triglyc-erides. Thus, in general, it augments glucose intolerance in diabetic patients. A 23-yr-old female patient with Graves' disease and type 2 DM, complying with methimazole and insulin injection, had symptoms of nausea, polyuria and generalized weakness. Her serum glucose and osmolarity were 32.7 mM/L, and 321 mosm/kg, respectively. Thyroid function tests revealed that she had more aggravated hyperthyroid status; 0.01 mU/L TSH and 2.78 pM/L free T3 (reference range, 0.17-4.05, 0.31-0.62, respectively) than when she was discharged two weeks before (0.12 mU/L TSH and 1.41 pM/L free T3). Being diagnosed as HHS and refractory Graves' hyperthyroidism, she was treated successfully with intravenous fluids, insulin and high doses of methimazole (90 mg daily). Here, we described the case of a woman with Graves' disease and type 2 DM developing to HHS.

Determination of Urinary Myo-/Chiro-Inositol Ratios from Korean Diabetes Patients

Of two major forms (myo- and chiro-inositol) of inositols, only chiro-inositol enhances the activity of proteins involved in intracellular glucose metabolism. This study aims to determine the urinary myo-/chiro-inositol ratio in type 1 and type 2 diabetes patients and compare its ratio with the normal control group. The 24-hour urinary myo- and chiro-inositols in 71 Korean diabetes patients and 39 control subjects have been quantified using high-performance liquid chromatography, and their ratios have been evaluated as indices of insulin resistance. The level of 24-hour urinary myo-inositol was significantly higher in both type 1 and type 2 diabetes than with the control group, whereas the urinary chiro-inositol in type 1 or type 2 diabetes was lower than that in normal subjects. The myo-/chiro-inositol ratio in diabetes patients was higher than that in the control group. Twenty four-hour urinary myo-/ chiro-inositol ratios were significantly elevated in type 1 and type 2 diabetes patients compared to the control group, suggesting that a high ratio of urinary myo-/chiro- inositol in type 2 diabetes patients might be used for an index of insulin resistance.

Clinical Features in Patients with Amylase-Rich Pleural Effusion / 결핵

BACKGROUND: Pleural effusions with high amylase levels are reported frequently in patients with pancreatic diseases, a rupture of the esophagus and a malignancy. However, there is no data available on the clinical features of an amylase-rich pleural effusion in Korea. This report describes the causes of the high amylase levels in a pleural effusion and analyzes its association with malignancy. METHODS: The records of patients with an amylase-rich pleural effusion who were assessed at the Gyeongsang National University Hospital from January 1998 to August 2002 were examined retrospectively, and the distribution of amylase levels in those patients, the causative diseases, and the histological type in the case of a malignancy were analyzed. Among the 532 patients whose pleural effusion was evident on a chest X-ray, there were 36 cases with an amylase-rich pleural effusion. The amylase levels were determined by an enzyme method (Hitach 747 autoanalyzer). RESULTS: Of the 36 patients with an amylase-rich pleural effusion, there were 18 patients(50%) associated with a malignancy, 8 patients(22%) with a parapneumonic effusion, 7 patients(19%) with pancreatic disease, and 3 patients with other causes. The amylase level in a pleural effusion due to pancreatic disease was much higher than that due to other causes(p<0.01). Among the malignant pleural effusions with high amylase levels, the origin of the malignancy was a primary lung cancer in 13 cases and metastatic lung cancer in 5 cases. The histological types of malignant causes were adenocarcinoma in 10 cases(56%), squamous cell carcinoma in 2 cases(11%) and unknown type of carcinoma in 6 cases. The amylase level in the adenocarcinoma cases was much higher than that in the other cell type carcinomas(p<0.01). There was no significant association between the amylase level and the glucose level among the malignant cases with amylase-rich pleural effusion(p=0.21). CONCLUSION: The most frequent cause of an amylase-rich pleural effusion was a malignancy. Primary lung cancer and adenocarcinoma were the most common malignancies and histological types associated with a malignant pleural effusion with high amylase levels. The amylase level in a pleural effusion secondary to pancreatic disease was much higher than from any other causes.

A Case of Pituitary Tumor Causing Diabetes Insipidus and Associating with Adenoid Cystic Carcinoma in the Bronchus / 대한내분비학회지

The metastatic tumor occurs in about 6% to 20% of all cases with central diabetes insipidus. Many kinds of cancers such as breast, lung, colon, prostate, leukemia, and lymphoma can metastasize to the pituitary and its stalk. Primary adenoid cystic carcinoma arising in the bronchus is an uncommon disease. It is histologically and ultrastructurally identical to salivary gland adenoid cystic tumor and is regarded as a slowly growing, low graded-malignancy. This is a case report of a 52-year-old woman with diabetes insipidus caused by a pituitary tumor that might have been associated with adenoid cystic carcinoma arising in the bronchus. The patient was diagnosed by water deprivation test, chest CT scan, bronchoscopic biopsy, and brain MRI scan. The water deprivation test showed the patient had central diabetes insipidus, while chest CT scan revealed a lung mass lesion with distal right intermediate bronchial obstruction. The primary malignancy was confirmed by bronchoscopic biopsy. Finally, we confirmed that the patient had a 7mm-sized mass in the posterior pituitary gland and a thickened stalk by brain MRI scan.

A Case of Anterior Pituitary Agenesis in an Adult Woman / 대한내분비학회지

Dear Author, You have used abbreviations that will need to be defined in the main paper, i.e. PIT1, PROP1 and MRI. This is just for your advice. Pituitary agenesis is an uncommon cause of panhypopituitarism. It has been proposed that breech delivery, or birth trauma, is a major factor causing pituitary agenesis. Recent studies have suggested that genetic defects in the PIT1 or PROP1 gene might be involved in the pathogenesis of pituitary agenesis. In this case we report on the diagnosis of a 33-years old female patient with-growth retardation and sexual infantilism. We diagnosed anterior pituitary hormones deficiencies, with the exception of adrenocorticotropic hormone, by a combined pituitary stimulation test. We observed pituitary agenesis using sella MRI. Involvement of the PIT1 or PROP1 genes in this case remains to be determined. Here we report a case of pituitary agenesis found in an adult woman together with a brief review about this disease entity.

A Study of Serum HBV Markers in Term Pregnant Women and Their Neonates / 영남의대학술지

To evaluate the status of hepatitis B virus infection in the mothers and neonates and to determine the maternal-neonatal transmission of hepatitis B virus, 2,276 term pregnant women were screened for presence of serum HBsAg, at the Department of Obstetrics and Gynecology, Yeungnam University Hospital, during the period of 18 months from Jan. 1986 to Jun. 1987, and the sera of sixty-six HBsAg carrier mothers and their neonates were tested for HBV markers and liver enzymes. The results were as follows: 1. The prevalence rate of asymptomatic HBsAg carrier in the term pregnant women was 4.7% (53/1,279). 2. Positive rates of HBsAg and anti-HBs in the sera of sixty-six neonates born to asymptomatic HBsAg carrier mothers were 12.1% and 9.1%, respectively. Transient elevation of SGOT (three to four times of upper normal limit) was detected in one of eight HBsAg-positive neonates and one of six anti-HBs positive neonates. 3. Positive rates of anti-HBc, HBeAg and anti-HBe in the sera of sixty-six asymptomatic HBsAg carrier term pregnant women were 93.9%, 45.5%, 50%, respectively. The rates of transmission of maternal anti-HBc, HBeAg and anti-HBe to the neonates were 85.5 (53/62), 90% (27/30) and 87.9% (29/33), respectively. 4. Serum HBsAg was detected in four of thirty neonates born to HBeAg positive HBsAg carrier mother, three of thirty-three neonates born to anti-HBe positive HBsAg carrier mothers, and one of three neonates born to both HBeAg and anti-HBe negative HBsAg carrier mothers.

A Clinical Study on Macrosomia / 영남의대학술지

Obstetric problems concerning macrosomia were evaluated by retrospective review of 91 pregnancies that resulted in the delivery of an infant weighing 4,000 gm or more at the Yeungnam University Hospital during 3 1/2 years from Jun 1983 to Oct 1986. The results obtained were as follows 1. Macrosomic infants weighing 4,000 gm or more occurred in 2.8% of the deliveries. 2. 65.9% of macrosomic infants and 53.5% of total infants were male. The ratio of male was statistically higher in the macrosomic infants than in the total infants (P<0.05) 3. The incidence of macrosomia was higher with increasing gestational age, and deliveries at 42 weeks or more gestation were more common in the macrosomic infants than in the total infants (P<0.01).