Journal of Korean Endocrine Society最新文献

{"title":"A Case of Complete Agenesis of the Dorsal Pancreas in a Patient with Newly Diagnosed Diabetes Mellitus.","authors":"Dong Pil Kim, K. Park, Dong Sun Kim, B. Ko, J. Lee, Jae Hyuk Lee, J. Shin, Byung Jun Kim, Hyun-Jin Kim","doi":"10.3803/JKES.2010.25.1.78","DOIUrl":"https://doi.org/10.3803/JKES.2010.25.1.78","url":null,"abstract":"Agenesis of the dorsal pancreas is a rare congenital anomaly caused by underdevelopment or agenesis of the dorsal pancreatic bud that forms the upper head, neck, body and tail of the pancreas. We report a case of agenesis of the dorsal pancreas, which was found under examination of diabetes mellitus (DM). A 16-year-old girl was transferred to our hospital because of a positive urine glucose reading during a school-conducted examination. Abdominal computed tomography and magnetic resonance cholangiopancreatography revealed the deficit of the pancreatic body and tail. Diabetes-associated autoimmune antibodies were negative in a blood test. Decreased β-cell function was demonstrated by oral glucose tolerance and glucagon stimulation tests. Although the notion that agenesis of the dorsal pancreas leads to decreased endocrine or exocrine function is controversial, the results of this study suggest that we should consider these causes of diabetes mellitus. When treating a young patient with diabetes mellitus, we should consider causes of diabetes mellitus such as congenital anomaly or maturity onset diabetes, in addition to type 1 and type 2 diabetes mellitus. (J Korean","PeriodicalId":119859,"journal":{"name":"Journal of Korean Endocrine Society","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127813628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Primary Hyperparathyroidism with Rapid Regression of a Brown Tumor after Parathyroidectomy.","authors":"J. Mok, Ha Yeon Kim, H. Ter, Sang Ock Kim, Dong Kyun Kim, Ji sun Han, S. Y. Park, Sa Rah Lee, M. Park, Dukkuy Kim","doi":"10.3803/JKES.2010.25.1.50","DOIUrl":"https://doi.org/10.3803/JKES.2010.25.1.50","url":null,"abstract":"Primary hyperparathyroidism is mainly caused by parathyroid adenoma (85%) and is characterized by hypercalcemia, osteoporosis, renal stones, and gastrointestinal and neurological disorders. Because of improvements in blood analysis over the last two decades, primary hyperparathyroidism is typically diagnosed early and asymptomatically. A rare clinical manifestations of primary hyperparathyroidism, brown tumors (osteitis fibrosa cystica), are osteolytic lesions resulting from long-term hyperparathyroidism. Radiologically, it is difficult to distinguish a brown tumor from plasmacytoma, multiple myeloma, or bone metastasis. We report a case of a 44-year-old man with primary hyperparathyroidism that caused a large brown tumor (11 × 5 × 8 cm) that mimicked plasmacytoma or cancer metastasis on pelvic magnetic resonance imaging. After a bone biopsy report that was highly suggestive of a brown tumor, serum calcium and intact parathyroid hormone levels were determined. The lesion was ultimately diagnosed as a brown tumor and a parathyroidectomy was performed. After 1 year, the lesion has nearly regressed by follow up of the anteroposterior view of the pelvis and bone mineral density has improved. The present case highlights the importance of considering brown tumors in the evaluation of patients presenting with hypercalcemia and osteolytic lesions without definite","PeriodicalId":119859,"journal":{"name":"Journal of Korean Endocrine Society","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134331175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of the Efficacy of Octreotide Long-acting Repeatable and Lanreotide Autogel in Acromegalic Patients","authors":"Jeong Kyung Park, Eun Jig Lee","doi":"10.3803/JKES.2010.25.1.25","DOIUrl":"https://doi.org/10.3803/JKES.2010.25.1.25","url":null,"abstract":"25 성장호르몬은 191개의 아미노산으로 구성된 폴리펩타이 드로 뇌하수체에서 분비되어 신체 내 주요한 합성 작용과 지질 대사에 관여한다. 이 호르몬의 작용은 대부분 인슐린양 성장인자 I과 간접적으로 연관되어 있고 인슐린양 성장인자 I은 성장호르몬에 의해 합성, 분비된다[1]. 말단비대증에서 만성적으로 증가된 성장호르몬은 다른 조직의 성장인자의 과잉생산을 초래하며, 특히 인슐린양 성 장인자-I의 과잉으로 인해 골막과 연골의 성장을 자극하고 장기의 비대를 일으켜 질환의 특징적 외형을 만들어 낼 뿐 만 아니라 당과 지질 대사에 심각한 변화를 불러와 당뇨병, 고지혈증 등 심혈관계 위험에 관계되는 질환을 초래한다. 이 에 따라 말단비대증 환자에서 성장호르몬의 감소가 사망률 의 감소와 연관된다는 것을 확인한 연구들이 있어 왔다[2,3]. Orme 등[4]은 1,362명의 말단비대증 환자에 대한 다기관 후향적 연구에서 치료 후의 성장호르몬 수치가 상승함에 따 라 대장암에 의한 사망률, 악성 질환의 빈도, 심혈관계 질환 및 전체 사망률이 증가하는 것을 보여주었고 특히 치료 후 성장호르몬이 2.5 ng/mL 이하로 조절된 경우 일반 인구와 비슷한 사망률을 가지는 것을 확인하였다. 따라서 말단비대 증의 치료 목표는 성장호르몬을 적절하게 억제함으로써 증 상을 호전시키고 장기적인 합병증과 사망률을 감소시키는 데에 있다고 하겠다. 지난 수십 년간 말단비대증의 치료는 수술과 방사선치료만이 시도되었으나 1980년 대 소마토스 타틴 유사체가 도입되면서 약물치료가 중요한 치료법으로 대두되고 있으며 일부에서는 일차적 치료제로 소마토스타틴 유사체를 이용하기도 한다[5]. 소마토스타틴 유사체로서 처음 소개된 약물이 옥트레오 타이드인데, 이는 반감기가 2시간으로 짧아 효과적인 성장 호르몬 분비 억제를 위해 하루 세 번의 피하주사가 필요했 다. 잦은 투약에 따른 불편감과 낮은 순응도에 대처하기 위 해 개발된 약이 서방형 옥트레오타이드와 서방형 란레오타 이드로 이들은 이황화물 가교를 갖는 여덟 개의 아미노산으 로 구성되어 있으며 생분해성인 중합체가 활성 펩타이드를 감싸고 있는 입자 형태로 만들어졌다[6]. 일반적으로 서방형 옥트레오타이드는 10~30 mg을 4주 간격, 란레오타이드는 30 mg을 7~14일 간격으로 투약하게 된다. 서방형 란레오타이드와 옥트레오타이드의 상대적 효율에 대해서는 아직 논쟁의 여지가 있으나 대다수의 연구들에서 일차 또는 이차 치료로 두 약제를 사용했을 때 옥트레오타 이드가 란레오타이드 서방형에 비해 성장호르몬 감소 유지 에 더 효과적임을 밝힌 바 있다[7,8]. 이러한 란레오타이드의 한계점을 극복하기 위해 좀 더 장 기 지속형 제제로 개발된 약이 란레오타이드 오토젤이다. 이 는 친수성과 소수성 잔기가 이황화물 가교로 연결된 구조로 서 물에 혼합하면 자체회합으로 반고형의 겔을 형성하게 된 다. 사전 충전 방식으로 4주 간격으로 깊은 피하층에 주사 하도록 되어 있다[6]. 서방형 옥트레오타이드와 란레오타이드 오토젤의 효과에 대한 비교 연구는 많지 않다. 이 중 van Thiel 등[9]은 서방 형 옥트레오타이드와 란레오타이드 오토젤을 교체 투약한 환자들에게서 24시간동안 성장호르몬의 수치 변동을 기록하 여 두 군 사이에 차이가 없음을 보여주었다. 이 결과는 두 약제가 투약 방법이나 약동학적인 차이가 있더라도 동등한 효능을 가진다는 것을 확인한 셈이다. 이 외에 두 약제의 치 료 효과를 비교 분석한 소규모 연구들이 있었는데[10~12], Alexopoulou 등[12]의 연구에 의하면 6개월 이상 옥트레오 타이드 서방형의 치료를 받은 25명의 환자를 대상으로 란레 오타이드 오토젤로 변경 투약 하여 24주 후에 검사한 혈청 성장호르몬과 인슐린양 성장인자 I의 농도를 비교 하였을 때 평균 혈중 성장호르몬 농도는 2.9 ± 2.4 ug/L (기저치: 2.4 ± 1.8 ug/L)이었고 인슐린양 성장인자 I은 332 ± 193 ug/L (기저치: 337 ± 201 ug/L)로 유의한 차이가 없었다. 비록 소 말단비대증 환자에게서 서방형 옥트레오타이드와 란레오타이드 오토젤의 효과 비교","PeriodicalId":119859,"journal":{"name":"Journal of Korean Endocrine Society","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126380313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Graves' Disease with Pancytopenia","authors":"J. Shin, Hyunjin Kim, S. Kim, Dong Pil Kim, B. Ko, Dong Soon Kim, Jimyung Kim, S. Gong, Jung Ae Lee","doi":"10.3803/JKES.2009.24.4.272","DOIUrl":"https://doi.org/10.3803/JKES.2009.24.4.272","url":null,"abstract":"Hematological disorders, and especially single lineage abnormalities, have been described in patients suffering with thyrotoxicosis, but pancytopenia is a rare complication of thyrotoxicosis. Pancytopenia with thyrotoxicosis has been reported to be totally reversible with antithyroid drug treatment. We experienced a case with pancytopenia associated with Graves’ disease in a 57-year-old woman who had no specific cause of pancytopenia. She presented with dyspnea and palpitation. The laboratory findings revealed thyrotoxicosis and pancytopenia. Increased radioisotope uptake was seen on the thyroid scan and normal cellularity and maturation were found in the bone marrow aspiration biopsy. Based on these findings, she was diagnosed as ,","PeriodicalId":119859,"journal":{"name":"Journal of Korean Endocrine Society","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2009-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124142513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ectopic ACTH Syndrome with Bilateral Pheochromocytoma in Multiple Endocrine Neoplasia Type 2A","authors":"J. Moon, Yoon Jung Kim, Y. Seo, H. Choi, J. Kim, Ju Ri Park, Y. Lee, Hee Young Kim, S. Kim, D. Choi","doi":"10.3803/JKES.2009.24.4.265","DOIUrl":"https://doi.org/10.3803/JKES.2009.24.4.265","url":null,"abstract":"Multiple endocrine neoplasia type 2A (MEN 2A) is an autosomal dominant syndrome characterized by the presence of medullary thyroid carcinoma, pheochromocytoma, and hyperparathyroidism. MEN 2A arises due to a germline missense mutation of the RET proto-oncogene. Specific RET mutation analysis has revolutionized the diagnosis and therapy of this disorder, and early thyroidectomy may have lowered the morbidity and mortality associated with these diseases. Ectopic adrenocorticotropic hormone (ACTH) syndrome is characterized by hypercortisolism due to the hypersecretion of ACTH outside of the pituitary gland; the most common causes are malignancies, but rarely adrenal pheochromocytoma may be the cause. We describe here a case of ectopic ACTH syndrome with bilateral pheochromocytoma in a 29-year-old man with MEN 2A presenting with medullary thyroid carcinoma and hyperparathyroidism. MEN 2A was confirmed by the detection of the RET proto-oncogene mutation. The laboratory results were compatible with ectopic ACTH syndrome. Immunohistochemical studies of the pheochromocytoma tissue confirmed the etiology of the ACTH secretion. This is the first confirmed case of the ectopic ACTH syndrome with bilateral pheochromocytoma in a Korean patient with MEN 2A. (J Korean Endocr Soc 24:265~271, 2009)","PeriodicalId":119859,"journal":{"name":"Journal of Korean Endocrine Society","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2009-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133170288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing the Prevalence of Primary Aldosteronism in Hypertensive Diabetic and Non-diabetic Patients","authors":"Y. Jang, K. S. Kim, H. Kim","doi":"10.3803/JKES.2009.24.4.254","DOIUrl":"https://doi.org/10.3803/JKES.2009.24.4.254","url":null,"abstract":"Background: Primary aldosteronism is the most common cause of secondary hypertension in humans. Its prevalence is estimated to be 10-15% among hypertensive patients. It is also associated with insulin resistance and diabetes mellitus. The aim of our study was to compare the prevalence of primary aldosteronism in hypertensive patients with presence of diabetes mellitus. Methods: We reviewed retrospectively the clinical records of 104 hypertensive patients for whom we also measured plasma renin activity (PRA) and plasma aldosterone concentrations (PAC). Results: Among 104 hypertensive patients, 44 had diabetes and 60 did not. There were no significant differences in clinical characteristics between non-diabetic and diabetic patients except for age and the number of antihypertensive agents. Patients with target organ damage were more common among diabetic patients. There was no correlation between PAC and the number of target organs damaged. In addition, Four patients from the non-diabetic and two from the diabetic group had a rat io over 30 for PRA/PAC and a PAC of over 15 ng/dL. Two non-diabetic patients and one diabetic patient were found, on abdomen CT, to have an adrenal adenoma. The rest of the patients refused further tests. Conclusion: The prevalence of primary aldosteronism in diabetic patients does not differ significantly from that in non-diabetic patients. Therefore, the present routine screening test for primary aldosteronism in","PeriodicalId":119859,"journal":{"name":"Journal of Korean Endocrine Society","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2009-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130223178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinico-pathologic Characteristics of the Primary Thyroid Cancer in Patients with Breast Cancer","authors":"H. Shin, H. W. Jang, Ji Young Park, J. Chung, Y. Min, Myung-Shik Lee, M. Lee, K. Kim, S. Kim","doi":"10.3803/JKES.2009.24.4.240","DOIUrl":"https://doi.org/10.3803/JKES.2009.24.4.240","url":null,"abstract":"Background: Both thyroid and breast cancers occur more frequently in women than in men. Some suggest that estrogen plays a role in the tumorigenesis of both cancers. The aim of this study was to identify the prevalence and clinico-pathologic characteristics of primary thyroid cancer in patients with breast cancer. Methods: We retrospectively obtained clinical and pathologic data for 112 patients diagnosed with both thyroid and breast cancer from a single center. Patients with thyroid cancer were grouped according to the chronological sequence of tumor diagnosis. When thyroid and breast cancers were diagnosed within 12 months of each other, they were considered to have been diagnosed simultaneously. Female patients who had only papillary thyroid cancer were used as a historic control. Results: Between 1994 and 2008, 7,827 patients at our hospital were diagnosed with breast cancer and 6,571 patients with thyroid cancer. There were 112 patients who had both thyroid and breast cancer. All thyroid cancers (111/112) except one hurthle cell cancer were papillary thyroid cancers. Average tumor size of thyroid cancer cases diagnosed 1) after or 2) simultaneously with the diagnosis of breast cancer was significantly lower than that for 3) thyroid cancer cases found before breast cancer diagnosis or 4) historical controls with papillary thyroid cancer [sizes (in cm), respectively, were: 1) 0.9 ± 0.6 2) 0.9 ± 0.5 vs 3) 1.4 ± 0.9 4) 1.4 ± 1.1, P < 0.05]. No patients had distant metastases and there were no statistically significant differences in known risk factors for recurrence and survival of patients with thyroid cancer. Conclusion: Thyroid cancer is the most common second primary malignancy in patients with breast cancer and most of them are papillary thyroid cancers. There are no differences in risk factors for tumor recurrence and patient survival compared with those with conventional papillary thyroid cancer except for differences in tumor size. These difference in size may reflect an increase in medical surveillance in patients after they are diagnosed with breast cancer. (J Korean Endocr Soc 24:240~246, 2009) ꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏ","PeriodicalId":119859,"journal":{"name":"Journal of Korean Endocrine Society","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2009-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131345050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pituitary Apoplexy in Korea - Characteristics, Treatment Options and Outcomes.","authors":"J. Lim, Jin Taek Kim, Min Joo Kim, Tae Hyuk Kim, Yenna Lee, H. Y. Cho, C. Shin, K. Park, H. Jang, B. Cho, Hong-Kyu Lee, S. Kim","doi":"10.3803/JKES.2009.24.4.247","DOIUrl":"https://doi.org/10.3803/JKES.2009.24.4.247","url":null,"abstract":"Background: Reports on pituitary apoplexy in Korea are limited. There are two treatment options for pituitary apoplexy - surgical decompression and conservative management. In this study, we examined clinical presentation and outcomes following different therapies in Korean patients with pituitary apoplexy. Methods: Clinical data and treatment outcomes from 52 patients with pituitary apoplexy who visited Seoul National University Hospital between January 1992 and June 2008 were reviewed retrospectively. Patients were divided into 2 groups according to management options (a surgery group vs. a conservative management group) and their outcomes were compared. For patients who underwent surgery due to neurological symptoms, outcomes were compared between early and late surgery groups. Results: Headache (73.1%) was the most common presenting symptom, and more than half of the patients were reported to have visual symptoms. The most common type of pathology was a nonfunctioning pituitary adenoma (67.3%). Nine patients received conservative management and 43 underwent surgical decompression. Their recovery from neurological and endocrinological abnormalities were similar. Among patients who showed neurological symptoms, 9 underwent surgery within 1 week of symptom onset and 24 underwent surgery after 1 week. There was no significant difference between outcomes of early and late surgery groups except recovery from impaired visual deficit was greater in the late surgery group. Conclusion: Patients with pituitary apoplexy in Korea show similar clinical features as similar patients in other countries. In our study, there was no significant difference between clinical outcomes of the surgery group and the conservative treatment group. (J Korean Endocr Soc 23:247~253, 2009) ꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏ","PeriodicalId":119859,"journal":{"name":"Journal of Korean Endocrine Society","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2009-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123982573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Insulin Autoimmune Syndrome in a Patient with Partial Hypopituitarism","authors":"Obin Kwon, Eun Young Park, J. Yoon, K. J. Kim, Yong‐ho Lee, J. Hong, Eun Jig Lee, Sungkil Lim, Hyun Chul Lee, B. Cha","doi":"10.3803/JKES.2009.24.4.281","DOIUrl":"https://doi.org/10.3803/JKES.2009.24.4.281","url":null,"abstract":"Insulin autoimmune syndrome is one of the rare causes of hypoglycemia, and characterized by hyperinsulinemic hypoglycemia associated with high titer of antibodies to endogenous insulin. We report a case of insulin autoimmune syndrome in a 57-year-old woman, presenting with mental changes due to hypoglycemia. She had no history of diabetes or insulin administration. The serum C-peptide level was 4.69 ng/mL and the insulin concentration was 229.55 μ U/mL, when fasting plasma glucose level was 32 mg/dL. The insulin-to-glucose ratio was 7.17, while there was no radiologic evidence of insulinoma. The insulin antibody level was over 100 μU/mL, resulting in the diagnosis of insulin autoimmune syndrome. Hormonal studies revealed partial hypopituitarism and a lack of glucagon-response to hypoglycemia. Hypoglycemia disappeared with replacement of prednisolone with levothyroxine therapy. Under secretion of growth hormone and of adrenocorticotropic hormone due to hypopituitarism were associated with insufficient counterregulation to hypoglycemia. One should keep in mind that insulin autoimmune syndrome or hypopituitarism is one cause of hypoglycemia in patients with no history of diabetes, and corticosteroid can be an effective treatment for","PeriodicalId":119859,"journal":{"name":"Journal of Korean Endocrine Society","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2009-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128638405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pathological Mechanism of Glucocorticoid-induced Osteoporosis","authors":"Hyun-Ju Kim","doi":"10.3803/JKES.2009.24.4.231","DOIUrl":"https://doi.org/10.3803/JKES.2009.24.4.231","url":null,"abstract":"231 글루코코르티코이드(glucocorticoid: GC)는 항염증과 면 역억제 기능이 있어 자가면역질병, 천식, 피부염, 관절염 등 여러 질병의 치료에 보편적으로 사용되는 약제이다. GC의 장기간 투여는 이러한 질병을 효과적으로 억제하지만, 대부 분의 환자에게서 골다공증을 초래하게 된다. 통계적으로 살 펴보면, GC를 투여하는 환자의 경우 1년 이내 골밀도의 12%가 급격히 감소되고 그 이후로는 뼈의 손실이 서서히 진행되어 2~5% 정도의 골밀도가 매년 점차적으로 감소됨이 보고된 바 있다[1]. GC에 의해 유도되는 골다공증의 흔한 발생빈도와 심각성에도 불구하고, 이에 대한 치료는 매우 어 려운 실정이다. 그러므로 골다공증의 병리학적 기전에 대한 보다 정확한 이해를 통해 이에 대한 예방과 치료방법의 개 선이 이루어질 수 있다. 지금까지 GC에 의해 유도되는 골다 공증(glucocorticoid-induced osteoporosis: GIO)의 병리학적 기전에 대한 많은 연구들이 이루어져 왔으나, secondary hyperparathyroidism 및 성호르몬에 대한 GC의 영향으로는 GIO의 원인을 충분히 설명할 수 없다. 반면, 골세포에 대한 GC의 직접적인 영향에 대한 연구가 수행되어 GIO의 발병 기전이 밝혀진 바 있다. 이 강좌에서는 파골세포에 대한 GC의 영향[2]과 최근 GC 표적분자로 발굴된 Calpain6의 역할을 중심으로 GIO의 새로운 병리학적 기전을 살펴보고 자 한다.","PeriodicalId":119859,"journal":{"name":"Journal of Korean Endocrine Society","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2009-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129713136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}