A Case of Autoimmune Pancreatitis Presenting as a Deterioration in Glycemic Control in a Patient with Pre-Existing Type 2 Diabetes / 임상당뇨병

The present article demonstrates an unusual case of type 1 autoimmune pancreatitis (AIP), focusing on the cause of deterioration in glycemic control and weight loss in a patient with pre-existing type 2 diabetes mellitus (DM). A 67-year-old man was diagnosed with type 2 DM 23 years prior and presented with weight loss of approximately 6 kg over a period of 3 months and hemoglobin A1c (HbA1c) of 9.1%. His carbohydrate antigen 19-9 (CA 19-9) level was elevated to 158.54 U/mL (normal, 0~37 U/mL). Considering these findings, we needed to rule out hidden malignancy. Computed tomography of the abdomen showed diffuse swelling of the pancreas uncinated process. The serum immunoglobulin G (IgG) level was elevated to 2,418 mg/dL (normal, 700~1,600 mg/dL), and IgG4 level was elevated to 1,115.0 mg/dL (normal range, 3.9~86.4 mg/dL). This case highlights that AIP should be considered as a cause of significant weight loss and a deterioration in glycemic control in patients with DM. Furthermore, a pancreatic imaging study should be considered in clinical practice to differentiate pancreatic cancer and AIP.

An Unusual Case of Bilateral Peripheral Edema in a Male with Undiagnosed Type 2 Diabetes Mellitus / 임상당뇨병

The present article demonstrates an unusual case of bilateral lower extremity edema caused by neurogenic areflexic bladder as the first physical symptom of diabetes. A 52-year-old man presented to the emergency department because of massive edema of his lower limbs. The edema had been present for 2 weeks, was symmetrical, and was progressively covering the lower limbs up to the inguinal area, scrotal bag, and penis and was accompanied by dysuria and an interrupted urine stream. Laboratory findings revealed a serum glucose level of 657 mg/dL and glycated hemoglobin (HbA1c) level of 15.6%. Computed tomography (CT) of the abdomen and pelvis revealed marked enlargement of the bladder with bilateral hydronephrosis and hydroureter. In addition, CT demonstrated bilateral compression of the iliac veins caused by the enlarged bladder. This case highlights the importance of a broad differential diagnosis for patients with diabetes and extensive peripheral edema. Neurogenic bladder should be considered in the differential diagnosis, even in newly diagnosed diabetic patients.

Synchronous parathyroid carcinoma and papillary thyroid carcinoma in a patient with long-standing schizophrenia

No abstract available.

Recurrent Hyperthyroidism Following Postpartum Thyroiditis in a Woman with Hashimoto's Thyroiditis

Postpartum thyroid dysfunction occurs in 5-10% of women within one year after delivery. Women with hypothyroidism antedating pregnancy are at high risk for postpartum thyroiditis and should be closely monitored during the first year post-partum. Here, we report a case of recurrent hyperthyroidism between two episodes of postpartum thyroiditis in a woman diagnosed with subclinical hypothyroidism prior to pregnancy. It is of particular interest that spontaneously remitting hyperthyroidism as a sequela of postpartum thyroiditis can occur.

An Elderly Patient With Prostate Cancer and Colon Cancer 10 Years After a Diagnosis of Medullary Thyroid Carcinoma

Medullary thyroid carcinomas (MTC) are rare tumors that account for approximately 5-10% of all thyroid malignancy in the West. The reported incidence of MTC is less than 5% in Korea. Its prognosis is relatively good with a 15-year survival rate of 64-84%. The incidence of thyroid cancer has been increasing rapidly worldwide and the overall survival of patients with thyroid cancer is excellent. The occurrence of second primary malignancy (SPM) among survivors of thyroid cancer is a concern, together with life expectancy. Recent studies reported a 6-45% increase in the risk of developing SPM after the diagnosis thyroid cancer. We reported a patient with prostate and colon cancer that were diagnosed 10 years after the diagnosis of medullary thyroid carcinoma.

Humeral Osteomyelitis due to Staphylococcal aureus Infection as the Initial Presentation of Diabetes Mellitus / 임상당뇨병

Diabetes mellitus is a common disorder and presents in different ways. Shoulder pain is a common musculoskeletal complaint, especially in middle-aged or older-aged men. While it is widely accepted that diabetics have an increased propensity to develop infections, a diagnosis of osteomyelitis of the humerus as the etiology of constant shoulder pain might be delayed, as occurred in this case study, until patients' develop clear signs of infection. Here, we describe a case of subacute osteomyelitis as the first physical symptom of diabetes; the possibility of osteomyelitis should therefore be investigated in all patients with diabetes mellitus who develop joint or bone-related pain.

The Organ Donation Rates in the Neurosurgical Field: Preliminary Study in a Single Institute / 대한이식학회지

BACKGROUND: In this study, we analyzed the brain death patients and the donation rates in our neurosurgical field and we discuss the factors that may be important for maximizing these rates by review of literatures. METHODS: We performed a retrospective reviews of 3,016 patients who were admitted into the neurosurgical intensive care unit (NICU) from January 1, 2003 till December 31, 2008. RESULTS: A total of 300 deaths in the NICU was recorded. The major cause of death was cerebral lesion (92%, n=276). Among these deaths, the cerebral lesion was caused by hemorrhage (59%, n=176) and trauma (33%, n=100). The number of the medically or clinically suitable organ donors was 58 cases (19% of all deaths). Organ donation was realized in 37 cases (64% of all the potential donors). Among the non-donation cases, 16 cases refused organ donation, corresponding to a refusal rate of 28%. Two cases were not suitable due to infection, one case was not suitable due to early death, and two cases were not suitable due to legal problems. CONCLUSIONS: Despite that Koreans overwhelmingly support organ donation and transplantation, the actual donation rate remain low. The organ donation rate of our city as 10 PMP was higher than that of whole country last year. As a preliminary study, it will be necessary to analyze the difference of organ donation rate between our city and other cities to identify predictors to affect on donation.

A case of Methimazole-Induced Cholestatic Jaundice With Agranulocytosis / 대한내분비학회지

Methimazole is a widely used and generally well-tolerated antithyroid agent. Adverse reactions occur in 1~5% of patients taking methimazole medication, but these are most commonly transient, benign leukopenia and a skin rash. Severe cholestatic jaundice, combined with agranulocytosis, has been known as a rare complication. Herein, a case of methimazole induced cholestatic jaundice, with agranulocytosis, is reported.

A Case of Isolated ACTH Deficiency Manifestated by Atrial Fibrillation and Hypoglycemia / 대한내분비학회지

Isolated ACTH deficiency is a rare cause of secondary adrenocortical insufficiency caused by the defect of synthesis or release of ACTH in pituitary gland. The clinical presentation can be simiilar to that of primary adrenal insufficiency, but there is a greater tendency for hypoglycemia and absence of hyperpigmentation. The patient, 80 year-old female, was admitted in chief complaint of deteriorated mental states. On admission, serum sodium was 127mEq/L, potassium 4.4mEq/L, blood glucose 27mg/dL and on routine E.C.G. was atrial fibrillation was revealed. The basal morning serum cortisol level was 9.97 pg/dL it dosent respond to insulin-induced hypoglycemia enoughly, but other pituitary functions were intact in pituitary cocktail stimulation test. In CRH stimulation test, there was no remarkable response in serum ACTH and cortisol level. Brain MRI failed to reveal any anatomic abnormalities of the sellar or suprasellar area consistent with the defect of pituitary ACTH secretion. This case was a isolated ACTH deficiency, So, we conclude that associated with atrail fibrillation and hypoglycemia.