A Case of Pseudohypoparathyroidism with Graves' Disease

Pseudohypoparathyroidism is a rare disease that is characterized by target cell resistance to the effects of parathyroid hormone and this disease is classified into various types depending on the phenotypic and biochemical findings. The patients with pseudohypoparathyroidism present with the clinical and biochemical features of hypoparathyroidism, but they have an increased serum level of parathyroid hormone. We experienced a case of pseudohypoparathyroidism in a 24 years old woman who had Graves' disease at that time. She had hypocalcemia, hyperphosphatemia, an elevated serum parathyroid hormone level and a normal urinary basal cyclic AMP(adenosine monophosphate) level. She also had a normal phenotypic appearance. Therefore, she was classified as suffering with pseudohypoparathyroidism type II. The clinical and laboratory abnormalities were improved by calcium supplementation in addition to vitamin D. To the best of our knowledge, this is the first case of pseudohypoparathyroidism combined with Graves' disease in Korea.

A case of diabetes mellitus associated with Klinefelter's syndrome / 대한내과학회지

An increased frequency of diabetes or impaired glucose tolerance in Klinefelter's syndrome has been previously reported. Insulin resistance is considered to be the cause of this phenomenon in Klinefelter's syndrome, which is associated with low serum SHBG and sex hormone deficiency. Sex hormone deficiencies also result in dyslipidemia and metabolic syndrome. The interrelationship between diabetes, metabolic syndrome, and androgen deficiency is complex. Here we report a case of an 18-year-old man first diagnosed with diabetes mellitus 3 years ago. Upon physical examination the patient showed characteristic phenotypes compatible with primary hypogonadism. Subsequently, tests aimed at determining the cause of hypogonadism, including a chromosomal analysis, suggested Klinefelter's syndrome. The patient's HOMA-IR score was compatible with insulin resistance. Therefore, when diabetes mellitus develops at a young age with characteristic phenotypes, a careful history and physical examination may be needed to determine whether the patient might have primary hypogonadism caused by Klinefelter's syndrome.

The Effect of alpha-Lipoic Acid on Proteinuria and Renal TGFbeta Expression in Obese Type 2 Diabetic Rat Model / 당뇨병

BACKGROUND: It is well known that renal TGFbeta expression is related to the development of diabetic nephropathy. Alpha-lipoic acid (ALA), a potent antioxidant and cofactor of mitochondrial respiratory enzymes, can improve the insulin resistance and the vascular endothelial dysfunction, and suppresses the development of diabetic vascular complications. This study was undertaken to investigate whether ALA could reduce urinary protein excretion and renal TGFbeta protein expression in obese type 2 diabetes mellitus animal model, Otsuka Long-Evans Tokushima Fatty (OLETF) rat. METHODS: Obese 30 male OLETF rats were randomly divided to 3 groups at the age of 30 weeks. The rats in the Control group fed normal rat chow while the rats in the ALA group were fed with rat chow containing ALA (0.5% of food weight). Ten rats in the Pair-fed group were fed with normal rat chow, but were given the same amount of food as consumed by the ALA group. During 5 weeks of ALA feeding, food intake and body weight were checked in metabolic chamber. Blood glucose levels, HbA1c and urinary protein excretion were measured at 30 weeks and 35 weeks of age, and renal TGFbeta protein expression at 35 weeks of age was measured by Western blot and represented by relative unit (RU). Immunohistochemical staining for TGFbeta protein in renal tissue was also examined at 35 weeks of age. RESULTS: Food intake, body weight, blood glucose levels, HbA1c and urinary protein excretion among the Control, ALA and Pair-fed groups at 30 weeks of age were not different. At 35 weeks of age, food intake was significantly decreased in the ALA group than the Control group (Control group vs. ALA group, 27.7 +/- 1.1 g/day vs. 22.4 +/- 1.4 g/day, P < 0.001), and body weight was significantly decreased in the ALA group than the Control and Pair-fed groups (Control group: 694.4 +/- 10.3 g, ALA group: 600.4 +/- 7.4 g, Pair-fed group: 685.4 +/- 11.6 g, P < 0.001). Blood glucose levels were significantly decreased in the ALA group than the Control and Pair-fed groups (Control group: 157.7 +/- 4.6 mg/dL, ALA group: 130.7 +/- 4.8 mg/dL, Pair-fed group: 153.7 +/- 3.3 mg/dL, P < 0.001) although blood glucose levels from 30 weeks to 34 weeks of age and HbA1c at 35 weeks of age were not different among the groups. Urinary protein excretion and renal TGFbeta protein expression were significantly decreased in the ALA group than the Control and Pair-fed groups (urinary protein excretion, Control group: 5.033 +/- 0.254 mg/mgCr, ALA group: 3.633 +/- 0.303 mg/mgCr, Pair-fed group: 4.977 +/- 0.339 mg/mgCr, P < 0.001; renal TGFbeta protein expression, Control group: 7.09 +/- 0.17 RU, ALA group: 4.14 +/- 0.26 RU, Pair-fed group: 7.00 +/- 0.29 RU, P < 0.001). In the ALA group at 35 weeks of age, urinary protein excretion and renal TGFbeta protein expression were positively related in the Control, ALA and Pair-fed groups (Control group, r = 0.847, P = 0.002; ALA group, r = 0.954, P < 0.001; Pair-fed group, r = 0.858, P = 0.002). TGFbeta staining in glomeruli was observed in all groups but was decreased in the ALA group at 35 weeks of age. CONCLUSION: These results suggest that ALA may prevent the increase of food intake, body weight, blood glucose, urinary protein excretion and renal TGFbeta protein expression in obese type 2 diabetic rat model. The effect of ALA on diabetic nephropathy presented as proteinuria and renal TGFbeta expression in diabetic patients needs to be further clarified.

Effects of soybean supplementation on blood glucose, plasma lipid levels, and erythrocyte antioxidant enzyme activity in type 2 diabetes mellitus patients

The purpose of this study was to investigate the effect of soybean on blood glucose and lipid concentrations, and antioxidant enzyme activity in type 2 diabetes mellitus (DM) patients. We divided patients into two groups and fed them, respectively, a basal diet (control group) and a basal diet with 69 g/d of soybean (soybean group) for 4 weeks. Pills with roasted soybean powder were provided to the soybean supplementation group three times a day. Macronutrients intake except dietary fiber was similar between the two groups. No significant differences were observed in dietary intakes or body weight before and after the supplementation. Energy composition ratio of C:F:P was 65:19:16 in the control group, 64:20:16 in the soybean group. The blood parameters of subjects before supplementation, such as fasting blood glucose, postprandial glucose level, total cholesterol, triglyceride, LDL-cholesterol and HbA1C were not different between the two groups. After supplementation, fasting blood glucose (p<0.001), postprandial glucose level (p<0.001) and serum triglyceride level (p<0.05) were significantly reduced in the soybean group in comparison with the control group. The total cholesterol level was not significantly different between the control and the supplemented group after 4 weeks of treatment. TBARS levels of the soybean group were not significantly different from those of the control group. The activities of catalase (p<0.01) and glutathione peroxidase (p<0.05) were significantly higher in the soybean group compared to the control group. The results of this study suggest that soybean supplementation would be helpful to control blood glucose and serum lipid in diabetic patients. Also, soybean showed an antioxidant activity that may contribute to enhance the effect of antioxidant defense. This activity contributes to protection against oxidative damage in type 2 DM patients. Soybean may have potential use in the disease management of patients with DM.

The relation of the testosterone level with metabolic syndrome and coronary artery disease in Korean middle-aged and elderly men / 대한내과학회지

BACKGROUND: Abdominal obesity is an essential component of metabolic syndrome and it causes insulin resistance. In contrast to women, the serum testosterone level has an inverse relationship with the visceral fat mass in men. Therefore, we investigated the relation of the serum testosterone concentration with metabolic syndrome and coronary artery disease in Korean middle-aged and elderly men. METHODS: 211 male subjects who were admitted to the cardiology department due to chest pain at Hanyang University Hospital from January to December, 2005 (mean age: 59.1+/-10.7 yrs) were enrolled in this study. All the blood samplings for laboratory tests, including the testosterone and estradiol tests, were done between 6 AM to 8 AM. Coronary artery disease was defined when there was more than 50% narrowing of the vascular lumen on the coronary angiography. Metabolic syndrome was defined according to the NCEP-ATP III guidelines. RESULTS: Among the other cardiovascular risk factors, metabolic syndrome was the most important contributor to coronary artery disease (adjusted OR=4.32, 95% CI: 1.96-9.52). Even after adjustment for age, BMI, smoking, alcohol consumption and hypertension, lower testosterone was associated with a higher fasting glucose level (p<0.01) and higher insulin resistance (p<0.05). Each SD (1.88 ng/mL) increase in the total testosterone was associated with a 51% reduced risk of having metabolic syndrome (OR=0.49; 95% CI, 0.36-0.68). Although men with coronary artery disease tended to have lower testosterone levels, there was no statistical significance. CONCLUSIONS: Lower testosterone levels might have a causative role in the development of metabolic syndrome and possibly coronary artery disease through the induction of insulin resistance.

A Case of Thyrotoxicosis Presented as Rhabdomyolysis / 대한내분비학회지

There have been a few reports on rhabdomyolysis caused by thyroid storm, but no cases of thyrotoxicosis related rhabdomyolysis have been reported until now. Here, a rare case of rhabdomyolysis, accompanied by thyrotoxicosis, is reported. A 21-year-old man was admitted to our hospital with severe pain and weakness in both legs. The initial laboratory findings revealed a high muscle enzyme level and severe hypokalemia. In evaluation of the rhabdomyolysis, the thyroid function test was compatible with that of Graves' disease, with the rhabdomyolysis subsequently diagnosed, presenting as thyrotoxicosis. The possible mechanisms for this complaint were hypokalemia-induced muscle ischemia, a thyrotoxicosis-induced excessive hypermetabolic state and pressure-induced muscle ischemia. Therefore, the work up for the cause of rhabdomyolysis should include thyrotoxicosis. The management of rhabdomyolysis is hydration, prevention of acute renal failure, correction of aggravating factors and treatment of the underlying cause, for example, thyrotoxicosis.

A case of hyperthyroidism with complete atrioventricular block / 대한내과학회지

The importance of cardiovascular system involvement in hyperthyroidism has been recognized for many years. Many electrocardiographic abnormalities have been described in hyperthyroidism, including sinus tachycardia, atrial fibrillation, and atrial or ventricular extrasystoles and the increase in resting heart rate are characteristics of hyperthyroidism. In the middle aged or elderly patients, often with mild but prolonged elevation of plasma thyroid hormone, symptoms and sign of heart failure and complicating atrial fibrillation may eliminate the classical clinical feature and mask the more classical endocrine manifestation of the disease. Though rare in hyperthyroidism, the development of heart block is important to recognize in clinical practice. The mechanism of variable delayed conduction (from 1st degree to complete heart block) in hyperthyroidism is not well documented until now. We experienced 67-year-old female patient who complained of loss of body weight. After work-up with thyroid function test and electrocardiogrpahy, we found that she had hyperthyroidism with complete atrioventricular block. We started antithyroid drug and continued to monitor electrocardiophy. We are going to give the radioactive iodine theraphy and in the case of symptomatic atrioventricular block, we will make a insertion of pacemaker.

A Clinical Observation on Twelve Cases of Primary Aldosteronism / 대한내분비학회지

BACKGROUND: Primary aldosteronism describes a group of disorders characterized by long-standing aldosterone excess, with suppressed renin activity, resulting in hypertension and hypokalemia. The protean clinical and biochemical characteristics of this syndrome have important implications regarding its pathophysiology and responsiveness to treatment. METHODS: The cases of 12 primary aldosteronisms, diagnosed at Hanyang University Hospital between 1996 and 1999, were reviewed. RESULTS: The 12 cases were composed of 9 aldosterone-producing adenoma, 2 adrenal hyperplasia and a case of idiopathic hyperaldosteronism. There were 9 women and 3 men. The mean age was 46 yrs (range, 23 to 64 yrs). At the initial visit, the mean blood pressure was 160+/-26/104+/-14 mmHg, and one case of idiopathic hyperplasia had normal blood pressure. The mean serum K+ level was 2.6+/-0.5 mEq/L (range, 1.5 to 3.5 mEq/L). The mean plasma renin activity and plasma aldosterone concentration were 0.4+/-0.4 ng/ml/hr (range, 0.2 to 1.6 ng/ml/hr) and 407.5+/-199.8 pg/mL (range, 225 to 800 pg/mL), respectively. Different steps of diagnostic modalities were applied for the preoperative differential diagnosis. All patients, with the exception of the one with idiopathic hyperaldosteronism, were managed by a unilateral laparoscopic adrenalectomy, as they were all diagnosed under the impression of adrenal adenomas. Ultimately, 9 cases were proven to have adrenal adenomas. One hypertensive case, with hypokalemia, had adrenal hyperplasia, and the case with normotension was found to have adrenal nodular hyperplasia from the pathology. The size of the tumors ranged from 1.4 to 2.4 cm in diameter. Among the 11 cases that underwent an adrenalectomy, the blood pressures in 6 cases normalized after the operation, while the other 5, including the one with unilateral hyperplasia, were still in need of antihypertensives for the control of elevated blood pressures, even after the operation. The other case of idiopathic hyperaldosteronism was managed by the prescription of spironolactone. CONCLUSION: From these, it can be suggested that the clinical diversity of the syndrome, especially in the pathophysiology and response to operation, awaits the development of a better preoperative lateralization procedure

A Case of Thyrotoxic Storm Triggered by Virgorous Palpation of Thyroid Gland After Delivery / 대한산부인과학회잡지

Although the mortality has been reduced with aggressive approach, thyrotoxic storm or crisis is still a life-threatening condition and usually triggered by preeclampsia, placenta previa, congestive heart failure, infections and induction of labor during pregnancy. We report here a 28-year-old pregnant woman suspicious of placenta previa without a previous history of hyperthyroidism was admitted to the hospital with vaginal spotting and labor. After receiving a Cesarean section, thyrotoxic manifestations were developed and she became stable with antithyroid therapy. The second attack of thyrotoxic storm was presented after a thyroid ultrasonographic study. It appears that the vigorous examination of thyroid gland carries a significant risk of thyrotoxic crisis in poorly controlled hyperthyroidism.

Gene Expression of Surfactant Protein A mRNA of the Lung in Endotoxin and Thiourea Treated Rats / 결핵

BACKGROUND: The surfactant protein A(SP-A) is important in the regulation of surfactant secretion, synthesis and recycling. Since the acute respiratory distress syndrome(ARDS) is usually viewed as the functional and morphological expression of a similar underlying lung injury caused by a variety of insults and since abnormalities in surfactant function have been described in ARDS, the authors investigated the different effects of endotoxin and thiourea on the accumulation of mRNA encoding SP-A. METHODS: Sprague-Dawley rats were given 5 mg/kg intraperitoneal endotoxin from Salmonella enteritidis and 3.5 mg/kg intraperitoneal thiourea and sacrified at different time periods. RESULTS: 1) SP-A mRNA was significantly increased 67.0% in 6 hours and 73.4% in 24 hours after 5 mg/kg endotoxin treatment respectively(P<0.005, P<0.005). 2)SP-A mRNA was significantly decreased 32.9% in 24 hours after 3.5 mg/kg thiourea treatment(P<0.05). CONCLUSIONS: These results indicate that the differential regulation of surfactant protein A in vivo is evident and suggest that surfactant protein A might be differentially regulated during different kind of insults of lung injury at different time periods without altering lung wet to dry ratios.

New Scoring Systems for Severity Outcome of Liver Cirrhosis and Hepatocellular Carcinoma: Current Issues Concerning The Child-Turcotte-Pugh Score and The Model of End-Stage Liver Disease (MELD) Score / 대한간학회지

It has been approximately 30 years since Child-Turcotte-Pugh score has been used as a predictor of mortality in patients with liver cirrhosis and hepatocellular carcinoma (HCC). Recently, new prognostic models such as Model for End-Stage Liver disease (MELD), Short- and Long-term Prognostic Indices (STPI and LTPI), Rockall score, and Emory score were proposed for predicting survival in patients with liver cirrhosis treated by transjugular intrahepatic portosystemic shunt (TIPS). In MELD scoring, three independent variables which showed a wide range of results including serum creatinine, serum bilirubin and international normalization ratio (INR) of prothrombin time were evaluated in log(e) scale in comparison with simply categorized-into-three scoring system of Child-Turcotte-Pugh. The etiology of liver cirrhosis was applied to the score of MELD: alcoholic or cholestatic, 0; viral or others, 1. Concurrent statistic (C-statistic) of MELD (0.73-0.84) was slightly superior or insignificantly different to that (0.67-0.809) of Child-Turcotte-Pugh score. In February 2002, UNOS status 2a and 2b were replaced with MELD score for priority allocation of liver transplantation. MELD score does not reflect the severity of patients with HCC or metabolic disorders. For assessing prognosis in patients with liver cirrhosis or HCC, there seems little reason to replace the well established Child-Turcotte-Pugh score. Herein the literatures was briefly reviewed.

Outbreak of Hepatitis by Orientia tsutsugamushi in the Early Years of the New Millenium / 대한간학회지

BACKGROUND/AIMS: Orientia -tsutsugamushi infection is an acute febrile disease due to the accidental transmission through human skin of forest dwelling vector Leptotrombidium larva. The authors observed liver dysfunctions in patients diagnosed with tsutsugamushi disease (Scrub typhus) in the past 3 years and report the data in the hope of bringing attention to this disease in the differential diagnosis of autumn-season hepatitis, especially of non-A, non-B and non-C hepatitis. METHODS: Medical records of 22 patients diagnosed with tsutsugamushi disease by the hemagglutinin method between October 2000 and November 2002 were reviewed. RESULTS: Female gender was dominant in the ratio of 3.4:1. Mean age was 56.4 +/- 2.6. Admission was between 23rd September and 15th November with the peak between mid October and early November. Fever, being the most common symptom, was observed in 21 cases, myalgia in 13, arthralgia in 12, chills in 6, and skin rash in 6. An incubation period of 7-9 days was most common (10 cases), 13-15 days (4), 10-12 days (3), within 3 days (3), and 4-6 days (2). Average ALT, AST and GGTP were increased to 93.2 +/- 17.3 IU/L (18 +/- 345 IU/L), 92.5 +/- 11.7 IU/L (34-255 IU/L) and 132.2 +/- 14.5 IU/L (19-251 IU/L), respectively, but total bilirubin was normal. All the patients improved with doxycycline therapy. CONCLUSIONS: Since it usually shows liver dysfunction, it is important to take Orientia tsutsugamushi into consideration in differential diagnosis of autumn-season, febrile hepatic disease.

Liver Cirrhosis and Diabetes Mellitus / 대한간학회지

No abstract available.

Hydroxyurea Therapy in Hemoglobin Madrid Patients / 대한혈액학회지

Unstable hemoglobins (Hb) are variants of adult Hb that tend to precipitate and form insoluble inclusions (Heinz bodies) within red blood cells (RBC) and RBC precursors. More than 100 structurally different unstable Hb variants showing broad spectrum of manifestations from asymptomatic to severe hemolytic anemia and dyserythropoiesis have been discovered. Hydroxyurea is a potent ribonucleotide reductase inhibitor and have been proposed as a new therapy for beta chain hemoglobinopathies through activation of gamma chain synthesis. We treated two patients (A : son, B : father) with highly unstable Hb diagnosed as Hb Madrid [Beta 115(G17)Ala->Pro] by direct DNA sequencing and restriction enzyme analysis. Our patients received hydroxyurea in dosages varying from 0.75g to 1.3g daily for 89 weeks. We could not show the clinical and hematological improvements after hydroxyurea therapy in thses patients. Optimization of dosage and long term side effects of hydroxyurea should be studied further.

A Case of Lymphocytic Hypophysitis in a Postmenopausal Woman / 대한내분비학회지

A 64-year-old Korean woman presented with a 3-week history of severe headache and ocular pain. Her brain MRI showed a cystic pituitary mass compressing the optic chiasm. A hormonal study revealed anterior pituitary insufficiency and a slightly increased prolactin level. We performed a transsphenoidal resection of the pituitary mass. A pathological examination revealed the presence of a heavy inflammatory infiltrate, composed of lymphocytes and plasma cells, and destruction of the adenohypophysial structures. Five months after surgery, her hormonal levels had nearly normalized, without hormone replacement therapy. A follow-up MRI showed no recurrence. We conclude that lymphocytic hypophysitis should be included in the differential diagnosis of pituitary mass at any age. We discuss the features that can help to make a preoperative differential diagnosis, and selection of the appropriate treatment.

Effect of TRH on Phospholipase D Activity in GH3 Cell / 대한내분비학회지

BACKGROUND: GH3 cells are a well characterized and widely used model used for the in vitro study of growth hormone (GH) secretion. Thyrotropin releasing hormone (TRH) binds to receptors belonging to the family of G protein-coupled receptors, and secrets both GH & prolactin. Phospholipase D (PLD) is an enzyme that hydrolyses phosphatidylcholine to yield phosphatidic acid and choline, and plays important roles in cellular proliferation and hormonal secretion. To elucidate the pathway of the action of TRH in GH3 cells, we investigated the activities of PLC and PLD in GH3 cells treated with TRH or phorbor 12-myristate 13-acetate (PMA). METHODS: GH3 cells were labeled with [3H] myristate, followed by incubation of with 0.3% ethanol, prior to before the addition of the agonists. The total lipids were extracted from the harvested cells following treatment with the agonists. The PLD activity was assessed by measuring [3H] phosphatidylethanol from the [3H] phospholipid using thin layer chromatography. RESULTS: TRH (1 muM) stimulated the PLC activity by 44-fold over that of the control values. TRH (1 microM), mastoparan (5 muM), and PMA (500 muM) for 30 minutes increased PLD activity by 1.9, 1.5 and 2.2 fold, respectively, in comparison to the controls. The PLD activities after 15, 30, 60, 120 and 240 min treatments of TRH (1 microM) were 142%, 170%, 172%, 160% and 115%, respectively. CONCLUSION: These results suggest that TRH stimulates not only the PLC activity, but also the PLD activity in GH3 cells.

A Case of Thyroid Storm Developed after Dilatation and Curettage for Invasive Molar Pregnancy / 대한내분비학회지

Thyroid dysfunction is one of the more prevalent clinical situations encountered by primary care physicians. Thyroid storm is defined as a life-threatening exacerbation of the hyperthyroid state in which there is evidence of decompensation of one or more organ systems. Common precipitants include infection, surgery, diabetic ketoacidosis, vascular accidents, non-compliance with antithyroid medication, and emotional stress, but rarely develop in invasive molar pregnancy. An 18-year-old woman presented to the emergency department complaining of lower abdominal pain and vaginal spotting. She had no previous history of hyperthyroidism. Under the diagnosis of invasive molar pregnancy, dilatation and curettage was performed. However, right after the procedure the patient developed a semi-coma metal status, high grade fever, and tachycardia. Prompt diagnosis of thyroid storm was made and treatment followed immediately. We present a case of thyroid storm and a review of thyroid storm precipitated by invasive molar pregnancy.

A Case of Sporadic Nonfamilial Hypophosphatemic Osteomalacia / 대한내분비학회지

Acquired hypophosphatemic rickets, or osteomalacia, requires the recognition of the typical clinical and radiological features of osteomalacia in association with hypophosphatemia, which is caused by the decrease in intestinal absorption or impaired renal tubular phosphate reabsorption. The latter form may either be hereditary or acquired. Acquired hypophosphatemic osteomalacia includes oncogenic osteomalacia, neurofibromatosis, fibrous dysplasia, renal tubular acidosis and sporadic nonfamilial hypophosphatemic osteomalacia. A 33-year-old man presented with bone pain, progressive severe muscle weakness and a height loss of more than 10 cm over a 5 year period. The familiy history was negative for bone disease or other renal tubular defects. He was found to have hypophosphatemia, impaired phosphate reabsorption, normocalcemia, normal vitamin D metabolite levels, normal PTH and elevated alkaline phophatase. A bone biopsy showed thickened unmineralized osteoid compared to pelvic bone in control cases. Clinical symptoms, such as bone pain and muscle weakness, were improved after supplementation of oral phosphorus and calcitriol, although the serum phosphorus level did not normalize.

A Case of Steroid induced Myopathy in Patient with Iatrogenic Cushing Syndrome / 대한내분비학회지

Many endocrinologic diseases can induce muscular diseases. Myopathy caused by exogenous steroid is a common problem in patients prescribed steroids as therapy. We report a case of iatrogenic steroid myopathy in a 55-year-old female who had taken steroids under her own volition at a local pharmacy for more than 3 months due to skin rash and itching. She complained of severe proximal muscle wasting and weakness in the lower extremities and also exhibited other stigmata of Cushing's syndrome such as moon face, buffalo hump or easy bruising. Needle electromyography showed the typical pattern of myopathy. Muscle biopsy revealed intermixed numerous, markedly atrophic and angulated basophilic fibers and a few fat cells without inflammation. In addition there was marked and selective atrophy of type II fiber on ATPase staining in pH 9.4 buffer. After discontinuation of steroid treatment, she has experienced slow improvement through physical therapy, including isotonic exercise.

Effect of thyroid hormone on the alcohol dehydrogenase activities in rat tissues

The effects of thyroid hormone on hepatic and gastric alcohol dehydrogenase (ADH) activities (nM of NADH/min/mg of cytosolic protein) have been investigated in male Sprague Dawley rats treated with thyroxine (1 mg/kg, po) for 14 days. Whereas hepatic ADH activity in thyroxine-treated rats decreased by 61.3% of control rats (26.4 vs 43.2, p<0.001), gastric ADH activity increased by 262.9% of control rats (4.9 vs 1.9, p<0.001). As for the activities of the lung and kidney, thyroxine treatment did not produce any statistically significant changes. These data suggest that thyrotoxicosis causes a decrease of hepatic alcohol metabolism, and that the increase of gastric ADH activity in thyrotoxic rats can partly restore the first-pass metabolism of ethanol.