Endocrinology and Metabolism

Original Articles

Clinical Study
Stimulated Salivary Cortisol as a Noninvasive Diagnostic Tool for Adrenal Insufficiency: Yoon Ji Kim, Jung Hee Kim, A Ram Hong, Kyeong Seon Park, Sang Wan Kim, Chan Soo Shin, Seong Yeon Kim; Endocrinol Metab. 2020;35(3):628-635. Published online September 22, 2020; DOI: https://doi.org/10.3803/EnM.2020.707

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Background
Salivary cortisol is routinely used as a diagnostic test for Cushing syndrome. The diagnostic use of salivary cortisol for adrenal insufficiency (AI), however, is less established. We aimed to investigate the utility of morning basal and adrenocorticotropic hormone-stimulated salivary cortisol in diagnosing AI in Korean adults.
Methods
We prospectively included 120 subjects (female, n=70) from Seoul National University Hospital. AI was defined as a stimulated serum cortisol level of <496.8 nmol/L during the short Synacthen test (SST). Serum and saliva samples were drawn between 8:00 AM and 10:00 AM. Salivary cortisol levels were measured using an enzyme immunoassay kit.
Results
Thirty-four patients were diagnosed with AI according to the SST results. Age, sex, body mass index, serum albumin levels, and serum creatinine levels did not significantly differ between the normal and AI groups. Basal and stimulated salivary cortisol levels were positively correlated with basal (r=0.538) and stimulated serum cortisol levels (r=0.750), respectively (all P<0.001). Receiver operating characteristic curve analysis yielded a cutoff level of morning basal salivary cortisol of 3.2 nmol/L (sensitivity, 84.9%; specificity, 73.5%; area under the curve [AUC]=0.822). The optimal cutoff value of stimulated salivary cortisol was 13.2 nmol/L (sensitivity, 90.7%; specificity, 94.1%; AUC=0.959). Subjects with a stimulated salivary cortisol level above 13.2 nmol/L but a stimulated serum cortisol level below 496.8 nmol/L (n=2) had lower serum albumin levels than those showing a concordant response.
Conclusion
The diagnostic performance of stimulated salivary cortisol measurements after the SST was comparable to serum cortisol measurements for diagnosing AI.

Citations

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Extensive expertise in endocrinology: adrenal crisis in assisted reproduction and pregnancy
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The Reliability of Salivary Cortisol Compared to Serum Cortisol for Diagnosing Adrenal Insufficiency with the Gold Standard ACTH Stimulation Test in Children
Silvia Ciancia, Sjoerd A. A. van den Berg, Erica L. T. van den Akker
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РІВЕНЬ СТРЕСУ В ДІТЕЙ ШКІЛЬНОГО ВІКУ З COVID-19
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Annals of Allergy, Asthma & Immunology.2022; 128(4): 464. CrossRef
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Endocrinology and Metabolism.2022; 37(4): 599. CrossRef
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Laura van Smeden, Annet Saris, Khulan Sergelen, Arthur M. de Jong, Junhong Yan, Menno W. J. Prins
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Clinical Study
Diagnostic Role of Captopril Challenge Test in Korean Subjects with High Aldosterone-to-Renin Ratios: Jung Hee Kim, Kyeong Seon Park, A Ram Hong, Chan Soo Shin, Seong Yeon Kim, Sang Wan Kim; Endocrinol Metab. 2016;31(2):277-283. Published online May 13, 2016; DOI: https://doi.org/10.3803/EnM.2016.31.2.277

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Abstract PDF PubReader

Background

Diagnosis of primary aldosteronism (PA) begins with aldosterone-to-renin ratio (ARR) measurement followed by confirmative tests. However, the ARR has high false positive rates which led to unnecessary confirmatory tests. Captopril challenge test (CCT) has been used as one of confirmatory tests, but the accuracy of it in the diagnosis of PA is still controversial. We aimed to examine the clinical efficacy of CCT as a post-screening test in PA.

Methods

In a prospective study, we enrolled subjects with suspected PA who had hypertension and ARR >20 (ng/dL)/(ng/mL/hr). Sixty-four patients who underwent both the saline infusion test and the CCT were included.

Results

The diagnostic performance of plasma aldosterone concentration (PAC) post-CCT was greater than that of ARR post-CCT and ARR pre-CCT in PA (area under the curve=0.956, 0.797, and 0.748, respectively; P=0.001). A cut-off value of 13 ng/dL showed the highest diagnostic odds ratio considering PAC post-CCT at 60 and 90 minutes. A PAC post-CCT of 19 ng/dL had a specificity of 100%, which can be used as a cut-off value for the confirmative test. Determining the diagnostic performance of PAC post-CCT at 90 minutes was sufficient for PA diagnosis. Subjects with PAC post-CCT at 90 minutes <13 ng/dL are less likely to have PA, and those with PAC post-CCT at 90 minutes ≥13 but <19 ng/dL should undergo secondary confirmatory tests.

Conclusion

The CCT test may be a reliable post-screening test to avoid the hospitalization in the setting of falsely elevated ARR screening tests.

Citations

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Exclusion Tests in Unilateral Primary Aldosteronism (ExcluPA) Study
Rui Zhu, Tungalagtamir Shagjaa, Giacomo Rossitto, Brasilina Caroccia, Teresa Maria Seccia, Dario Gregori, Gian Paolo Rossi
The Journal of Clinical Endocrinology & Metabolism.2023; 108(2): 496. CrossRef
Captopril challenge test in the diagnosis of primary aldosteronism: consistency between 1- and 2- h sampling
Xinyu Liu, Chao Guo, Jin Bian, Sufang Hao, Ying Lou, Huimin Zhang, Xianliang Zhou, Jun Cai, Wenjun Ma
Frontiers in Endocrinology.2023;[Epub] CrossRef
Performance of Confirmatory Tests for Diagnosing Primary Aldosteronism: a Systematic Review and Meta-Analysis
Alexander A. Leung, Christopher J. Symonds, Gregory L. Hundemer, Paul E. Ronksley, Diane L. Lorenzetti, Janice L. Pasieka, Adrian Harvey, Gregory A. Kline
Hypertension.2022; 79(8): 1835. CrossRef
Baseline Plasma Aldosterone Level and Renin Activity Allowing Omission of Confirmatory Testing in Primary Aldosteronism
Junji Kawashima, Eiichi Araki, Mitsuhide Naruse, Isao Kurihara, Katsutoshi Takahashi, Kouichi Tamura, Hiroki Kobayashi, Shintaro Okamura, Shozo Miyauchi, Koichi Yamamoto, Shoichiro Izawa, Tomoko Suzuki, Akiyo Tanabe
The Journal of Clinical Endocrinology & Metabolism.2020; 105(5): e1990. CrossRef
The number of positive confirmatory tests is associated with the clinical presentation and incidence of cardiovascular and cerebrovascular events in primary aldosteronism
Aya Saiki, Daisuke Tamada, Reiko Hayashi, Kosuke Mukai, Tetsuhiro Kitamura, Mitsuyoshi Takahara, Michio Otsuki, Iichiro Shimomura
Hypertension Research.2019; 42(8): 1186. CrossRef
The characteristics of captopril challenge test–positive patients using various criteria
Satoshi Kidoguchi, Naoki Sugano, Naomi Hayashi-Ishikawa, Norihiko Morisawa, Goro Tokudome, Takashi Yokoo
Journal of the Renin-Angiotensin-Aldosterone System.2019; 20(3): 147032031987089. CrossRef
Confirmatory tests for the diagnosis of primary aldosteronism: A systematic review and meta‐analysis
Sicen Wu, Jun Yang, Jinbo Hu, Ying Song, Wenwen He, Shumin Yang, Rong Luo, Qifu Li
Clinical Endocrinology.2019; 90(5): 641. CrossRef
The captopril challenge test for diagnosing primary Aldosteronism in a Chinese population
Ke-ying Zhu, Yan Zhang, Wen-jing Zhang, Hong-yun Li, Wen-huan Feng, Da-long Zhu, Ping Li
BMC Endocrine Disorders.2019;[Epub] CrossRef
Confirmatory Tests for the Diagnosis of Primary Aldosteronism
Ying Song, Shumin Yang, Wenwen He, Jinbo Hu, Qingfeng Cheng, Yue Wang, Ting Luo, Linqiang Ma, Qianna Zhen, Suhua Zhang, Mei Mei, Zhihong Wang, Hua Qing, Dennis Bruemmer, Bin Peng, Qifu Li
Hypertension.2018; 71(1): 118. CrossRef
Evaluation of the Saline Infusion Test and the Captopril Challenge Test in Chinese Patients With Primary Aldosteronism
Xiao Meng, Yanyan Li, Xiaohao Wang, Jianwei Li, Yuping Liu, Yerong Yu
The Journal of Clinical Endocrinology & Metabolism.2018; 103(3): 853. CrossRef
Articles inEndocrinology and Metabolismin 2016
Won-Young Lee
Endocrinology and Metabolism.2017; 32(1): 62. CrossRef
Optimal follow-up strategies for adrenal incidentalomas: reappraisal of the 2016 ESE-ENSAT guidelines in real clinical practice
A Ram Hong, Jung Hee Kim, Kyeong Seon Park, Kyong Young Kim, Ji Hyun Lee, Sung Hye Kong, Seo Young Lee, Chan Soo Shin, Sang Wan Kim, Seong Yeon Kim
European Journal of Endocrinology.2017; 177(6): 475. CrossRef
Agkihpin, a novel SVTLE from Gloydius halys Pallas, promotes platelet aggregation in vitro and inhibits thrombus formation in vivo in murine models of thrombosis
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Clinical Study
Characterization of Patients with Type 2 Diabetes according to Body Mass Index: Korea National Health and Nutrition Examination Survey from 2007 to 2011: Dong-Hwa Lee, Kyong Yeun Jung, Kyeong Seon Park, Kyoung Min Kim, Jae Hoon Moon, Soo Lim, Hak Chul Jang, Sung Hee Choi; Endocrinol Metab. 2015;30(4):514-521. Published online December 31, 2015; DOI: https://doi.org/10.3803/EnM.2015.30.4.514

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Abstract PDF PubReader

Background

The present study aimed to investigate the clinical characteristics of type 2 diabetes mellitus (T2DM) in Korean adults according to body mass index (BMI) and to analyze the association with cardiovascular disease (CVD).

Methods

We conducted a cross-sectional study of data from the Korea National Health and Nutrition Examination Survey from 2007 to 2011. A total of 3,370 patients with T2DM were divided into categories according to BMI. We conducted a comparison of the T2DM patient population composition by BMI category between different countries. We investigated the prevalence of awareness, treatment, and target control of T2DM according to BMI.

Results

Patients with T2DM had a higher BMI, and were more likely to have a history of CVD than healthy controls. For Korean adults with T2DM, 8% had BMI ≥30 kg/m². By contrast, the population of patients with T2DM and BMI ≥30 kg/m² was 72% in patients in the USA and 56% in the UK. The rate of recognition, treatment, and control has worsened in parallel with increasing BMI. Even in patients with BMI 25 to 29.9 kg/m², the prevalence of CVD or high risk factors for CVD was significantly higher than in patients with BMI 18.5 to 22.9 kg/m² (odds ratio, 2.07).

Conclusion

Korean patients with T2DM had lower BMI than those in Western countries. Higher BMI was associated with lower awareness, treatment, and control of diabetes, and a positive association was observed between CVD or high risk factors for CVD and BMI, even for patients who were overweight but not obese.

Citations

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Influenza vaccination trend and related factors among patients with diabetes in Korea: Analysis using a nationwide database
Dong-Hwa Lee, Bumhee Yang, Seonhye Gu, Eung-Gook Kim, Youlim Kim, Hyung Koo Kang, Yeong Hun Choe, Hyun Jeong Jeon, Seungyong Park, Hyun Lee
Frontiers in Endocrinology.2023;[Epub] CrossRef
Diet Quality Scores and Asthenoteratozoospermia Risk: Finding From a Hospital-Based Case–Control Study in China
Qi Cui, Hui-Han Wang, Qi-Jun Wu, Xiao-Bin Wang, Ren-Hao Guo, Xu Leng, Xiao-Ling Tan, Qiang Du, Bo-Chen Pan
Frontiers in Nutrition.2022;[Epub] CrossRef
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Ildiko Lingvay, Priya Sumithran, Ricardo V Cohen, Carel W le Roux
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Secular trends and determinants of influenza vaccination uptake among patients with cardiovascular disease in Korea: Analysis using a nationwide database
Min Kim, Bumhee Yang, Seonhye Gu, Eung-Gook Kim, So Rae Kim, Kyeong Seok Oh, Woong-Su Yoon, Dae-Hwan Bae, Ju Hee Lee, Sang Min Kim, Woong Gil Choi, Jang-Whan Bae, Kyung-Kuk Hwang, Dong-Woon Kim, Myeong-Chan Cho, Hyun Lee, Dae-In Lee
Frontiers in Cardiovascular Medicine.2022;[Epub] CrossRef
Triglyceride glucose (TyG) index as a predictor of incident type 2 diabetes among nonobese adults: a 12-year longitudinal study of the Korean Genome and Epidemiology Study cohort
Byoungjin Park, Hye Sun Lee, Yong-Jae Lee
Translational Research.2021; 228: 42. CrossRef
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A-Reum Lee, Da-Yeon Lee, Min-Ji Kim, Hyang-Sook Lee, Ka-Hye Choi, Seo-Young Kim, Young-Woo Lim, Young-Bae Park
Journal of Korean Medicine.2021; 42(1): 46. CrossRef
Effect of cilostazol, a phosphodiesterase‐3 inhibitor, on coronary artery stenosis and plaque characteristics in patients with type 2 diabetes: ESCAPE study
Dong‐Hwa Lee, Eun Ju Chun, Tae Jung Oh, Kyoung Min Kim, Jae Hoon Moon, Sung Hee Choi, Kyong Soo Park, Hak Chul Jang, Soo Lim
Diabetes, Obesity and Metabolism.2019; 21(6): 1409. CrossRef
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Miyong To Kim, Kim Byeng Kim, Jisook Ko, Nicole Murry, David Levine, Ju-Young Lee
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House dust mite and Cockroach specific Immunoglobulin E sensitization is associated with diabetes mellitus in the adult Korean population
Mee Kyoung Kim, Jee Sun Jeong, Kyungdo Han, Ki Hyun Baek, Ki-Ho Song, Hyuk-Sang Kwon
Scientific Reports.2018;[Epub] CrossRef
Long‐term effects on glycaemic control and β‐cell preservation of early intensive treatment in patients with newly diagnosed type 2 diabetes: A multicentre randomized trial
Suk Chon, Sang Youl Rhee, Kyu Jeung Ahn, Sei Hyun Baik, Yongsoo Park, Moon Suk Nam, Kwan Woo Lee, Soon Jib Yoo, Gwanpyo Koh, Dae Ho Lee, Young Seol Kim, Jeong‐Taek Woo
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Kyung Min Ko, Kyungdo Han, Youn Jee Chung, Kun-Ho Yoon, Yong Gyu Park, Seung-Hwan Lee
Endocrinology and Metabolism.2017; 32(2): 248. CrossRef
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Bone Research.2017;[Epub] CrossRef
Social Networking Services-Based Communicative Care for Patients with Diabetes Mellitus in Korea
Hun-Sung Kim, Yoo Jeong, Sun Baik, So Yang, Tong Kim, Hyunah Kim, Hyunyong Lee, Seung-Hwan Lee, Jae Cho, In-Young Choi, Kun-Ho Yoon
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Eun Ju Lee, Tae Nyun Kim
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Response: Characterization of Patients with Type 2 Diabetes according to Body Mass Index: Korea National Health and Nutrition Examination Survey from 2007 to 2011 (Endocrinol Metab 2015;30:514-21, Dong-Hwa Lee et al.)
Sung Hee Choi
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Letter: Characterization of Patients with Type 2 Diabetes according to Body Mass Index: Korea National Health and Nutrition Examination Survey from 2007 to 2011 (Endocrinol Metab 2015;30:514-21, Dong-Hwa Lee et al.)
Eun-Hee Cho
Endocrinology and Metabolism.2016; 31(2): 345. CrossRef

Adrenal gland
Limited Diagnostic Utility of Plasma Adrenocorticotropic Hormone for Differentiation between Adrenal Cushing Syndrome and Cushing Disease: A Ram Hong, Jung Hee Kim, Eun Shil Hong, I Kyeong Kim, Kyeong Seon Park, Chang Ho Ahn, Sang Wan Kim, Chan Soo Shin, Seong Yeon Kim; Endocrinol Metab. 2015;30(3):297-304. Published online August 4, 2015; DOI: https://doi.org/10.3803/EnM.2015.30.3.297

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Abstract PDF PubReader

Background

Measurement of the plasma adrenocorticotropic hormone (ACTH) level has been recommended as the first diagnostic test for differentiating between ACTH-independent Cushing syndrome (CS) and ACTH-dependent CS. When plasma ACTH values are inconclusive, a differential diagnosis of CS can be made based upon measurement of the serum dehydroepiandrosterone sulfate (DHEA-S) level and results of the high-dose dexamethasone suppression test (HDST). The aim of this study was to assess the utility of plasma ACTH to differentiate adrenal CS from Cushing' disease (CD) and compare it with that of the HDST results and serum DHEA-S level.

Methods

We performed a retrospective, multicenter study from January 2000 to May 2012 involving 92 patients with endogenous CS. The levels of plasma ACTH, serum cortisol, 24-hour urine free cortisol (UFC) after the HDST, and serum DHEA-S were measured.

Results

Fifty-seven patients had adrenal CS and 35 patients had CD. The area under the curve of plasma ACTH, serum DHEA-S, percentage suppression of serum cortisol, and UFC after HDST were 0.954, 0.841, 0.950, and 0.997, respectively (all P<0.001). The cut-off values for plasma ACTH, percentage suppression of serum cortisol, and UFC after HDST were 5.3 pmol/L, 33.3%, and 61.6%, respectively. The sensitivity and specificity of plasma ACTH measurement were 84.2% and 94.3%, those of serum cortisol were 95.8% and 90.6%, and those of UFC after the HDST were 97.9% and 96.7%, respectively.

Conclusion

Significant overlap in plasma ACTH levels was seen between patients with adrenal CS and those with CD. The HDST may be useful in differentiating between these forms of the disease, especially when the plasma ACTH level alone is not conclusive.

Citations

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