Current Status of Low-Density Lipoprotein Cholesterol Target Achievement in Patients with Type 2 Diabetes Mellitus in Korea Compared with Recent Guidelines

Background@#We evaluated the achievement of low-density lipoprotein cholesterol (LDL-C) targets in patients with type 2 diabetes mellitus (T2DM) according to up-to-date Korean Diabetes Association (KDA), European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS), and American Diabetes Association (ADA) guidelines. @*Methods@#This retrospective cohort study collected electronic medical record data from patients with T2DM (≥20 years) managed by endocrinologists from 15 hospitals in Korea (January to December 2019). Patients were categorized according to guidelines to assess LDL-C target achievement. KDA (2019): Very High-I (atherosclerotic cardiovascular disease [ASCVD]) <70 mg/dL; Very High-II (target organ damage [TOD], or cardiovascular risk factors [CVRFs]) <70 mg/dL; high (others) <100 mg/dL. ESC/EAS (2019): Very High-I (ASCVD): <55 mg/dL; Very High-II (TOD or ≥3-CVRF) <55 mg/dL; high (diabetes ≥10 years without TOD plus any CVRF) <70 mg/dL; moderate (diabetes <10 years without CVRF) <100 mg/dL. ADA (2019): Very High-I (ASCVD); Very High-II (age ≥40+ TOD, or any CVRF), for high intensity statin or statin combined with ezetimibe. @*Results@#Among 2,000 T2DM patients (mean age 62.6 years; male 55.9%; mean glycosylated hemoglobin 7.2%) ASCVD prevalence was 24.7%. Of 1,455 (72.8%) patients treated with statins, 73.9% received monotherapy. According to KDA guidelines, LDL-C target achievement rates were 55.2% in Very High-I and 34.9% in Very High-II patients. With ESC/EAS guidelines, target attainment rates were 26.6% in Very High-I, 15.7% in Very High-II, and 25.9% in high risk patients. Based on ADA guidelines, most patients (78.9%) were very-high risk; however, only 15.5% received high-intensity statin or combination therapy. @*Conclusion@#According to current dyslipidemia management guidelines, LDL-C goal achievement remains suboptimal in Korean patients with T2DM.

A Position Statement of the Utilization and Support Status of Continuous Glucose Monitoring in Korea / 임상당뇨병

The accuracy and convenience of continuous glucose monitoring (CGM), which efficiently evaluates glycemic variability and hypoglycemia, are improving. There are two types of CGM: professional CGM and personal CGM. Personal CGM is subdivided into real-time CGM (rt-CGM) and intermittently scanned CGM (isCGM). CGM is being emphasized in both domestic and foreign diabetes management guidelines. Regardless of age or type of diabetes, CGM is useful for diabetic patients undergoing multiple insulin injection therapy or using an insulin pump. rt-CGM is recommended for all adults with type 1 diabetes (T1D), and can also be used in type 2 diabetes (T2D) treatments using multiple insulin injections. In some cases, short-term or intermittent use of CGM may be helpful for patients with T2D who use insulin therapy other than multiple insulin injections and/or oral hypoglycemic agents. CGM can help to achieve A1C targets in diabetes patients during pregnancy. CGM is a safe and cost-effective alternative to self-monitoring blood glucose in T1D and some T2D patients. CGM used in diabetes management works optimally with proper education, training, and follow up. To achieve the activation of CGM and its associated benefits, it is necessary to secure sufficient repetitive training and time for data analysis, management, and education. Various supports such as compensation, insurance coverage expansion, and reimbursement are required to increase the effectiveness of CGM while considering the scale of benefit recipients, policy priorities, and financial requirements.

Popliteal Artery Agenesis Detected by CT Angiography

Variations in the popliteal artery and its tibial branches are common and have assumed greater importance with the technological advances that have made below-knee interventional revascularization feasible. The authors report a rare anatomic variant of popliteal artery agenesis, describing the CT angiographic findings with emphasis on the differential point from the occlusive disease and reviewing the embryologic development of the lower extremity vasculature.

Diagnostic value of BRAF(V600E) mutation analysis in fine needle aspiration for evaluation of thyroid nodules / 고신대학교의과대학학술지

OBJECTIVES: Ultrasound-guided fine-needle aspiration (FNA) is routinely used in the evaluation of thyroid nodules. However, it has several pitfalls, as has been noted in nondiagnostic and indeterminate cases. This study aims to investigate the value of BRAF(V600E) mutation co-testing in FNA cytology. METHOD: A total of 310 patients underwent BRAF(V600E) mutation co-testing in FNA cytology on thyroid nodules between June 2013 and June 2014. Of the 310 patients, 69 patients who had undergone a surgery for thyroid nodules were included in this study. The presence of the BRAF(V600E) mutation was determined by allele-specific polymerase chain reaction amplification of exon 15 of the BRAF gene. RESULTS: Of 69 cases, 33 (47.8%) were BRAF(V600E) mutation positive. The BRAF(V600E) mutation was not significantly associated with high-risk features such as tumor size, lymph node metastasis, and pathological stage. The respective diagnostic performance of FNA (P = 0.02), BRAF(V600E) mutation (P = 0.03), and ultrasonographic (P = 0.00) findings was statistically significant. The sensitivity, specificity and positive predictive value of FNA was 64.9%, 83.3%, and 94.8%. The sensitivity, specificity and positive predictive value of BRAF(V600E) mutation was 56.1%, 91.7%, and 96.9% and the US features was 91.2%, 91.7%, and 98.1% respectively. However, sensitivity of FNA with BRAF(V600E) mutation (77.2%) was lower than FNA with US (92.9%) and combination all together (92.9%). CONCLUSION: In this study, we found that US features were the most useful in preoperative differential diagnosis of thyroid nodules. BRAF(V600E) mutation co-testing in FNA cytology was also useful for diagnosis of thyroid tumors.

Are there differences in hepatitis-B immunization status between diabetes and non-diabetes subjects in Korea? / 고신대학교의과대학학술지

OBJECTIVES: The American Diabetes Association (ADA) recommends hepatitis-B virusVIruS vaccination for unvaccinated adults with diabetes. However, the Korean Diabetes Association (KDA) did not recommend hepatitis-B vaccination for unvaccinated adults with diabetes. This study was performed to assess the differences in hepatitis-B virus antigen and antibody status between Korean patients with diabetes and those without by using national survey data. METHODS: We analyzed hepatitis-B virus antigen and antibody status in 9,771 South Korean people from the general population based on the Korean National Health and Nutrition Examination Survey. Diabetes patients were defined as those with a measured fasting plasma glucose over 126 mg/dL or those who had been previously diagnosed with diabetes by other health care centers. RESULTS: Subjects with diabetes accounted for 812 (8.3%) among the 9771 study subjects. The prevalence ofhepatitis-B (HBsAg) seropositive subjects was not significantly different (3.9% vs. 4.6%, P = 0.09) between subjects with diabetes and those without. The prevalence of hepatitis-B antibody (HBsAb) positive subjects and unimmunized subjects was not significantly different (55.2% vs. 58.2%, P = 0.09, 40.9% vs. 37.2%, P = 0.09) between the two groups. The prevalence of unimmunized subjects decreased by age ( 70 years 48.5% vs. 42.8%) but was not significantly different between the 2 groups. CONCLUSIONS: From this study, we conclude that there are not sufficient grounds to recommend routine hepatitis-B virus vaccination for unvaccinated Korean subjects with diabetes at this point in time in Korea. Further prospective studies will be needed.

Obesity and Insulin Resistance According to Age in Newly Diagnosed Type 2 Diabetes Patients in Korea / 고신대학교의과대학학술지

OBJECTIVES: With the rapid increase in the prevalence of diabetes, the age groups of diabetic patients are becoming diversified. This study will examine the degree of obesity, insulin resistance, and insulin secretion ability among patients first diagnosed with diabetes according to age and gender. METHODS: The subjects of this study included 616 patients who were first diagnosed with diabetes during a routine physical examination. This sample was obtained from a total of 28,075 adults aged 19 years and older who received the examination among 33,829 participants in the Korea National Health & Nutrition Examination Survey (KNHANES) from 2007–2010. The subjects were categorized by age into young age (age: 19 – 39 years), middle age (age: 40 – 59 years), and old age (age: 60 years and older). The degree of obesity was categorized according to body mass index (BMI) into normal weight (BMI: 18.5 ~ 22.9), overweight (BMI: 23 ~ 24.9), and obesity (BMI: 25 or above). Insulin resistance was evaluated by homeostatic model assessment of insulin resistance (HOMA-IR). RESULTS: It was found that 14.1% (n = 87) of a total of 616 subjects (324 men, 292 women) were in the young age group, 43.8% (n = 270) were in the middle age group, and 42.1% (n = 259) were in the old age group. In addition, 83.3% of men that were overweight or obesity were in the young age group, while 79.2% and 60.5% were in the middle age and old age groups, respectively. A total of 82.2% of women that were overweight or obesity were in the young age group, while 79.5% and 77% were in the middle age and old age groups, respectively. For men, the more obesity they were in all age groups, the higher their HOMA-IR. For women, the more obesity they were in the young age and middle age groups, the higher their HOMA-IR; however, women in the old age group showed the highest HOMA-IR when they were of normal weight. CONCLUSION: Among diabetic patients first diagnosed with the disease in Korea, the youth population had the highest obesity rate. Insulin resistance increases as an individual's weight increases among those patients who are first diagnosed with diabetes; the only exception noted is for elderly women.

Response: Expression of Glucagon-Like Peptide-1 Receptor in Papillary Thyroid Carcinoma and Its Clinicopathologic Significance (Endocrinol Metab 2014;29:536-44, Min Jung Jung et al.)

No abstract available.

Radiation Induced Peripheral Arterial Disease associated with Diabetes which Initially Considered as Diabetic Foot Disease / 임상당뇨병

Therapeutic high-dose radiation can induce atherosclerotic changes of affected arteries. Radiation-associated atherosclerotic diseases of coronary, carotid and subclavian arteries have been demonstrated for years in cancer survivors, but peripheral arterial disease (PAD) associated with radiation is rarely reported. PAD is one of the major macrovascular complications of diabetes and is associated with morbidity and increased mortality. We experienced a case of PAD associated with radiation therapy in a 65-year-old diabetic female patient who had undergone cervical cancer treatment 19 years prior. Computed tomographic angiogram showed occlusion and stenosis from common iliac arteries to superficial femoral arteries. However, both infrapopliteal arteries that are commonly involved in diabetes associated PAD were preserved. She was successfully treated with percutaneous angioplasty combined with femoro-femoral bypass operation. Based on the extent and severity of arterial stenosis in this non-smoking diabetic woman who had a history of high-dose radiation to her pelvis, we concluded that atherosclerotic lesions in this patient were caused by high-dose pelvic irradiation and then exacerbated by diabetes. Therefore, special attention should be given to diabetic patients with history of pelvic irradiation with regard to development of atherosclerosis of peripheral arteries, especially in the pelvic area.

Causes of amenorrhea in Korea: Experience of a single large center / 대한생식의학회지

OBJECTIVE: To investigate the causes of amenorrhea in Korean women. METHODS: Medical records from 1,212 women with amenorrhea who visited the Department of Obstetrics and Gynecology, Asan Medical Center, between January 1989 and December 2011 were retrospectively reviewed. Amenorrhea was categorized as either primary or secondary. RESULTS: Primary amenorrhea was identified in 132 of the patients (10.9%) and secondary amenorrhea in 1,080 (89.1%). The most frequent causes of primary amenorrhea were gonadal dysgenesis (28.0%, 37/132); Mayer-Rokitansky-Kuster-Hauser syndrome (20.0%, 27/132); and constitutional delay and androgen insensitivity syndrome (8.3%, 11/132; 8.3%, 11/132, respectively). Secondary amenorrhea was due to polycystic ovary syndrome (48.4%, 523/1,080); premature ovarian insufficiency (14.0%, 151/1,080); and nutrition-related hypogonadotropic hypogonadism (8.3%, 90/1,080). CONCLUSION: In this retrospective study, gonadal dysgenesis was the most common cause of primary amenorrhea and polycystic ovary syndrome was the most common cause of secondary amenorrhea in Korean women.

Diagnostic Value of Preoperative Serum Thyroglobulin Measurement for the Diagnosis of Malignancy in Follicular or Hurthle Cell Neoplasms of the Thyroid Gland / 고신대학교의과대학학술지

OBJECTIVES: The aim of this retrospective study was whether serum Tg predicts malignancy in follicular or Hurthle-cell neoplasms on fine needle aspiration. METHODS: A chart review of 111 patients (90 females, 21 males; mean age 46.8 +/- 11.9 years) with follicular or Hurthle-cell neoplasms on fine needle aspiration, who were surgically treated between Sep. 2001 and Sep. 2011, was performed. Predictive factors for malignancy were identified by the chi-squared test and multivariate logistic regression. RESULTS: There were no differences between 41 malignant and 70 benign lesions in serum Tg or any of the normalized indexes. Receiver-operator characteristic analysis revealed no cut-off value. Lesions with serum Tg levels greater than 500 g/L had no significant difference. And also there were no independent predictors of malignancy by multivariate logistic regression. CONCLUSIONS: In this study, the author found that serum Tg has poor accuracy for predicting malignancy in follicular or Hurthle cell neoplasms on fine needle aspiration.

Expression of Glucagon-Like Peptide-1 Receptor in Papillary Thyroid Carcinoma and Its Clinicopathologic Significance

BACKGROUND: Incretin-based therapies are rapidly becoming one of the main glycemic control strategies in diabetes. Considering the large numbers of papillary thyroid carcinomas (PTCs) and possible effects of glucagon-like peptide-1 (GLP-1) on cell proliferation, the expression of GLP-1 receptor (GLP-1R) in PTC is likely to have clinical significance. We performed this study to evaluate the expression of GLP-1R in PTC and the clinical meaning of GLP-1R expression in PTC. METHODS: Fifty-six cases of PTC, four cases of medullary thyroid cancer (MTC), seven cases of nodular hyperplasia and 56 normal thyroid tissue samples were selected for immunostaining for GLP-1R. Clinical parameters were obtained by retrospective review of medical records. RESULTS: Immunohistochemical staining for GLP-1R showed immunoreactivity in 18 of 56 cases of PTC (32.1%). All four cases of MTC exhibited cytoplasmic GLP-1R expression. Nodular hyperplasia exhibited immunoreactivity in two of seven cases (28.6%). All normal thyroid follicular cells showed negative immunoreactivity. In univariable and multivariable analyses, tumor multifocality was negatively correlated with GLP-1R expression. Extrathyroidal extension showed positive association with GLP-1R expression that was almost significant. Sex, age, tumor size, and lymph node metastasis were not significantly associated with GLP-1R expression. CONCLUSION: Some parts of PTC tissues express GLP-1R, and GLP-1R expression in PTC was negatively correlated with tumor multifocality. The long-term influence of pharmacologically increased GLP-1 on thyroid follicular cells and development and progression of tumors originating from thyroid follicular cells should be investigated.

Expression of Glucagon-Like Peptide 1 Receptor during Osteogenic Differentiation of Adipose-Derived Stem Cells

BACKGROUND: Glucagon-like peptide 1 (GLP-1), an incretin hormone well known for its glucose-lowering effect, was recently reported to exert an anabolic effect on bone. Although the exact mechanism is not known, it likely involves the GLP-1 receptor (GLP-1R), which is expressed in some osteoblastic cell lines. Adipose-derived stem cells (ADSCs) have mesenchymal stem cell-specific characteristics, including osteoblastic differentiation potential. We evaluated the expression of GLP-1R during osteogenic differentiation of ADSCs. METHODS: ADSCs were isolated from subcutaneous adipose tissue obtained from three male donors during plastic surgery and were subjected to osteogenic induction. Mineralization was assessed by Alizarin Red staining on day 21. Expression of alkaline phosphatase (ALP), osteocalcin (OC), and GLP-1R was measured by real-time polymerase chain reaction in triplicate for each patient on days 0, 7, 14, and 21. Target mRNA expression levels were normalized to that of beta-actin. RESULTS: ADSCs were fibroblast-like in morphology, adhered to plastic, and had multipotent differentiation potential, as assessed using specific antigen markers. The osteogenic markers ALP and OC were notably upregulated at 21 days. Osteogenic differentiation resulted in a time-dependent increase in the expression of GLP-1R (P=0.013). CONCLUSION: We demonstrated upregulation of GLP-1R gene expression during osteogenic differentiation of ADSCs. This finding suggests that GLP-1 may induce osteogenic differentiation in bone tissue.

Milk-Alkali Syndrome in a Patient with Postoperative Hypoparathyroidism During Long-Term Maintenance of Calcium Supplementation / 대한내분비외과학회지

Calcium plays a critical role in neuromuscular excitement and other cellular functions. Therefore, extracellular calcium concentration is maintained within a very narrow range through interaction of calcium regulating hormones such as parathyroid hormone, calcitonin, and vitamin D. Thus, symptomatic severe hypercalcemia has rarely occurred in a clinical situation, particularly in patients with hypoparathyroidism. In general, a large amount of calcium and vitamin D should be supplied in order to avoid hypocalcemia in hypoparathyroid patients. A 63-year old female patient was admitted suffering from nausea, vomiting, and weakness for two weeks. She had a history of total thyroidectomy and subsequent permanent hypoparathyroidism and long-term calcium and vitamin D supplementation. For over 10 years she had not changed her daily amount of calcium and vitamin D intake. Her initial serum calcium was 17.5 mg/dL, creatinine was 2.57 mg/dL, and total CO2 was 33.1 meq/L. After thorough examination, we concluded that milk-alkali syndrome was the cause of severe hypercalcemia. Therefore, special pay attention should be paid to aged patients on calcium supplementation in situations of increased risk of dehydration and renal insufficiency, even though the usual amount of calcium intake was unchanged for several years.

Women Are Diagnosed with Type 2 Diabetes at Higher Body Mass Indices and Older Ages than Men: Korea National Health and Nutrition Examination Survey 2007-2010

BACKGROUND: Many epidemiologic studies have shown that women with type 2 diabetes have an increased risk of developing cardiovascular disease compared with men with diabetes. The aim of this study is to elucidate whether disparities of adiposity, age and insulin resistance (IR) at the time of diabetes diagnosis exist between women and men in the adult Korean population. METHODS: Data from The Korea National Health and Nutrition Examination Survey, performed in Korea from 2007 to 2010, were used. In the survey, anthropometric data and blood samples were obtained during a fasting state. IR and beta-cell function were calculated using the homeostasis model assessment (HOMA-IR and HOMA-beta, respectvely). RESULTS: The mean age of diabetes diagnosis was 58.5 years in women and was 55.1 years in men (P=0.015). The mean body mass index (BMI) of newly diagnosed diabetes subjects was 26.1 kg/m2 in women and 25.0 kg/m2 in men (P=0.001). The BMI was inversely related to age in both genders, and the higher BMI in women than men was consistent throughout all age groups divided by decade. The HOMA-IR in women with diabetes is higher than in men with diabetes (7.25+/-0.77 vs. 5.20+/-0.32; P=0.012). CONCLUSION: Korean adult women are diagnosed with type 2 diabetes at higher BMI and older age than men and are more insulin-resistant at the time of diabetes diagnosis. This may help explain why women with diabetes have an increased risk of developing cardiovascular disease after the diagnosis of diabetes, compared to men.

A Case of Medullary Thyroid Carcinoma with de novo V804M RET Germline Mutation

Many cases of RET proto-oncogene mutations of hereditary medullary thyroid carcinoma (MTC) have been reported in Korea. However, MTC with V804M RET proto-oncogene germline mutations have not been reported in Korea. A 33-yr-old man was diagnosed with a 0.7-cm sized thyroid nodule. Laboratory testing revealed serum calcitonin was elevated. The patient underwent total thyroidectomy with central compartment neck dissection for the thyroid tumor. RET gene analysis was performed in both the index patient and his family. There were no V804M RET mutation and abnormal laboratory findings within his family except the index patient. Therefore, this patient was a de novo V804M RET germline mutation.

Luteal estradiol supplementation in gonadotropin-releasing hormone antagonist cycles for infertile patients in vitro fertilization / 대한생식의학회지

OBJECTIVE: To evaluate the effect of the addition of estradiol to luteal progesterone supplementation in GnRH antagonist cycles for infertile patients undergoing IVF/ICSI. METHODS: One hundred and ten infertile patients, aged 28 to 39 years, were recruited for this prospective randomized study. They were randomly assigned to receive vaginal progesterone gel (Crinone) along with 4 mg estradiol valerate (group 1, n=55) or only Crinone (group 2, n=55) for luteal support. A GnRH antagonist multiple dose protocol using recombinant human FSH was used for controlled ovarian stimulation (COS) in all of the subjects. The COS results and pregnancy outcomes of the two groups were compared. RESULTS: Group 1 and 2 were comparable with respect to the patient characteristics. The COS and IVF results were also comparable between the two groups. There were no differences in the clinical pregnancy rate (PR) and multiple PR between the two groups. However, the embryo implantation rate were significantly higher in group 1 than that in group 2 (22.2% vs. 13.3%, p=0.035). The incidence of luteal vaginal bleeding (LVB) was significantly lower in group 1 (7.4% vs. 27.8%, p=0.010). CONCLUSION: The addition of estradiol to luteal progesterone supplementation in GnRH antagonist cycles reduces the incidence of LVB and increases the embryo implantation rate in infertile patients undergoing IVF/ICSI.

Mature Cystic Teratoma / 대한내과학회지

No abstract available.

A Case of Polypoid Esophageal Carcinosarcoma with Spontaneous Resected Stalk / 대한소화기내시경학회지

Carcinosarcomas of the esophagus are rare malignant neoplasms that consist of both carcinomatous and sarcomatous components, which comprise approximately 1~2% of all esophageal neoplasms. Usually, esophageal carcinosarcomas are the polypoid type, and patients with esophageal carcinosarcoma have progressive dysphagia. The multiplicity in terminology appears to be related to the uncertain histogenesis of these tumors. We report a case of a polypoid esophageal carcinosarcoma with a spontaneous resected stalk in a 45 year-old male patient who presented with progressive dysphagia and weight loss.

Hemoclipped Dieulafoy's Lesion in Giant Diverticulum in the 3rd Portion of Duodenum / 대한소화기내시경학회지

A duodenal diverticulum is common in the second portion of the duodenum and can occur at any age. An obstruction, bleeding, perforation, diverticulitis are not an uncommon complicationa of duodenal diverticulum. As a rare complication, bleeding in the duodenal diverticulum may be massive, and duodenal diverticulum is resected primarily as a result of the difficulty in determining the site of bleeding. However, there has been a recent increase in endoscopic diagnosis and the treatment of diverticular bleeding. Band ligation increases the risk of duodenal diverticular perforation because of the thin diverticular wall. An endoscopic hemoclip is a preferable method for endoscopic sclerotherapy. We report a 48- year-old man with a giant duodenal diverticulum that was treated with a hemoclip. The duodenal diverticular perforation was treated effectively with supportive care.

Developmental Toxicity by Exposure to Bisphenol A Diglycidyl Ether during Gestation and Lactation Period in Sprague-dawley Male Rats / 예방의학회지

OBJECTIVES: Bisphenol A diglycidyl ether (BADGE) is the major component in commercial liquid epoxy resins, which are manufactured by co-reacting bisphenol A with epichlorohydrin. This study was performed to show the developmental effects of prenatal and postnatal exposures to BADGE in male rat offspring. METHODS: Mated female rats were divided into four groups, each containing 12 rats. The dosing solutions were prepared by thoroughly mixing BADGE in corn oil at the 0, 375, 1500 and 3000 mg/kg/day concentrations. Mated females were dosed once daily by oral gavage on gestation day (GD) 6 - 20 and postnatal day (PND) 0 - 21. Pregnant female dams were observed general symptoms and body weight. Also, male pups were observed the general symptoms, body weight, developmental parameters (e.g. anogenital distance, pina detachment, incisor eruption, nipple retention, eye opening, testis descent), organ pathologic changes and hormone levels of plasma. RESULTS: Pregnant rats treated with BADGE died at a rate of about 70% in the 1500 mg/kg/day group and all rats treated with 3000 mg/kg/day died. Body weight, for male pups treated with doses of 375 mg/kg/day, was significantly lower than in the control group at PND 42, 56, and 63 (p<0.05). Evaluation of body characteristics including; separation of auricle, eruption of incisor, separation of eyelid, nipple retention, descent of testis, and separation of the prepuce in the BADGE treated group showed no difference in comparisons with the control group. AGD and adjusted AGD (mm/kg) for general developmental items in BADGE 375 mg/kg/day treated pups tended to be longer than in controls, however, these differences were not statistically significant. Relative weights of adrenal gland, lung (p<0.05), brain, epididymis, prostate, and testis (p<0.01) were heavier than in control in measures at PND 9 weeks. There were no significant changes in comparisons of histological findings of these organs. Loss of spermatids was observed in the seminiferous tubule at PND 9 weeks, but no weight changes were observed. The plasma estrogen levels were similar in the control and treatment groups at PND 3, 6 and 9 weeks. The plasma testosterone levels in the control group tended to increase with age. However, in the BADGE 375 mg/kg/day treated male pups it did not tend to increase. CONCLUSIONS: These findings suggest that BADGE is a chemical that has developmental effects consistent with it being an endocrine disruptor.