Endocrinology and Metabolism

Volume 27(1); March 2012

Review Articles

Current Progress on Tissue Engineering of Bone and Cartilage.: Shinsuke Ohba, Hironori Hojo, Ung il Chung; Endocrinol Metab. 2012;27(1):1-11. Published online March 1, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.1.1

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No abstract available.

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The principles of tissue engineering and its recent advances and future prospects
Woo Seob Kim
Journal of the Korean Medical Association.2014; 57(2): 145. CrossRef

Mechanism of Lipid Induced Insulin Resistance: An Overview.: Samir Bhattacharya, Rakesh Kundu, Suman Dasgupta, Sushmita Bhattacharya; Endocrinol Metab. 2012;27(1):12-19. Published online March 1, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.1.12

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Abstract PDF

Type 2 diabetes (T2D) is rapidly spreading throughout the world. It's an insidious disease and still treated in an indirect manner without having specific drug target. In majority cases T2D is treated with drugs that address type 1 diabetes, majority of drugs aim to increase insulin release although the root cause for T2D is not the dearth of insulin release, it occurs in the later stage of disease development. T2D silently progressed in the patient; it begins with insulin resistance that takes place due to the loss of insulin sensitivity. Though insulin resistance is the centre of pathogenesis, our treatment of the disease has not yet addressed it. It is now a fact that insulin resistance is manifested by lipid and fatty acids (FAs) play a critical role in blunting insulin sensitivity. Our understanding is still poor in deciphering how lipid impose insulin insensitivity, majority of workers suggest it is because of insulin signaling defects which implements insulin function in inhibiting glucose to the cell from circulation. Number of long chain saturated FA has been shown to produce insulin signaling defects. However, we really need further investigation to find specific target(s) for FA induced damage. In addition to these information, a new dimension of T2D is getting attractive is fetuin-A/alpha2-Heremans-Schmid Glycoprotein, a secretary protein from liver. Its gene locus has been identified as T2D susceptible. Fetuin-A's excess expression occurs by FA and it disrupts adipocyte function. It has been shown to be associated with T2D especially in obesity. In this review, we briefly discuss the present status on the mechanistic understanding of lipid induced insulin resistance that leads to T2D. More we understand the mechanism; opportunity to fight the battle with T2D will be increasing. Since, this field is now vast; we covered a few major events.

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The SWGEDWGEIW from Soybean Peptides Reduces Insulin Resistance in 3T3-L1 Adipocytes by Activating p-Akt/GLUT4 Signaling Pathway
Guofu Yi, Xia Sang, Yuxia Zhu, Di Zhou, Shuibing Yang, Yue Huo, Yang Liu, Bushra Safdar, Xianyong Bu
Molecules.2023; 28(7): 3001. CrossRef

Endocrine Disrupting Chemicals and Pubertal Development.: Shin Hye Kim, Mi Jung Park; Endocrinol Metab. 2012;27(1):20-27. Published online March 1, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.1.20

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During the past decades, advancement in pubertal onset especially in girls has been noticed worldwide. Genetic factors and increasing prevalence of adiposity may contribute, however ubiquitous presence of endocrine disrupting chemicals (EDCs) is suspected to be involved in the trend of earlier pubertal onset. Most of known EDCs have estrogenic and/or anti-androgenic actions and few have androgenic or anti-estrogenic effects. Some studies reported earlier age at menarche after exposure to polycholorinated biphenyls (PCBs), polybrominated biphenyls, dicholordiphenyltrichloroethane, phthalate esters, while several other studies found no effect of these compounds on Tanner stages or age at menarche in girls. Limited studies reported an association of delayed puberty in boys and exposure to PCBs or the pesticide endosulfan. However, epidemiological research on the effects of EDCs on sexual maturation is hampered by many pitfalls, such as the mixture of many chemicals with different effects in environment, unidentified critical window of exposure, and limited knowledge about the time lag between exposure and effect. In this paper, we reviewed possible mode of actions of different chemical compounds, and summarized animal/human studies shown the effects of EDCs on the pubertal development.

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Effects of Sleep Pattern, Stress, Menstrual Attitude, and Behavior That Reduces Exposure to Endocrine Disrupting Chemicals on Premenstrual Syndrome in Adolescents
Hye Jin Kim, So Young Choi, Haeyoung Min
Korean Journal of Women Health Nursing.2019; 25(4): 423. CrossRef
Relationship among Pro-environmental Attitude, Behavior to Decrease Exposure, Knowledge of Endocrine Disruptors, and Obesity-related Profiles in Nursing Students
Min A Kim
Journal of Korean Biological Nursing Science.2016; 18(3): 160. CrossRef
Comparison of growth and pubertal progression in wild type female rats with different bedding types
Byung Ho Kang, Shin-Hee Kim, Kyung A Jung, So Youn Kim, Sung-Hoon Chung, Young Shil Park, Kyung Lim Yoon, Kye Shik Shim
Annals of Pediatric Endocrinology & Metabolism.2015; 20(1): 53. CrossRef

Editorial

Impact of the Serum Adiponectin Concentration on the Progression of Carotid Atherosclerosis in Patient with Type 2 Diabetes Mellitus.: Hye Jin Yoo, Kyung Mook Choi; Endocrinol Metab. 2012;27(1):28-30. Published online March 1, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.1.28

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Abstract PDF: No abstract available.

Original Articles

Impact of Serum Adiponectin Concentration on Progression of Carotid Atherosclerosis in Patients with Type 2 Diabetes Mellitus.: Chul Sik Kim, Ju Ri Park, Sung Hoon Yu, Jun Goo Kang, Ohk Hyun Ryu, Seong Jin Lee, Eun Gyung Hong, Doo Man Kim, Jae Myung Yoo, Sung Hee Ihm, Moon Gi Choi, Hyung Joon Yoo; Endocrinol Metab. 2012;27(1):31-38. Published online March 1, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.1.31

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Abstract PDF: BACKGROUND
Increased cardiovascular events, which is the leading cause of death in type 2 diabetic patients, are mainly caused by accelerated atherosclerosis. Adiponectin has been suggested as a risk factor for cardiovascular diseases in cross-sectional studies. However, little is known about the impact of adiponectin on the progression of carotid atherosclerosis in type 2 diabetic patients. This study was conducted to evaluate the impact of early adiponectin levels on the progression of carotid atherosclerosis. METHODS: From March 2009, 150 patients with type 2 diabetes were consecutively enrolled in our affiliated outpatient clinic. Anthropometric and biochemical data, including adiponectin levels, were measured in each participant. We measured the carotid intima-media thickness (CIMT) at baseline and at 1-year follow-up (n = 111). Then, we prospectively studied the relationship between the serum adiponectin levels and the progression of CIMT for 1 year. RESULTS: Adiponectin levels negatively correlated with CIMT (r = -0.219, P = 0.015). Moreover, mean progression of CIMT was 0.016 +/- 0.040 mm. However, there was no correlation between adiponectin levels and the progression of CIMT within 1-year follow-up period (r = -0.156, P = 0.080). Age (beta = 0.556, P = 0.004), LDL cholesterol (beta = 0.276, P = 0.042), and A1C (beta = 0.309, P = 0.038) were found to be independent risk factors for CIMT. However, A1C (beta = 0.311, P = 0.042) was found to be the only independent risk factor for the progression of CIMT. CONCLUSION: In our study, adiponectin levels were negatively associated with CIMT. However, it did not affect the progression of CIMT at 1-year follow-up. Overall glycemic control is the most important factor in the progression of CIMT in patients with type 2 diabetes.

Association of Coronary Artery Disease and Osteoporotic Vertebral Fracture in Korean Men and Women.: Sun Ok Song, Kyung Won Park, Seung Hoon Yoo, Won Jun Koh, Byung Soo Kang, Tae Ho Kim, Hyeong Jin Kim, Yun Hyeong Cho, Deok Kyu Cho, Se Hwa Kim; Endocrinol Metab. 2012;27(1):39-44. Published online March 1, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.1.39

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Abstract PDF

BACKGROUND
The association of osteoporotic vertebral fracture or osteoporosis with coronary artery disease (CAD) was investigated in Korean men and women. METHODS: Four hundred consecutive postmenopausal women and men aged 50 years and older, undergoing coronary angiography, were enrolled for the evaluation of established or suspected coronary artery disease. CAD was diagnosed if there was narrowing of > 50% diameter in one or more major coronary artery. Morphometric vertebral fracture was assessed using lateral thoracic and lumbar spine radiographs. Bone mineral density was performed using dual-energy x-ray absorptiometry. RESULTS: Of the 400 subjects in the study (mean age of 61.9 +/- 11.6 years), 256 patients had CAD. Vertebral fracture was observed in 94 (23.5%) patients. There was no difference in vertebral fracture according to the presence or absence of CAD. In logistic regression analysis, vertebral fracture was not significantly associated with CAD after adjustment for multiple risk factors. Although women had lower BMD at any given site than men, BMD was not associated with the presence or absence of CAD among 191 patients. CONCLUSION: Our study demonstrated that osteoporotic vertebral fracture or osteoporosis was not associated with coronary artery disease in Korean men and women.

Citations

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Fundamental and practical aspects of coronary artery calcification
O. L. Barbarash, V. V. Kashtalap, I. A. Shibanova, A. N. Kokov
Russian Journal of Cardiology.2020; 25: 4005. CrossRef
Assessment of Subclinical Manifestations of Atherosclerosis of Coronary and Peripheral Arteries and Bone Strength Parameters in Women
I. A. Skripnikova, M. A. Kolchina, O. V. Kosmatova, M. A. Myagkova, V. E. Novikov, O. Yu. Isaykina, O. M. Drapkina
Rational Pharmacotherapy in Cardiology.2020; 16(6): 868. CrossRef
Association factor analysis between osteoporosis with cerebral artery disease
Eun-Sun Jin, Je Hoon Jeong, Bora Lee, Soo Bin Im
Medicine.2017; 96(9): e6164. CrossRef
VASCULAR CALCIFICATION, ATHEROSCLEROSIS AND BONE LOSS (OSTEOPOROSIS): NEW PATHOPHYSIOLOGICAL MECHANISMS AND FUTURE PERSPECTIVES FOR PHARMACOLOGICAL THERAPY
A. Dolzhenko, T. Richter, S. Sagalovsky
Almanac of Clinical Medicine.2016; 44(4): 513. CrossRef
Aortic Calcification and Bone Metabolism: The Relationship between Aortic Calcification, BMD, Vertebral Fracture, 25-Hydroxyvitamin D, and Osteocalcin
Kwang Joon Kim, Kyoung Min Kim, Kyeong Hye Park, Han Seok Choi, Yumie Rhee, Yong Ho Lee, Bong Soo Cha, Myong Jin Kim, Sun Min Oh, J. Keenan Brown, Sung Kil Lim
Calcified Tissue International.2012; 91(6): 370. CrossRef

Frequency of RAS Mutations and PAX8/PPARgamma Rearrangement in Follicular Thyroid Tumors in Korea.: Hye Jeong Kim, Hye Won Jang, Seo Young Sohn, Yoon La Choi, Hee Jin Kim, Young Lyun Oh, Sun Wook Kim, Jae Hoon Chung; Endocrinol Metab. 2012;27(1):45-53. Published online March 1, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.1.45

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Abstract PDF

BACKGROUND
Follicular thyroid tumors harbor several genetic alterations such as RAS mutations and PAX8/PPARgamma rearrangement. The aims of our study were to investigate the prevalence of RAS mutations and PAX8/PPARgamma rearrangement in follicular thyroid tumors and to correlate RAS mutations and/or PAX8/PPARgamma rearrangement with clinicopathologic features in Korean patients with follicular thyroid carcinomas. METHODS: RAS mutations were investigated by polymerase chain reaction and DNA sequencing in surgical specimens of 37 follicular thyroid carcinomas (FTCs) and 16 follicular thyroid adenomas (FTAs). PAX8/PPARgamma rearrangement was analyzed by fluorescent in situ hybridization in surgical specimens of 31 FTCs and 13 FTAs. RESULTS: RAS mutations were detected in 30% (11 of 37) of FTCs and 19% (three of 16) of FTAs. Three of 11 FTC patients with RAS mutations died of thyroid cancer, but none of the 26 FTC patients without RAS mutations. PAX8/PPARgamma rearrangement was found in 10% (three of 31) of FTCs, but in none of the 13 FTAs. All three FTC patients with PAX8/PPARgamma rearrangement remained in complete remission during follow-up. There were no FTC patients with both RAS mutations and PAX8/PPARgamma rearrangement. CONCLUSION: The prevalence of RAS mutations in our series of follicular tumors was similar to previous studies. The frequency of PAX8/PPARgamma rearrangements in our group of FTC was lower than previous western reports, but higher than Japanese reports. RAS mutations may be associated with hematogeneous metastasis and poor survival while PAX8/PPARgamma rearrangement may be related to more favorable prognosis in Korean patients with FTCs.

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Preoperative serum thyroglobulin and changes in serum thyroglobulin during TSH suppression independently predict follicular thyroid carcinoma in thyroid nodules with a cytological diagnosis of follicular lesion
Hye Jeong Kim, Ji-Oh Mok, Chul Hee Kim, Yeo Joo Kim, Sang Jin Kim, Hyeong Kyu Park, Dong Won Byun, Kyoil Suh, Myung Hi Yoo
Endocrine Research.2017; 42(2): 154. CrossRef
Mutation Profile of Well-Differentiated Thyroid Cancer in Asians
Young Shin Song, Jung Ah Lim, Young Joo Park
Endocrinology and Metabolism.2015; 30(3): 252. CrossRef
Analysis of RAS mutation and PAX8/PPARγ rearrangements in follicular-derived thyroid neoplasms in a Korean population: frequency and ultrasound findings
S. H. Jeong, H. S. Hong, J. J. Kwak, E. H. Lee
Journal of Endocrinological Investigation.2015; 38(8): 849. CrossRef

Case Reports

A Case of Sheehan's Syndrome with Pancytopenia.: Hyun Suk Lee, Byung Woon Kwon, Jin Hyung Han, Hee Jin Kim; Endocrinol Metab. 2012;27(1):54-58. Published online March 1, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.1.54

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Abstract PDF: Sheehan's syndrome is characterized by varying degrees of anterior pituitary dysfunction due to postpartum ischemic necrosis of the pituitary gland after massive bleeding. The spectrum of clinical presentation of Sheehan's syndrome is broad, with changes from nonspecific complaints, such as weakness, fatigue, and anemia, to severe pituitary insufficiency resulting in coma and death. Normochromic anemia is commonly associated with Sheehan's syndrome, but pancytopenia is rarely observed in patients with Sheehan's syndrome. We describe a 57-year-old woman with Sheehan's syndrome who presented with pancytopenia that was treated by hormone replacement with levothyroxine and glucocorticoid.

Papillary Thyroid Carcinoma Manifesting as an Autonomously Functioning Thyroid Nodule.: Ji Hyun Kim, Gyeong Jae Na, Ki Won Kim, Hee Ja Ko, Sung Wan Jeon, Yeo Joo Kim, Sang Jin Kim, Hyeun Duk Jo, Chang Jin Kim; Endocrinol Metab. 2012;27(1):59-62. Published online March 1, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.1.59

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Abstract PDF

Hyperfunctioning thyroid carcinoma is very rare. Hence, radionuclide imaging of thyroid hot nodules usually suggests a benign tumor, and less than 4% of cases have been reported as malignant. We would like to present a case of a hyperfunctioning papillary thyroid carcinoma that was initially treated with radioactive iodine. A 58-year-old woman was referred to our hospital for palpable thyroid nodule and a 5-kg weight loss within 6 months. Thyroid function test revealed thyrotoxicosis, and thyroid autoantibodies were absent. 99mTc thyroid scintigraphy showed a 2 x 2 cm-sized hyperactive hot nodule at the left lobe. Despite radioactive iodine treatment with a dose of 10 mCi 131I, thyroid function did not improve. Fine needle aspiration revealed papillary thyroid cancer. The patient underwent total thyroidectomy. Although clinical features and thyroid scans suggest a benign nodule, the possibility of malignancy should not be ruled out. Malignant thyroid hot nodules are rare; however, its possibility should be taken into account. Therefore, we suggest that ruling out malignancy by existing diagnostic guidelines can misdiagnose even a typical case with benign features. As thyroid nodule detection is getting sensitive and accurate, we present this case to discuss whether additional diagnostic approaches would be necessary for thyroid nodules.

Citations

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Ultrasonographic Characteristics of the Hyperfunctioning Thyroid Nodule and Predictive Factors for Thyroid Stimulating Hormone Suppression
Won Sang Yoo, Hoon Sung Choi
International Journal of Thyroidology.2019; 12(1): 35. CrossRef
Papillary Thyroid Carcinoma Presented as a Hot Nodule with Hyperthyroidism
Sung Hye Kong, Seo Young Lee, Ye Seul Yang, Jae Hoon Moon
International Journal of Thyroidology.2016; 9(1): 47. CrossRef

A Case of Simultaneous Presentation of Thyroid Crisis and Diabetic Ketoacidosis.: Kyung Ae Lee, Kyung Taek Park, Hea Min Yu, Heung Yong Jin, Ji Hyun Park, Hong Sun Baek, Tae Sun Park; Endocrinol Metab. 2012;27(1):63-67. Published online March 1, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.1.63

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Abstract PDF

Two important endocrine emergencies, thyroid crisis and diabetic ketoacidosis (DKA), are uncommon when presented together, but pose serious complications. Without appropriate management, they may result in high mortality. Although several cases of simultaneous presentation of thyroid crisis and DKA have been reported, it is a clinically unusual situation and remains a diagnostic and management challenge in clinical practice. We report rare case with simultaneous presentation of thyroid crisis and DKA without previous warning symptoms. A 23-year-old-woman was brought to the emergency department presenting with acute abdominal pain for one day. She was healthy and there was no personal history of diabetes or thyroid disease. Through careful physical examination and laboratory tests, the patient was diagnosed with thyroid crisis combined with DKA. Concomitance of these two endocrine emergencies led to sudden cardiac arrest, but she was successfully resuscitated. This emphasizes the importance of early recognition and prompt management when the two diseases are presented concomitantly.

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Health Behaviors and Risk Factors Associated with Chronic Kidney Disease in Korean Patients with Diabetes: The Fourth Korean National Health and Nutritional Examination Survey
Suk Jeong Lee, Chae Weon Chung
Asian Nursing Research.2014; 8(1): 8. CrossRef

A Case of Sunitinib-Induced Destructive Thyroiditis.: Bu Kyung Kim, Young Sik Choi, Yo Han Park; Endocrinol Metab. 2012;27(1):68-71. Published online March 1, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.1.68

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Abstract PDF: Sunitinib is a multi-targeted tyrosine-kinase inhibitor used for gastrointestinal stromal tumors and renal cell carcinoma (RCC). Several recent studies have reported sunitinib-induced hypothyroidism and thyroid dysfunction; however, the underlying mechanisms are not clear. Here, we report a patient with metastatic RCC, who developed destructive thyroidtis due to sunitinib treatment. The course followed in this case may be useful in understanding the clinical course of sunitinib-induced thyroiditis.

A Case of Bilateral Struma Ovarii Combined with Subclinical Hyperthyroidism.: Sang Mi Kim, Bo Kwang Choi, Ji Hyun Kang, Mi Ra Kim, Yun Kyung Jeon, Sang Soo Kim, Bo Hyun Kim, In Ju Kim; Endocrinol Metab. 2012;27(1):72-76. Published online March 1, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.1.72

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Abstract PDF

Struma ovarii is a rare monodermal variant of ovarian teratoma accounting for only 2% of all mature teratomas. To be classified as a struma ovarii, teratoma must be composed predominantly of mature thyroid tissue (> 50%). This tumor is generally benign, although malignant transformation has been reported. Struma ovarii occur mostly as unilateral cases, so bilateral cases are quite rare (less than 6% of cases). Struma ovarii occur largely without symptoms or are accompanied by non-specific symptoms, such as abdominal pain, a palpable abdominal mass, and abdominal distension. The preoperative diagnosis is generally difficult. The incidence of hyperthyroidism has been reported to be 5-10% of patients with struma ovarii. Thus, cases of functional bilateral struma ovarii are very rare. We report a case of bilateral struma ovarii with subclinical thyrotoxicosis and a diffuse goiter, mimicking a malignant ovarian tumor, and include a brief review of related literature.

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Benign Teratoma of the Thyroid Gland
Chan Young Oak, Hee Kyung Kim, Tae Mi Yoon, Sang Chul Lim, Hyun Bum Park, Hyung Chul Park, Min Gui Han, Ho-Cheol Kang
Endocrinology and Metabolism.2013; 28(2): 144. CrossRef
Metastatic follicular struma ovarii complicating pregnancy: a case report and review of the literature
Woohyung Lee, Nam-Joon Yi, Hyeyoung Kim, Youngrok Choi, Minsu Park, Geun Hong, June Young Choi, Hyun Hoon Chung, Kwang-Woong Lee, Do-Joon Park, Hye Sook Min, June-key Chung, Kyung-Suk Suh
Korean Journal of Hepato-Biliary-Pancreatic Surgery.2012; 16(3): 123. CrossRef

A Case of Solitary Extramedullary Plasmacytoma of the Thyroid Presented as a Thyroid Tumor with Hashimoto's Thyroiditis.: Eunjung Jo, Dong Woo Ha, Jin Hee Choi, Kyung Nam Lee, Jung Seop Eom, Mi Ra Kim, Yun Kyung Jeon, Sang Soo Kim, Bo Hyun Kim, In Joo Kim; Endocrinol Metab. 2012;27(1):77-82. Published online March 1, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.1.77

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Abstract PDF

Extramedullary plasmacytomas most commonly occur in the nasal cavity, nasopharynx, paranasal sinuses, and larynx. Solitary extramedullary plasmacytoma (SEP) of the thyroid gland is rare. The diagnosis of SEP of the thyroid by cytology is typically difficult before surgery, and the entity is often confused with different cytology findings. We report a case of a 59-year-old man with primary plasmacytoma of the thyroid presented as a rapidly enlarging thyroid gland with Hashimoto's thyroiditis. He had been suffering from anterior neck swelling for 1 month. Several fine-needle aspiration biopsies yielded Hashimoto's thyroiditis. During a follow-up period of 3 years, the size of the thyroid gland increased and a mass lesion in right thyroid gland was detected. A total thyroidectomy was performed based on a diagnosis of a thyroid tumor with Hashimoto's thyroiditis. Permanent pathology identified the mass as an extramedullary plasmacytoma associated with Hashimoto's thyroiditis. Skeletal survey and serum electrophoresis tests were normal, and a bone marrow biopsy yielded no evidence of multiple myeloma. The patient underwent definitive radiotherapy and remained free from any recurrences during follow-up.

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It's not all about the thyroid! Extrinsic and unusual pathology affecting the thyroid gland: A pictorial review
Edward Walker, Shishir Karthik, Preetha Chengot, Sriram Vaidyanathan
Clinical Imaging.2022; 85: 29. CrossRef

Primary Hyperaparathyroidism due to Cystic Parathyroid Adenoma not Detected on 99mTc-Sestamibi Scan.: Ah Reum Khang, Eun Ki Kim, Eun Young Nam, Sun Ju Byeon, Jung Hee Kim, Jung Hun Ohn, Eun Shil Hong, Hyung Jin Choi, Kyeong Cheon Jung, Myung Whun Sung, Chan Soo Shin, Kyong Soo Park, Seong Yeon Kim; Endocrinol Metab. 2012;27(1):83-88. Published online March 1, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.1.83

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Abstract PDF

Parathyroid cysts, which can be divided into functional and non-functional cysts, are rare causes of primary hyperparathyroidism. A technetium-99m-methoxyisobutylisonitrile (99mTc-sestamibi) parathyroid scan is a sensitive diagnostic tool for the localization, although it sometimes shows a false-negative result. Here we report a case of presumed cystic parathyroid adenoma based on clinical findings and analysis of cystic fluid with negative findings in a parathyroid scan. A 44-year-old male patient visited the hospital due to leg pain and compressive symptoms (dysphagia, hoarseness) that had started 4-5 months before. His serum calcium level was 14.4 mg/dL and his intact parathyroid hormone (iPTH) had increased to 478.1 pg/mL. On neck computed tomography, a cystic nodule measuring 6.2 cm was detected in the inferior part of the right thyroid gland. Sestamibi uptake for this nodule was not detected on 2-h delayed imaging, and fluorodeoxyglucose positron emission tomography showed only subtle uptake. Fine-needle aspiration was performed and intracystic iPTH had increased to 61,600 pg/mL. Focused parathyroidectomy guided by intraoperative iPTH monitoring led to successful enucleation of the right inferior parathyroid gland. A parathyroid adenoma was confirmed, and his laboratory results had normalized. This study shows that cystic parathyroid adenoma can sometimes be difficult to detect on a 99mTc-sestamibi parathyroid scan.

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Functional parathyroid cystic adenoma: A rare cause of hypercalcemic crisis with primary hyperparathyroidism
BS Sumana, M Sabaretnam, Vijaya Sarathi, Akshatha Savith
Indian Journal of Pathology and Microbiology.2015; 58(4): 487. CrossRef
Normocalcemic primary hyperparathyroidism: long-term follow-up associated with multiple adenomas
Larissa Pimentel, Sirley Portela, Alyne Loureiro, Francisco Bandeira
Arquivos Brasileiros de Endocrinologia & Metabologia.2014; 58(5): 583. CrossRef

Ketoacidosis with Hypertriglyceridemia-Induced Pancreatitis in a Patient with Gestational Diabetes: A Case Report.: Hyun Hee Chung, Sang Hyun Park, Ji Sung Yoon, Kyu Chang Won, Hyoung Woo Lee; Endocrinol Metab. 2012;27(1):89-92. Published online March 1, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.1.89

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Abstract PDF

Hypertriglyceridemia-induced acute pancreatitis in pregnancy is not a common complication. Moreover, ketoacidosis in gestational diabetes occurs rarely. Here we report a case of ketoacidosis with hypertriglyceridemia-induced pancreatitis in a patient with gestational diabetes that was successfully treated with insulin and supportive care. In this case, a 36-year-old woman (at 32 weeks' gestation) was diagnosed with gestational diabetes 4 weeks prior, but did not have well controlled blood sugar. She complained of severe epigastric pain concomitant with nausea and vomiting. Radiology and laboratory tests found hypertriglyceridemia (1,996 mg/dL), acute pancreatitis, and ketoacidosis with absence of fetal deceleration on a non-stress test. The patient's condition improved with insulin therapy and fluid replacement. To our knowledge, this is the first report of a case of ketoacidosis with hypertriglyceridemia-induced pancreatitis in a patient with gestational diabetes.

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Acute Pancreatitis in a Pregnant Patient with Type IV Hyperlipoproteinemia
Sang Ho Lee, Jae Hyuck Jun, Young Seok Doh, Ji Woong Jang, Sae Hee Kim, Il Hyun Baek, Sung Hee Jung
The Korean Journal of Pancreas and Biliary Tract.2019; 24(2): 73. CrossRef
Hypertriglyceridemia-Induced Acute Pancreatitis
Jin Myung Park
The Korean Journal of Pancreas and Biliary Tract.2017; 22(4): 158. CrossRef
Cheese-like Material in the Heart: An Autopsy Case Report of Severe Hypertriglyceridemia in Diabetic Ketoacidosis Patient
Joo Young Na, Eun Hee Kim, Bon Young Koo, Ik Jo Chung, Byung Ha Choi, Nak Eun Chung
Korean Journal of Legal Medicine.2013; 37(4): 212. CrossRef

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