Endocrinology and Metabolism

Sung Koo Kang (Kang SK)

42 Articles

Thyroid
Risk of Malignancy in Thyroid Incidentalomas Identified by Fluorodeoxyglucose-Positron Emission Tomography: A Reum Chun, Hye Min Jo, Seoung Ho Lee, Hong Woo Chun, Jung Mi Park, Kyu Jin Kim, Chan Hee Jung, Ji Oh Mok, Sung Koo Kang, Chul Hee Kim, Bo Yeon Kim; Endocrinol Metab. 2015;30(1):71-77. Published online March 27, 2015; DOI: https://doi.org/10.3803/EnM.2015.30.1.71

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Background

Thyroid incidentalomas detected by 2-deoxy-2-¹⁸F-fluoro-D-glucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) have been reported in 1% to 4% of the population, with a risk of malignancy of 27.8% to 74%. We performed a retrospective review of FDG-avid thyroid incidentalomas in cancer screening subjects and patients with nonthyroid cancer. The risk of malignancy in thyroid incidentaloma and its association with the maximal standardized uptake value (SUV_max) in ¹⁸F-FDG PET/CT were evaluated to define the predictor variables in assessing risk of malignancy.

Methods

A total of 2,584 subjects underwent ¹⁸F-FDG PET/CT for metastatic evaluation or cancer screening from January 2005 to January 2010. Among them, 36 subjects with FDG-avid thyroid incidentalomas underwent further diagnostic evaluation (thyroid ultrasonography-guided fine needle aspiration cytology [FNAC] or surgical resection). We retrospectively reviewed the database of these subjects.

Results

Of the 2,584 subjects who underwent ¹⁸F-FDG PET/CT (319 for cancer screening and 2,265 for metastatic evaluation), 52 (2.0%) were identified as having FDG-avid thyroid incidentaloma and cytologic diagnosis was obtained by FNAC in 36 subjects. Of the subjects, 15 were proven to have malignant disease: 13 by FNAC and two by surgical resection. The positive predictive value of malignancy in FDG-avid thyroid incidentaloma was 41.7%. Median SUV_max was higher in malignancy than in benign lesions (4.7 [interquartile range (IQR), 3.4 to 6.0] vs. 2.8 [IQR, 2.6 to 4.0], P=0.001).

Conclusion

Thyroid incidentalomas found on ¹⁸F-FDG PET/CT have a high risk of malignancy, with a positive predictive value of 41.7%. FDG-avid thyroid incidentalomas with higher SUV_max tended to be malignant.

Citations

Citations to this article as recorded by

Incidental 68Ga-DOTATATE uptake in thyroid nodules: Is guideline-directed management still appropriate?
Kyla Wright, Jason C. Fisher, Gary D. Rothberger, Jason D. Prescott, John D. Allendorf, Kepal Patel, Insoo Suh
Surgery.2024; 175(1): 228. CrossRef
Prediction of Malignant Thyroid Nodules Using 18F-FDG PET/CT–Based Radiomics Features in Thyroid Incidentalomas
Woo Seog Ko, Seong-Jang Kim
Clinical Nuclear Medicine.2023; 48(6): 497. CrossRef
KSNM60 in Nuclear Endocrinology: from the Beginning to the Future
Chae Moon Hong, Young Jin Jeong, Hae Won Kim, Byeong-Cheol Ahn
Nuclear Medicine and Molecular Imaging.2022; 56(1): 17. CrossRef
The value of 99mTc-MIBI scan in the detection of malignancy potential of hypermetabolic thyroid incidentalomas of 18F-FDG PET/CT
G. Tatar, G. Alçın, Ö. Erol Fenercioglu, E. Beyhan, H.Y. Barut, N. Ergül, T.F. Çermik
Médecine Nucléaire.2022; 46(3): 139. CrossRef
Diagnosis of thyroid nodules
Erik K Alexander, Edmund S Cibas
The Lancet Diabetes & Endocrinology.2022; 10(7): 533. CrossRef
PET/CT Variants and Pitfalls in Head and Neck Cancers Including Thyroid Cancer
Jasna Mihailovic, Ronan P. Killeen, John A. Duignan
Seminars in Nuclear Medicine.2021; 51(5): 419. CrossRef
Characteristics of malignant thyroid lesions on [18F] fluorodeoxyglucose (FDG)-Positron emission tomography (PET)/Computed tomography (CT)
Hatem Nasr, Hussein Farghaly, Abdullah Alqarni, Seham Al-Salem, Mohamed Sayed
European Journal of Radiology Open.2021; 8: 100373. CrossRef
Focal Thyroid Incidentalomas on 18F-FDG PET/CT: A Systematic Review and Meta-Analysis on Prevalence, Risk of Malignancy and Inconclusive Fine Needle Aspiration
J. F. de Leijer, M. J. H. Metman, A. van der Hoorn, A. H. Brouwers, S. Kruijff, B. M. van Hemel, T. P. Links, H. E. Westerlaan
Frontiers in Endocrinology.2021;[Epub] CrossRef
Thyroid incidentaloma: next to be neglected or investigated?
S.I. Rybakov
INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (Ukraine).2021; 17(4): 361. CrossRef
Metastatic renal cell carcinoma in the thyroid gland
Mark M. Cruz, Gregory S. Schmidt, Jeptha T. Johnson, Thanh D. Hoang, Mohamed K. M. Shakir
Clinical Case Reports.2020; 8(11): 2302. CrossRef
Clinical significance of thyroid incidentalomas detected on fluorodeoxyglucose positron emission tomography scan (PETomas): An Indian experience
AVSAnil Kumar, Gaurav Datta, Harkirat Singh, ParthaBrata Mukherjee, Shashindran Vangal
World Journal of Nuclear Medicine.2019; 18(3): 273. CrossRef
Risk of Malignancy in FDG‐Avid Thyroid Incidentalomas on PET/CT: A Prospective Study
Chadi Nimeh Abdel‐Halim, Tine Rosenberg, Kristine Bjørndal, Anders Rørbæk Madsen, John Jakobsen, Helle Døssing, Mette Bay, Anders Thomassen, Anne Lerberg Nielsen, Christian Godballe
World Journal of Surgery.2019; 43(10): 2454. CrossRef
Is TI-RADS classification and Score Modified Method of thyroid nodules can be effective for evaluation of Thyroid Incidentalomas on FDG PET-CT imaging
Kara Pelin Ozcan, Koc Zehra Pinar, Balci Yüksel, Arpaci Rabia Bozdogan
Open Journal of Thyroid Research.2019; 2(1): 005. CrossRef
Hounsfield unit value has null effect on thyroid nodules at 18F-FDG PET/CT scans
Filiz Eksi Haydardedeoglu, Gulay Simsek Bagir, Nese Torun, Emrah Kocer, Mehmet Reyhan, Melek Eda Ertorer
Archives of Endocrinology and Metabolism.2018; 62(4): 460. CrossRef
Utility of 18F-FDG-PET/CT in patients suspected of paraneoplastic neurological syndrome: importance of risk classification
F. J. Pena Pardo, A. M. García Vicente, M. Amo-Salas, J. F. López-Fidalgo, J. A. Garrido Robles, J. Á. de Ayala Fernández, P. del Saz Saucedo, M. Muñoz Pasadas, A. Soriano Castrejón
Clinical and Translational Oncology.2017; 19(1): 111. CrossRef
Unusual Soft Tissue Uptake of F-18 Sodium Fluoride in Three Patients Undergoing F-18 NaF PET/CT Bone Scans for Prostate Cancer
Andrew S. Hawkins, Brandon A. Howard
Nuclear Medicine and Molecular Imaging.2017; 51(3): 274. CrossRef
Molecular imaging of advanced thyroid cancer: iodinated radiotracers and beyond
Prasanna Santhanam, Lilja B. Solnes, Steven P. Rowe
Medical Oncology.2017;[Epub] CrossRef
The assessment of incidental thyroid lesions on 18F-fluorodeoxyglucose positron emission tomography/computed tomogrophy: A single centre experience
Efnan Algin, Aytug Uner, Umit Ozgur Akdemir, Ozge Gumusay, Ozlem Kapucu, Ahmet Ozet
Journal of Oncological Sciences.2017; 3(2): 57. CrossRef
Cytological evaluation by fine needle aspiration biopsy of incidental focal increased fluorodeoxyglucose uptake in thyroid on positron emission tomography scan
Yanchun Li, Min Cui, Nami Azar, Dean Nakamoto, Claire W. Michael
Diagnostic Cytopathology.2017; 45(6): 501. CrossRef
[18F]FDG-PET/CT texture analysis in thyroid incidentalomas: preliminary results
M. Sollini, L. Cozzi, G. Pepe, L. Antunovic, A. Lania, L. Di Tommaso, P. Magnoni, P. A. Erba, M. Kirienko
European Journal of Hybrid Imaging.2017;[Epub] CrossRef
Management of PET diagnosed thyroid incidentalomas in British Columbia Canada: Critical importance of the PET report
Jordan Wong, Kaidi Liu, Celia Siu, Steven Jones, Marlise Sovka, Don Wilson, Sam M. Wiseman
The American Journal of Surgery.2017; 213(5): 950. CrossRef
Incidental hypermetabolic PET positive lesions in thyroid and pituitary glands in a patient with lung cancer: A case of two uncommon findings in a single patient
Pratima Nayak, Kyaw Soe, Mona Natwa, Taha Sachak, Ming Jin, Norman L. Lehman, Fadi Nabhan
Journal of Clinical and Translational Endocrinology: Case Reports.2016; 2: 10. CrossRef
The incidence of 18F-FDG PET/CT thyroid incidentalomas andthe prevalence of malignancy: a prospective study
Mine ŞENCAN EREN, Özhan ÖZDOĞAN, Arzu GEDİK, Mehmet CEYLAN, Merih GÜRAY DURAK, Mustafa SEÇİL, Mehmet Ali KOÇDOR, Abdurrahman ÇÖMLEKÇİ, Hatice DURAK
TURKISH JOURNAL OF MEDICAL SCIENCES.2016; 46: 840. CrossRef
Should the Prevalence of Incidental Thyroid Cancer Determine the Extent of Surgery in Multinodular Goiter?
Krzysztof Kaliszewski, Marta Strutyńska-Karpińska, Agnieszka Zubkiewicz-Kucharska, Beata Wojtczak, Paweł Domosławski, Waldemar Balcerzak, Tadeusz Łukieńczuk, Zdzisław Forkasiewicz, Pei-Yi Chu
PLOS ONE.2016; 11(12): e0168654. CrossRef
The incidence of thyroid cancer in focal hypermetabolic thyroid lesions
Martin Barrio, Johannes Czernin, Michael W. Yeh, Miguel F. Palma Diaz, Pawan Gupta, Martin Allen-Auerbach, Christiaan Schiepers, Ken Herrmann
Nuclear Medicine Communications.2016; 37(12): 1290. CrossRef
Incidental Detection of Follicular Thyroid Carcinoma in 68Ga-PSMA PET/CT Imaging
Sait Sager, Betül Vatankulu, Lebriz Uslu, Kerim Sönmezoglu
Journal of Nuclear Medicine Technology.2016; 44(3): 199. CrossRef

Adrenal gland
Clinical Characteristics and Metabolic Features of Patients with Adrenal Incidentalomas with or without Subclinical Cushing's Syndrome: Bo-Yeon Kim, A-Reum Chun, Kyu-Jin Kim, Chan-Hee Jung, Sung Koo Kang, Ji-Oh Mok, Chul-Hee Kim; Endocrinol Metab. 2014;29(4):457-463. Published online December 29, 2014; DOI: https://doi.org/10.3803/EnM.2014.29.4.457

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Abstract PDF PubReader

Background

The aim of this study was to examine the clinical characteristics of adrenal incidentalomas discovered by computed tomography (CT) and to investigate metabolic features of subclinical Cushing's syndrome (SCS) in patients with adrenal incidentalomas in a tertiary hospital in Korea.

Methods

This retrospective study examined the clinical aspects of 268 patients with adrenal incidentalomas discovered by CT at Soonchunhyang University Bucheon Hospital. Clinical data and endocrine function of the patients as well as histological findings were obtained from medical records, while anatomic characteristics were analyzed by reviewing imaging studies. Hormonal tests for pheochromocytoma, Cushing's syndrome, and aldosterone-secreting adenoma were performed.

Results

Most (n=218, 81.3%) cases were nonfunctioning tumors. Of the 50 patients with functioning tumors (18.7%), 19 (7.1%) were diagnosed with SCS, nine (3.4%) with overt Cushing's syndrome, 12 (4.5%) with primary aldosteronism, and 10 (3.7%) with pheochromocytoma. Malignant tumors (both primary and metastatic) were rare (n=2, 0.7%). Body mass index, fasting glucose, hemoglobin A1c, and total cholesterol were significantly higher in patients with SCS in comparison with those with nonfunctioning tumors. The prevalence of type 2 diabetes mellitus and hypertension were significantly higher in patients with SCS compared with those with nonfunctioning tumors.

Conclusion

Functioning tumors, especially those with subclinical cortisol excess, are commonly found in patients with adrenal incidentalomas, although malignancy is rare. In addition, patients with SCS in adrenal incidentalomas have adverse metabolic and cardiovascular profiles.

Citations

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Management of Adrenal Cortical Adenomas: Assessment of Bone Status in Patients with (Non-Functioning) Adrenal Incidentalomas
Alexandra-Ioana Trandafir, Mihaela Stanciu, Simona Elena Albu, Vasile Razvan Stoian, Irina Ciofu, Cristian Persu, Claudiu Nistor, Mara Carsote
Journal of Clinical Medicine.2023; 12(13): 4244. CrossRef
Adrenalectomy improves blood pressure control in nonfunctioning adrenal incidentalomas and glycemic and lipid control in patients with autonomous cortisol secretion
Marta Araujo-Castro, César Mínguez Ojeda, María Noelia Sánchez Ramírez, Victoria Gómez Dos Santos, Eider Pascual-Corrrales, María Fernández-Argüeso
Endocrine.2022; 78(1): 142. CrossRef
Depression was associated with younger age, female sex, obesity, smoking, and physical inactivity, in 1027 patients with newly diagnosed type 2 diabetes: a Swedish multicentre cross-sectional study
Eva O. Melin, Pär Wanby, Thomas Neumark, Sara Holmberg, Ann-Sofi Nilsson Neumark, Karin Johansson, Mona Landin-Olsson, Hans Thulesius, Magnus Hillman, Maria Thunander
BMC Endocrine Disorders.2022;[Epub] CrossRef
Metabolic syndrome and Visceral Adiposity Index in non-functional adrenal adenomas
Savas Karatas, Yalcin Hacioglu, Selvihan Beysel
Archives of Endocrinology and Metabolism.2022;[Epub] CrossRef
DHEAS and Differential Blood Counts as Indirect Signs of Glucocorticoid Excess in Adrenal Non-Producing Adenomas
Eliza P. Winzinger, Hana Jandikova, Matthias Haase, Andreas Knauerhase, Tudor Winzinger, Matthias Schott, Holger S. Willenberg
Hormone and Metabolic Research.2021; 53(08): 512. CrossRef
Links between aldosterone excess and metabolic complications: A comprehensive review
C. Bothou, F. Beuschlein, A. Spyroglou
Diabetes & Metabolism.2020; 46(1): 1. CrossRef
Presentation and outcome of patients with an adrenal mass: A retrospective observational study
Nadeema Rafiq, Tauseef Nabi, SajadAhmad Dar, Shahnawaz Rasool
Clinical Cancer Investigation Journal.2020; 9(5): 198. CrossRef
Malignancy Risk and Hormonal Activity of Adrenal Incidentalomas in a Large Cohort of Patients from a Single Tertiary Reference Center
Ewa Cyranska-Chyrek, Ewelina Szczepanek-Parulska, Michal Olejarz, Marek Ruchala
International Journal of Environmental Research and Public Health.2019; 16(10): 1872. CrossRef
Biochemical and clinical characteristics of patients with primary aldosteronism – single centre experience
Nataša Vujačić, Ivan Paunović, Aleksandar Diklić, Vladan Živaljević, Nikola Slijepčević, Nevena Kalezić, Mirjana Stojković, Miloš Stojanović, Biljana Beleslin, Miloš Žarković, Jasmina Ćirić
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The association of low muscle mass with soluble receptor for advanced glycation end products (sRAGE): The Korean Sarcopenic Obesity Study (KSOS)
Tae Nyun Kim, Man Sik Park, Eun Joo Lee, Hye Soo Chung, Hye Jin Yoo, Hyun Joo Kang, Wook Song, Sei Hyun Baik, Kyung Mook Choi
Diabetes/Metabolism Research and Reviews.2018;[Epub] CrossRef
Nonfunctioning adrenal incidentaloma: A novel predictive factor for metabolic syndrome
Emanuela M. Ribeiro Cavalari, Marcela P. de Paula, Mariana Arruda, Nathália Carraro, Arthur Martins, Kamila de Souza, Maria C. Coelho, Nathalie Anne de Oliveira e Silva de Morais, Aline B. Moraes, Leonardo Vieira Neto
Clinical Endocrinology.2018; 89(5): 586. CrossRef
Guidelines for the Management of Adrenal Incidentaloma: the Korean Endocrine Society, Committee of Clinical Practice Guidelines
Jung-Min Lee, Mee Kyoung Kim, Seung-Hyun Ko, Jung-Min Koh, Bo-Yeon Kim, Sang-Wan Kim, Soo-Kyung Kim, Hae-Jin Kim, Ohk-Hyun Ryu, Juri Park, Jung-Soo Lim, Seong Yeon Kim, Young Kee Shong, Soon Jib Yoo
The Korean Journal of Medicine.2017; 92(1): 4. CrossRef
Glucose Metabolism Abnormalities in Cushing Syndrome: From Molecular Basis to Clinical Management
Carla Scaroni, Marialuisa Zilio, Michelangelo Foti, Marco Boscaro
Endocrine Reviews.2017; 38(3): 189. CrossRef
Clinical Guidelines for the Management of Adrenal Incidentaloma
Jung-Min Lee, Mee Kyoung Kim, Seung-Hyun Ko, Jung-Min Koh, Bo-Yeon Kim, Sang Wan Kim, Soo-Kyung Kim, Hae Jin Kim, Ohk-Hyun Ryu, Juri Park, Jung Soo Lim, Seong Yeon Kim, Young Kee Shong, Soon Jib Yoo
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Increased 3β-hydroxysteroid dehydrogenase 2 and 17α-hydroxylase activities in a virilized adolescent female with adrenal adenoma: A case report
GUOQING YANG, JINGTAO DOU, XIAOLIN ZHANG, WEIJUN GU, ZHAOHUI LV, JIN DU, JIANMING BA, YIMING MU, JUMING LU
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Subclinical hypercortisolism: a state, a syndrome, or a disease?
Guido Di Dalmazi, Renato Pasquali, Felix Beuschlein, Martin Reincke
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Incidentally Discovered Aldosterone and Cortisol Cosecreting Adrenal Cortical Adenoma
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Subclinical Cushing's Syndrome and Metabolic Disorder
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A Case of Lymphocytic Infundibuloneurohypophysitis Along with Central Diabetes Insipidus, and this Improved with Conservative Care.: Ji Myoung Lee, Sang Mi Park, Byung Hee Hwang, Hyun Sook Choi, Seong Su Lee, Jee Young Kim, Sung Rae Kim, Kwang Woo Lee, Ho Young Son, Sung Koo Kang, Soon Jib Yoo; J Korean Endocr Soc. 2008;23(2):142-147. Published online April 1, 2008; DOI: https://doi.org/10.3803/jkes.2008.23.2.142

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Abstract PDF: Idiopathic central diabetes insipidus is most likely to occur in young patients who have a clinical history of autoimmune disease. The presentation of clinical findings such as central diabetes insipidus and pituitary stalk thickening on sellar magnetic resonance imaging (MRI) in a young women would strongly suggest lymphocytic hypophysitis, which is a rare inflammatory process involving the pituitary stalk and the pituitary gland, yet this disease can sometimes regress.

The Effect of Oxidative Stress on the Proliferation and Differentiation of Human Bone Marrow Stromal Cell-Derived Osteoblasts.: Eun Sook Oh, Ki Hyun Baek, Won Young Lee, Ki Won Oh, Hye Soo Kim, Je Ho Han, Kwang Woo Lee, Ho Young Son, Sung Koo Kang, Moo Il Kang; J Korean Endocr Soc. 2006;21(3):222-232. Published online June 1, 2006; DOI: https://doi.org/10.3803/jkes.2006.21.3.222

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Abstract PDF

BACKGROUND
The objectives of our study were to assess the effects of oxidative stress on the proliferation, differentiation and apoptosis of human bone marrow stromal cell (BMSC)-derived osteoblasts and to explore pathways by which osteoblast cell apoptosis was induced. METHODS: Mononuclear cells including BMSCs were cultured to osteoblastic lineage. Different doses of hydrogen peroxide (H2O2) were added to the culture media. The colony forming units-fibroblastic (CFU-Fs) were stained with crystal violet and alkaline phosphatase (ALP). The MTT assay was done to see the effect of H2O2 on cell viability. The effect of H2O2 on osteocalcin gene expression was determined by RT-PCR. The matrix calcification measurement was performed. FACS analysis was performed to determine the osteoblasts apoptosis. Caspase-3, -8 and 9 activity assay and cytochrome c release were measured. RESULTS: The size and number of ALP (+) CFU-Fs were also decreased by H2O2 treatment. When compared with the control group, H2O2 significantly decreased the total number of cells of each culture well during MTT assay. H2O2 significantly diminished expression of osteocalcin mRNA. N-acetylcystein (NAC) blocked the diminution of cell viability and the inhibition of osteocalcin mRNA expression by H2O2. H2O2 reduced matrix calcification. FACS analysis revealed H2O2 increased percentage of apoptotic cells. Addition of H2O2 resulted in the increase of caspase-9 and -3 activity but not caspase-8, and release of cytochrome c to the cytosol. CONCLUSION: These data suggest that, in primary human BMSCs, oxidative stress inhibits proliferation of stromal cells and inhibits the differentiation to osteoblastic lineage. In addition, oxidative stress induces apoptosis of human BMSC-derived osteoblasts and this may be mediated by mitochondrial pathway of apoptotic signal.

Citations

Citations to this article as recorded by

Antioxidaitve and Differentiation Effects of Artemisia capillaris T. Extract on Hydrogen Peroxide-induced Oxidative Damage of MC3T3-E1 Osteoblast Cells
Jee-Eun Seo, Eun-Sun Hwang, Gun-Hee Kim
Journal of the Korean Society of Food Science and Nutrition.2011; 40(11): 1532. CrossRef

A Case of Early Gastric Cancer Coincidentally Developed in a Patient with Acromegaly.: Kyun Woo Park, So Young Lee, Hye Suk Son, Yi Sun Jang, Hye Soo Kim, Jong Min Lee, Bong Yun Cha, Kwang Woo Lee, Ho Young Son, Sung Koo Kang; J Korean Endocr Soc. 2006;21(2):165-169. Published online April 1, 2006; DOI: https://doi.org/10.3803/jkes.2006.21.2.165

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Abstract PDF: Acromegaly is associated with an increased risk for a variety of cancers such as colon cancer, prostate cancer and breast cancer. However, there have been few reports of gastric cancer developing in an acromegaly patient. A 66-year-old man suffered with diabetes mellitus and hypertension for 15 years, and he visited the endocrinology department due to dizziness. On physical examination, the biochemical studies and the sella MRI, he showed the typical features of acromegaly with pituitary microadenoma. During the cancer screening studies to find the cause of anemia, early gastric cancer was diagnosed by pathologic examination of the tissue biopsies. We described the summary of characteristics of the patient and reviewed literature.

A Case of Atypical McCune-Albright Syndrome Associated with Hyperthyroidism.: Yi Sun Jang, Seok Hui Kang, Woong Ryoung Jung, Woo Tae Kim, Hye Soo Kim, Jong Min Lee, Sung Dae Moon, Bong Yun Cha, Kwang Woo Lee, Ho Young Son, Sung Koo Kang; J Korean Endocr Soc. 2006;21(2):158-164. Published online April 1, 2006; DOI: https://doi.org/10.3803/jkes.2006.21.2.158

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Abstract PDF: McCune-Albright syndrome (MAS) is a sporadic disease that's characterized by polyostotic fibrous dysplasia, cafe-au-lait pigmentation of the skin, and multiple endocrinopathies, including sexual precocity, hyperthyroidism, acromegaly, and hypercortisolism. Recent evidence has shown that the clinical manifestations are caused by a postzygotic activating missense mutation in the gene coding for the alpha-subunit of Gs protein that stimulates c-AMP formation in the affected tissues. Substitution of the Arg(201) residue in Gsalpha with cysteine or histidine have been identified in many MAS patients and Arg(201) to Gly or Leu mutations have also been recently identified. We identified the Arg(201) to His mutation in the gene encoding Gsalpha in the thyroid tissue from a 36-year-old man who was suffering with polyostotic fibrous dysplasia and hyperthyroidism.

A Case of Pituitary Macroadenoma Accompanied with CRH Deficiency.: Yoo Jung Nahm, Jin Soo Kim, Keun Jong Cho, Uk Hyun Kil, Sung Yong Woo, Sung Rae Kim, Soon Jib Yoo, Sung Koo Kang, Ho Young Son; J Korean Endocr Soc. 2006;21(2):153-157. Published online April 1, 2006; DOI: https://doi.org/10.3803/jkes.2006.21.2.153

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Abstract PDF: Pituitary tumor can be accompanied with various pituitary hormone abnormalities. Pituitary tumors can be divided into functioning or nonfunctioning tumors. A functioning pituitary tumor, via the oversecretion of pituitary hormones, causes diverse clinical features. A nonfunctioning pituitary tumor can be accompanied with pituitary dysfunction and this may be due to compression or destruction of normal pituitary tissue, suppression of the pituitary portal system or direct damage to the hypothalamus. Corticotropin-releasing hormone (CRH) deficiency, which is caused by defects in the synthesis or release of CRH, is a cause of secondary adrenocortical insufficiency. The clinical presentations are hypoglycemia, weight loss, anemia, weakness, nausea, vomiting and hyponatremia. Acquired CRH deficiency has also been suggested to occur based on a lack of adrenocorticotropic hormone (ACTH) response to insulin-induced hypoglycemia, but there is a normal ACTH response to exogenous CRH. We experienced a case of a woman with pituitary macroadenoma accompanied with CRH deficiency. We report here on this case with the review of the literature.

The Changes in the Serum RANKL and OPG levels after Bone Marrow Transplantation: Association with Bone Mineral Metabolism.: Hyun Jung Tae, Ki Hyun Baek, Eun Sook Oh, Ki Won Oh, Won Young Lee, Hye Soo Kim, Je Ho Han, Bong Yun Cha, Kwang Woo Lee, Ho Young Son, Sung Koo Kang, Choon Choo Kim, Moo Il Kang; J Korean Endocr Soc. 2005;20(1):40-51. Published online February 1, 2005; DOI: https://doi.org/10.3803/jkes.2005.20.1.40

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Abstract PDF: BACKGROUND
The loss of bone mass is usually detected after bone marrow transplantation(BMT), particularly during the early post-transplant period. We recently reported that enhanced bone resorption following BMT was related to both the steroid dose and increase in IL-6. It was also suggested damage of the marrow microenvironment due to myeloablation and changes in bone growth factors contribute to post-BMT bone loss. Recently, the interactions of OPG and RANKL have been reported to be crucial in osteoclastogenesis and therefore in bone homeostasis. There are few data on the changes in RANKL/OPG status during the post-BMT period. This study investigated the changes in the levels of RANKL and OPG during the post-BMT period, and also assessed whether the changes in these cytokine levels actually influenced bone turnover and post-BMT bone loss. METHODS: We prospectively investigated 110 patients undergoing allogenic BMT and analyzed 36 (32.4+/-1.3 years, 17 men and 19 women) where DEXA was performed before and 1 year after the BMT. The serum bone turnover marker levels were measured before and 1, 2, 3, 4 and 12 wks, 6 Ms, and 1 yr after the BMT. The serum sRANKL and OPG levels were measured in all patients before and 1, 3 and 12 wks after the BMT. RESULTS: The mean bone losses in the lumbar spine and total proximal femur, which were calculated as the percent change from the baseline to 1 yr, were 5.2(P<0.01) and 11.6%(P<0.01), respectively. The mean serum ICTP, a bone resorption marker, increased progressively until 3 and 6 months after the BMT, but decreased gradually thereafter, reaching the basal values after 1 year. The serum osteocalcin levels decreased progressively until 3 wks after the BMT, then increased transiently at 3 and 6 Ms, but returned to the basal level by 1 yr. The serum sRANKL and OPG levels had increased significantly by weeks 1 and 3 compared with the baseline(P<0.01), but decreased at 3 months. The sRANKL/OPG ratio increased progressively until 3 weeks, but then decreased to the basal values. During the observation period, the percent changes from the baseline in the serum RANKL levels and RANKL/OPG ratio showed positive correlations with the percent changes from the baseline serum ICTP levels. Patients with higher RANKL levels and RANKL/OPG ratio during the early post-BMT period lost more bone mass at the lumbar spine. CONCLUSION: In conclusion, dynamic changes in the sRANKL and OPG levels were observed during the immediate post-BMT period, which were related to a decrease in bone formation and loss of L-spine BMD during the year following the BMT. Taken together, these results suggest that increased sRANKL levels and sRANKL/OPG ratios could be involved in a negative balance in bone metabolism following BMT.

A Case of Cerebral Infarction in Young Woman with Graves' Disease and Atrial Fibrillation.: Young Yong An, Yi Sun Jang, Hyung Doo Kim, Ji Young Park, Hong Gun Bin, Hye Soo Kim, Jong Min Lee, Suk Young Kim, Kwang Woo Lee, Ho Young Son, Sung Koo Kang; J Korean Endocr Soc. 2004;19(5):528-534. Published online October 1, 2004

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Abstract PDF: Thyrotoxicosis associated atrial fibrillation occurs in 9 to 22% of hyperthyroidism patients; its prevalence increases after the age 60 years. Atrial fibrillation is known to be major independent risk factor for a thromboembolic stroke. The characterization of patient subgroups with atrial fibrillation, with high or low rate risk factor of a stroke, would help clinicians decide the benefit or harm to patient of long term anticoagulation therapy. Thyrotoxicosis, old age, hypertension, diabetes, heart failure, history of stroke and thromboembolism are all high risk factors for a stroke in atrial fibrillation patients. Thus, anticoagulation therapy is recommended for stroke prevention in those groups with atrial fibrillation and thyrotoxicosis. Herein is reported a case of acute cerebral infarction, with thyrotoxic atrial fibrillation and congestive heart failure, in a young woman

A Case of the Milk-alkali Syndrome During Management of Idiopathic Hypoparathyroidism.: Yong Wan Park, Sung Rae Kim, Jung Min Lee, Seong Hun Kim, Sang Woo Han, Soon Jib Yoo, Kun Ho Yoon, Moo Il Kang, Bong Yun Cha, Kwang Woo Lee, Ho Young Son, Sung Koo Kang; J Korean Endocr Soc. 2004;19(4):439-445. Published online August 1, 2004

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Abstract PDF: Idiopathic hypoparathyroidism is a relatively rare disease characterized by hypocalcemia and hyperphosphatemia: this is due to a deficiency or a sereretory disorder of the parathyroid hormone without any prior operation nor underlying medical disoder. Calcium carbonate and vitamin D substitution are generally considered as the mainstay of therapy, but these treatments can cause hypercalcemia and hypercalciuria. Persistent ingestion of large amount of calcium carbonate can cause milk-alkali syndrome that is characterized by hypercalcemia, metabolic alkalosis and renal failure. Once a patient is diagnosed with milk-alkali syndrome, withdrawal of calcium carbonate and vitamin D is essential and treatment with saline diuresis and furosemide is the usually effective. In treatmenf of hypoparathyroidism with calcium carbonate and vitamin D substitution, evaluation of serum calcium and urinary calcium excretion is essential to avoid hypercalcemia and ypercalciuria. We concluded that during treatment with calcium carbonate and vitamin D substitution for patients with idiopathic hypoparathyroidism, they should have carefully laboratory monitoring, and they should be made aware of the circumstances influencing calcium metabolism

Primary Hyperaldosteronism with Increased Plasma Renin Activity due to Secondary Hypertensive Renal Impairment.: Kang Woo Lee, Hyuk Sang Kwon, Dong Il Shin, Chee Ho Noh, Jung Min Lee, Jong Min Lee, Kun Ho Yoon, Bong Yun Cha, Kwang Woo Lee, Ho Young Son, Sung Koo Kang; J Korean Endocr Soc. 2003;18(4):433-438. Published online August 1, 2003

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Abstract PDF: An increased plasma aldosterone concentration, with suppressed plasma renin activity (PRA), is an abnormal finding in primary hyperaldosteronism. A suppressed PRA is caused by aldosterone- dependent sodium retention and extracellular volume expansion. A case of primary hyperaldosteronism, due to adenoma, with increased PRA, was observed. An adrenalectomy and intraoperative renal biopsy was performed. In our patient, histologically proven renal arteriosclerosis was the probable cause of the escape of the PRA from the suppression by an aldosterone-producing adenoma. Normal blood pressure was not attained after the adrenalectomy. However, the blood pressure was then controlled by small doses of antihypertensive drug before resection of the tumor. In this case, the patient was treated with spironolactone, but the blood pressure was not correctly controlled. After the adrenalectomy, the blood pressure was well controlled with smaller dose of calcium channel blockers. So, an early adrenalectomy may be beneficial as soon as the diagnosis of an aldosterone-producing adenoma is confirmed, even in patients with hypertensive nephrosclerosis.

The Effects of Aging on the Proliferation and Differentiation of Osteoblasts from Human Mesenchymal Stem Cells.: Ki Hyun Baek, Hyun Jung Tae, Ki Won Oh, Won Young Lee, Chung Kee Cho, Soon Yong Kwon, Moo Il Kang, Bong Yun Cha, Kwang Woo Lee, Ho Young Son, Sung Koo Kang, Choon Choo Kim; J Korean Endocr Soc. 2003;18(3):296-305. Published online June 1, 2003

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Abstract PDF: BACKGROUND
Osteoblasts originate from osteoprogenitor cells in bone marrow stroma, termed mesenchymal stem cells (MSCs) or bone marrow stromal cells. Each MSC forms colonies (colony forming units-fibroblasts [CFU-Fs]) when cultured ex vivo. There are some reports about the age-related changes of the number and osteogenic potential of osteoprogenitor cells, but any relationship has not been clearly established in humans. In this study, we counted MSCs using CFU-Fs count and examined the proliferative capacity and differentiation potential of osteoprogenitor cells. Finally, we analyzed how these parameters varied with donor age. METHODS: Bone marrow was obtained from the iliac crest of young (n=6, 27.2+/-8.6 years old) and old (n=10, 57.4+/-6.7 years old) healthy donors. Mononuclear cells, including MSCs, were isolated and cultured in osteogenic medium. In primary culture, we compared the colony-forming efficiency of MSCs between the two groups and determined the matrix calcification. When primary culture showed near confluence, the cells were subcultured. Alkaline phosphatase activity, osteocalcinexpression by RT-PCR and proliferative potential by MTT assay were examined by the time course of secondary culture. RESULTS: At the 15th day of primary culture, the mean number of CFU-Fs was significantly higher in the younger donors (young: 148.3+/-28.9, old: 54.3+/-9.1, p=0.02) and the mean size of CFU-Fs was also larger in the younger donors than the older donors. However, matrix calcification was not different between the two groups (young: 103.6+/-50.6, old: 114.0+/-56.5, p=NS). In secondary culture, alkaline phosphatase activities were significantly lower in the older donors. The younger donors showed peak alkaline phosphatase activity at day 10, while the older donors didn't showed a remarkable peak (young: 935.5+/-115.0U/mg, old: 578.4+/-115.7U/mg, p<0.05). Total cell number as a proliferative index increased progressively during the secondary culture and a significantly greater cell number was noted in the younger donors. Osteocalcin expression was generally upregulated in the younger donors, but this was not statistically significant. CONCLUSION: Our study shows that the number of osteoprogenitor cells is decreased during aging and that the proliferative capacity and differentiation potential of osteoprogenitor cells seem to be reduced during aging.

A Case of Acute Rhabdomyolysis as a first Manifestation of Primary Hypothyroidism.: Jung Min Lee, Hyun Shik Son, Hye Jung Lee, Sook Hee Hong, Jong Min Lee, Bong Yun Cha, Kwang Woo Lee, Ho Young Son, Sung Koo Kang; J Korean Endocr Soc. 2003;18(1):79-84. Published online February 1, 2003

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Abstract PDF: Various symptoms, such as bradycardia, hypotension, fatigue, constipation, myalgia, muscle weakness, delayed tendon reflex, and so forth, presented in hypothyroidism. Of these symptoms, muscle weakness, myalgia, and delayed tendon reflex are common features of hypothyroid myopathy. Acute rhabdomyolysis, a very severe form of myopathy, but is a rare manifestation of primary hypothyrodism. A 29-year-old man developed acute rhabdomyolysis, associated with primary hypothyroidism as a first manifestation. After thyroxine replacement therapy, he exhibited some improvement in muscle weakness and in non-pitting edema. We report a case of primary hypothyroidism presenting with spontaneous rhabdomyolysis as a first manifestation.

The Changes of Serum Growth Factors after Hematopoietic Stem Cell Transplantation: Impact on Bone Mineral Metabolism.: Ki Hyun Baek, Eun Sook Oh, Ki Won Oh, Won Young Lee, Hye Soo Kim, Soon Yong Kwon, Je Ho Han, Moo Il Kang, Bong Yun Cha, Kwang Woo Lee, Ho Young Son, Sung Koo Kang, Choon Choo Kim; J Korean Endocr Soc. 2002;17(5):664-674. Published online October 1, 2002

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Abstract PDF: BACKGROUND
A loss of bone mass is usually detected after a bone marrow transplantation (BMT), especially during the early post-transplant period. We recently reported that enhanced bone resorption following a BMT was related to both the steroid dose and the increase in IL-6. We also suggested damage to the marrow stromal microenvironment, by myoablation, partly explains the impaired bone formation following a BMT. It is well known that some growth factors play important role in bone growth and osteogenesis. However, the pathogenetic role of bone growth factors in post-BMT bone loss is unknown and data on the changes in the growth factors, in accordance with bone turnover markers and bone mineral density (BMD) changes are scarce. We investigated changes in bone growth factors such as IGF-I (Insulin-like growth factor-I), fibroblast growth factor-2 (FGF-2) and Macrophage colony stimulating factor (M-CSF), during the post-BMT period, and assessed whether the growth factor changes influenced the bone turnover and post-BMT bone loss. The present study is the first prospective study to describe the changes in bone growth factors following a BMT. METHODS: We prospectively investigated 110 patients undergoing a BMT, and analyzed 36 patients (32.4+/-1.3 years, 17 men and 19 women) whose BMDs were measured before, and 1 year after, the BMT. The serum biochemical markers of bone turnover were measured before, 1, 2, 3 and 4 weeks, 3 and 6 months, and 1 year, after the BMT. The serum FGF-2, IGF-I and M-CSF levels were measured before and 1 and 3 weeks, and 3 months after the BMT. The correlation between the changes of growth factors and various bone parameters was analyzed. RESULTS: The mean bone losses in the lumbar spine and total proximal femur, calculated as the percentage change from the baseline to the level at 1 year, were 5.2 (p<0.05) and 11.6% (p<0.01), respectively. The serum type I carboxyterminal telopeptide (ICTP), a bone resorption marker, increased progressively until 6 months after the BMT, but thereafter decreased, to the base value after 1 year. Serum osteocalcin, a bone formation marker, decreased progressively, until 3 weeks after the BMT but then increased transiently, and finally returned to the base level at 1 year. The serum IGF-I and FGF-2 also decreased progressively until 3 weeks and 1 week after the BMT, respectively, then increased to the base values at 3 months. The serum M-CSF increased briskly at 1 week post-BMT, then decreased to the base level. There were positive correlations between the percentage changes from the baseline proximal femur BMD and the IGF-I levels 3 weeks and 3 months (r=0.52, p<0.01, r=0.41, p<0.05) post BMT. A Significant correlation was found between the IGF-I and osteocalcin levels pre-BMT, and 3 weeks after the BMT. Another positive correlation was found between the M-CSF and the ICTP levels at 3 weeks post BMT (r=0.54, p<0.05). CONCLUSION: In conclusion, there were significant changes in the serum IGF-I, FGF-2 and M-CSF levels in the immediate post-BMT period, which were related to a decrease in bone formation and loss in the proximal femoral BMD during the year following the BMT

A Case of Cured Diabetes Mellitus after Pheochromocytoma Removal.: Chang Kyun Hong, Yu Bae Ahn, Sul Hye Kim, Young Sik Woo, Seoung Goo Lee, Seung Hyun Ko, Ho Ki Song, Kun Ho Yoon, Moo Il Kang, Bong Yeon Cha, Kwang Woo Lee, Ho Young Son, Sung Koo Kang; J Korean Endocr Soc. 2001;16(4-5):502-507. Published online October 1, 2001

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Abstract PDF: Pheochromocytoma is usually associated with a combination of various clinical manifestations caused by the overproduction of catecholamines. It is frequently accompanied by impaired glucose tolerance operating through 2-and-adrenergic mechanisms. A 41-year-old-woman was admitted to the hospital because of poorly-controlled diabetes mellitus and hypertension. She had suffered intermittent paroxysmal attacks of headache and chest discomfort and had been treated intermittently over a 2 year period for diabetes mellitus and hypertension. At admission, the levels of serum epinephrine, norepinephrine urinary excretion of total metanephrine, and VMA were all abnormally elevated. Adrenal CT showed a well-defined, homogenous mass in the right adrenal region and the tumor was diagnosed as pheochromocytoma. After tumor resection, the increased blood level of catecholamines, the urinary excretion of total metanephrine, and VMA were normalized, as was the hyperglycemia state. Diabetes mellitus of the patient was considered permanently resolved after tumor removal by the result of glucose tolerance in 75g oral glucose tolerance test.

Effect of Intermittent Etidronate Therapy on the Prevention of Bone Loss after Kidney Transplantation.: Hye Soo Kim, Jong Min Lee, Sung Kwon Kim, Cheol Whee Park, Chul Woo Yang, Moo Il Kang, Suk Young Kim, Sung Koo Kang, Byung Kee Bang; J Korean Endocr Soc. 2001;16(4-5):426-437. Published online October 1, 2001

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Abstract PDF: BACKGROUND
Osteopenia or osteoporosis is one of the most frequently encountered complications in patients receiving various immunosuppressants after kidney transplantation. The few available preventive strategies for these complications tend to result in various outcomes. In this study, we evaluated the effect of intermittent etidronate therapy for the prevention of bone loss after kidney transplantation. METHODS: Fifty patients who received kidney transplantation for various reasons were recruited and followed for one year. Thirty-eight of these patients commenced etidronate treatment 7 days after operation, the other 12 were followed without etidronate therapy. The treatment consisted of 400mg of etidronate administered orally for 14 days, then repeated four-times every three months. Blood chemistry, iPTH and aluminium levels were tested periodically in all patients. Also checked were bone mineral density of the lumbar spine(L2-4) and femur at baseline, 6 and 12 months after kidney transplantation, as well as D-L spine lateral x-ray at baseline and 12 months. Serum osteocalcin and urine deoxypyridinoline were measured at baseline, 7 days and then every 3 months. RESULTS: Both the etidronate-treated and control groups showed significant decreases in bone mineral densities of the lumbar spine, femur neck and total femur at 6 and 12 months after kidney transplantation(p<0.005). Bone loss was significantly lower in the etidronate-treated group than the control at 12 months after kidney transplantation; lumbar spine(-3.54% vs. -9.51%, p<0.0005), femur neck (-5.41% vs. -8.91%, p<0.0005), total femur (-7.59% vs. -9.07%, p<0.005). Osteocalcin was decreased and deoxypyridinoline increased in both groups. No significant differences in the level or pattern of osteocalcin and deoxypyridinoline were observed in either group. New radiologic compression fractures were found in two patients of the treated group who exhibited severe osteoporosis at baseline during follow-up. CONCLUSIONS: The intermittent administration of etidronate seems to be effective in preventing rapid bone loss after kidney transplantation. Furthermore, this method is safe and convenient for administration and follow-up. Further studies will be required to elucidate the most effective treatment course for the prevention of fractures after kidney transplantation, especially in patients with established severe osteoporosis.

A Case of Intrathyroidal Parathyroid Adenoma Diagnosed by Fine-Needle Aspiration.: Hye Soo Kim, Eun Kyung Lee, Sung Ha Hwang, Myung Sook Kim, Eun Hee Lee, Jong Min Lee, Suk Young Kim, Bong Yun Cha, Kwang Woo Lee, Ho Young Son, Sung Koo Kang; J Korean Endocr Soc. 2000;15(4-5):614-621. Published online January 1, 2001

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Abstract PDF: Fine-needle aspiration can be successfully utilized in the preoperative localization of abnormal parathyroid tissue. Fine-needle aspirate immunostaining for parathyroid hormone (PTH) or chromogranin and thyroglobulin (Tg) with measurement of PTH and Tg levels in the needle washings (FNAB-PTH and FNAB-Tg) can differentiate an enlarged parathyroid tissue from other cervical masses, such as thyroid nodules and lymph nodes. Parathyroid mass can be successfully aspirated by guidance of ultrasonography or computed tomography. Thyroid nodules are the most frequent cause of reduced accuracy of the imaging studies, such as ultrasonography, computer-assisted tomography and scintigraphy. We report on a case of unsuspected intrathyroidal parathyroid adenoma coexisted with thyroid follicular adenoma presenting two thyroid nodules. After biochemical diagnosis of hyperparathyroidism, we could not localize the parathyroid lesion specifically with any imaging method. Through fine-needle aspiration of two thyroid nodules, we performed the immunostaining for chromogranin and thyroglobulin and the measurement of PTH and thyroglobulin levels in the aspirated materials. The results confirmed the right nodule to be thyroid lesion and the left nodule to be parathyroid lesion preoperatively.

The Effect of Hematopoietic Stem Cell Transplantation in the Origin and the Osteoblastic Differentiation of the Human Bone Marrow Stromal Cell.: Moo Il Kang, Seong Won Cho, Eun Sook Oh, Ki Hyun Baik, Won Young Lee, Ki Won Oh, Hye Soo Kim, Je Ho Han, Kun Ho Yoon, Bong Yun Cha, Kwang Woo Lee, Ho Young Son, Sung Koo Kang, Choon Choo Kim; J Korean Endocr Soc. 2000;15(4-5):571-581. Published online January 1, 2001

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Abstract PDF: BACKGROUND
Bone marrow transplantation is the treatment of choice for patients with certain- hematological malignancies, many of whom will survive many years thereafter. Bone disease is a potential longterm complication. But, little is known about the effects of bone marrow transplantation on bone. METHODS: In this study, bone marrow was obtained from healthy donor and transplant recipients. Then mononuclear cells including marrow stromal cells were isolated and cultured. At near confluence, bone marrow stromal cells were subcultured. Thereafter alkaline phosphatase activities of each group were measured by time course of secondary culture. We also analysed the origin of marrow stromal cells by the polymerase chain reaction using YNZ 22 minisatellite probe. RESULTS: l. Cells cultured in our system showed the characteristics of marrow stromal cells differentiated to osteoblasts. They were in fibroblast-like spindle shape and positive to alkaline pbosphatase histochemistry and Von Kossa histochemistry in secondary cultures. 2. The time required for the near confluence in the primary culture was 15 days and 22.9 days on the average in healthy donors and transplant recipients, respectively (p=0.003). 3. In secondary cultures, healthy donors and transplant recipients showed peak alkaline phosphatase activity at 10 days and 17 days, respectively (p=0.031). Alkaline phosphatase activity was lower in BMT recipients than in healthy donors during the whole period of secondary cultures. 4. In polymerase chain reaction analysis using YNZ 22 minisatellite probe, bone marrow stromal cells were of recipient origin. CONCLUSION: Recipient-derived bone marrow stromal cells may be damaged secondary to the effect of chemotherapy, glucocorticoid & total body irradiation which have given before bone marrow transplantation. So it may affect the differentiation of bone marrow stromal cells into the osteoblasts.

The Effect of Bone Marrow Transplantation on Bone Mineral Metabolism: 2 - Year Prospective Study.: Won Young Lee, Moo Il Kang, Eun Sook Oh, Ki Won Oh, Je Ho Han, Hyun Shik Son, Kun Ho Yoon, Bong Yun Cha, Kwang Woo Lee, Ho Young Son, Sung Koo Kang, Wan Sik Shin, Woo Sung Min, Choon Choo Kim; J Korean Endocr Soc. 2000;15(4-5):561-570. Published online January 1, 2001

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Abstract PDF: BACKGROUND
Loss of bone mass is usually detected after bone marrow transplantation (BMT), especially during the early post-transplant period. But little is known about the long-term effects of BMT on bone mineral metabolism. METHODS: We have investigated prospectively 12 patients undergoing BMT (4 autologous, 8 allogeneic) for hematologic diseases (8 leukemia, 3 SAA, 1 MDS). Serum concentrations of calcium, phosphorus, creatinine, gonadotropins, sex hormones and bone turnover markers (osteocalcin and ICTP) were measured. The samples were collected before BMT and 1, 2, 3, 4, and 12 weeks, 6 months and 1, 2 years thereafter. Bone mineral density (BMD) was measured with DEXA (Dual Energy X-ray Absorptiometry) before BMT, 1 year and 2 year after BMT. In patients with amenorrbea, hormone replacement therapy was started from around 1 year after BMT RESULTS: 1. The mean bone loss in the lumbar spine, calculated as the percent change from the baseline to the level at 1 year and 2 year was 7.3% and 1.9%, respectively. The mean bone loss in the total proximal femur from the baseline to the level at 1 year and 2 year was 8.0% and 8.3% respectively. 2. The serum ICTP increased progressively until four weeks after BMT. Thereafter, it decreased gradually to reach basal values after one year and thereafter no more change until 2 year. Serum osteocalcin decreased progressively until three weeks after BMT. After that, it increased and reached basal values after 3 months. Osteocalcin increased at 6 month transiently but thereafter, it decreased to the level of slightly above basal value at 2 year. 3. Patients who were treated with TBI or pateints with GVHD had a tendency of lower BMD at l year and 2 year after BMT than those of patients without TBI or GVHD. 4. Eight out of nine women went into a menopausal state immediately after BMT and remained amenorrhea, evidenced by high gonadotropins and low estradiol levels. In contrast to women, gonadotropins and testosterone levels were not changed significantly in men after BMT. CONCLUSION: The rapid impairment of bone formation and the increase in bone resorption, as shown by the biochemical markers in this study, might play a role in bone loss after BMT. The efficacy of HRT for the correction of hypogonadism and bone loss was evidenced by 2 year BMD which was much more increased compared to 1 year BMD, especially in vertebra.

The Nonthyroidal Illness Syndrome: Prognostic Value and Circulating Cytokines after Allogeneic Bone Marrow Transplantation.: Ki Won Oh, Moo Il Kang, Won Young Lee, Hyun Shik Son, Kun Ho Yoon, Bong Yun Cha, Kwang Woo Lee, Ho Young Son, Sung Koo Kang, Wan Sik Shin, Woo Sung Min, Choon Choo Kim, Byung Young Ahn, Hyung Sun Sohn; J Korean Endocr Soc. 2000;15(2):214-225. Published online January 1, 2001

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Abstract PDF: BACKGROUND
Alteration of thyroid hormone parameters are frequently observed in sick patients and commonly known as nonthyroidal illness syndrome(NTIS) or euthyroid sick syndrome(ESS). NTIS is seen in starvation, surgery, severe illness, and also bone marrow transplantation(BMT). The degree of reduction in thyroid hormone parameters correlated with the severity of NTIS and might predict the prognosis of underlying illness. Recently, particular attention is focused on the role of cytokines in developing the NTIS. This prospective study was designed to assess the relationship of serum thyroid hormone parameters and serum cytokine levels before and in the short-term follow-up after allogeneic BMT in order to predict patients outcome. METHODS: Included 80 patients that were mainly leukemia and severe aplastic anemia. Serum thyroid hormone parameters and serum cytokine levels were measured before and 7, 14, 21, 28 days and 3, and 6 months after BMT. RESULTS: Near-all patients experienced significant decrease of thyroid hormone levels and also significant increase of cytokine levels after BMT. After post-BMT 3 weeks, the serum cytokine levels were negatively correlated with the serum T3 and T4 levels, but not with the serum TSH levels. The patients treated with high-dose steroid or total-body irradiation tended to show lower levels of TSH and more delayed recovery compared to non-treated patients. The patients died after BMT represented generally lower levels of all thyroid hormone parameters than survival patients during entire follow-up period. CONCLUSION: Development of NTIS is associated with higher probability of fatal outcome after BMT and has prognostic relationship in this group of patients. Increased levels of cytokines, especially IL-6 and TNF-alpha, are often found in post-BMT NTIS patients and correlated with the changes in the levels of thyroid hormone parameters.

The Changes of Cytokines and Bone Turnover Markers after Bone Marrow Transplantation.: Won Young Lee, Moo Il Kang, Ki Won Oh, Hye Soo Kim, Seong Dae Mun, Je Ho Han, Hyun Shik Son, Sung Koo Kang, Wan Sik Shin, Woo Sung Min, Choon Choo Kim; J Korean Endocr Soc. 2000;15(1):85-96. Published online January 1, 2001

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Abstract PDF: BACKGROUND
Loss of bone mass is usually detected after BMT. The causes of bone loss are related with gonadal dysfunction and immunosuppressants. Cytokines, especially IL-6, play an important role in the pathogenesis of postmenopausal osteoporosis. However, the pathogenetic role of cytokines in post-BMT bone loss is unknown and data on the changes of cytokines in accordance with bone turnover markers are scarce. The aim of this study is to assess the relationship of bone turnover markers and cytokines of peripheral blood and bone marrow before and after allogeneic BMT. METHODS: This prospective study included two analyses. The first was a study of 46 BMT recipients, examining the relationship between bone turnover markers and cytokines of serum which were measured before and 1, 2, 3, 4 week and 3 months after BMT. The second was a study of 14 BMT patients, measuring bone marrow plasma cytokines such as IL-6 and TNF-alpha at post-BMT 3 week and bone turnover marker at the same time to assess the relationship between two parameters. RESULTS: Serum ICTP, bone resorption marker, increased progressively until 4 weeks (peak) after BMT and then decreased thereafter. Serum osteocalcin, bone formation marker, decreased progressively until 3 weeks after BMT and then increased thereafter. There was positive correlation between serum ICTP and bone marrow IL-6 levels at the post-BMT 3 week with a statistical significance, but the correlation between bone turnover markers and bone marrow TNF-alpha or peripheral blood cytokines was not found. CONCLUSION: Our data suggest that the progressive increase of bone resorption after BMT is related with the increase of bone marrow IL-6, which is a potent stimulator of bone resorption in vivo.

A Case of Oncogenic Osteomalacia Caused by Chondromyxoid Fibroma.: Ki Won Oh, Moo II Kang, Won Young Lee, Tae Kyu Lee, Jae Hyuck Chang, Jung Pil Suh, Bong Yun Cha, Kwang Woo Lee, Ho Young Son, Sung Koo Kang, Jeong Mi Park, Kyo Young Lee, Seung Koo Rhee, Young Kyun Woo; J Korean Endocr Soc. 1999;14(4):764-770. Published online January 1, 2001

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Abstract PDF: Oncogenic osteomalacia is a rare clinicopathological condition. The syndrome is characterized by hypophosphataemic osteomalacia with hyperphosphaturia, low plasma 1,25-dihydroxyvitamin D and normal plasma calcaemia and parathyroid hormone, associated with a tumor, generally of mesenchymal origin. Complete excision of the tumour results in cure of the whole syndrome. Recently we experienced 56-year-old woman with oncogenic osteomalacia caused by a chondromyxoid fibroma of the left foot. We report this case with the review of literatures.

Changes of Glucose Tolerance in Acromegaly Patients with 24 Hour Continuous Subcutaneous Infusion of Octreotide.: Ki Hyun Baik, Kun Ho Yoon, Jeong Min Lee, Chang Wook Kim, Paek Sun Kim, Sang Aha Jang, Soon Jib Yoo, Hyun Sik Son, Moo II Kang, Bong Yun Cha, Kwang Woo Lee, Ho Young Son, Sung Koo Kang; J Korean Endocr Soc. 1999;14(4):636-644. Published online January 1, 2001

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Abstract PDF: BACKGROUND
An important metabolic feature of acromegaly is a reduced action of insulin on hepatic gluconeogenesis and peripheral glucose disposal which mediated by growth hormone hypersecretion. Octreotide, a synthetic octapeptide somatostatin analogue exerts complex effects on hormonal and metabolic regulations affecting glucose homeostasis. This study was designed to ascertain the shorterm effect of octreotide on glucose tolerance in acromegaly. METHODS: 10 patients (five men and five women, age 47.9+/-11.8) were injected subcutaneously with octreotide, 100 micrograms for 24 hours. Patients were assessed with respect to growth hormone, glucose, and insulin response to a standard 100 g oral glucose tolerance test (OGTT) before and during the last 2 hour of octreotide infusion. RESULTS: During the therapy, there was significant decrease in mean blood glucose response to OGTT (678.4+/-51.9 vs 581.9+/-47.3 mg/dL/2hr: mean areas under the glucose curve, p=0.01) and mean serum insulin response to oral glucose load was significantly reduced in all patients (339.2+/-106.2 vs 256.7+/-111.3 U/mL/2hr: mean areas under the insulin curve, p=0.01). Using glucose tolerance test criteria three patients of 10 had normal glucose tolerance, four and three had impaired glucose tolerance and diabetes, respectively, at base line. While on octreotide these composition was changed to six patients of NGT, three of IGT and one diabetes. CONCLUSION: We conclude that insulin resistance mediated by GH hypersecretion was improved by shorterm octreotide treatment.

The Short-term Effects of Bone Marrow Transplantation on Bone Metabolism.: Soon Jib Yoo, Yoo Bae Ahn, Kun Ho Yoon, Moo Il Kang, Kwang Woo Lee, Ho Young Son, Sung Koo Kang, Ki Ho Song, Yoon Hee Choi, Bong Yeon Cha, Hye Soo Kim, Ki Won Oh, Sung Dae Moon, Sang Ah Jang, Chun Choo Kim; J Korean Endocr Soc. 1999;14(2):355-364. Published online January 1, 2001

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Abstract PDF: BACKGROUND
The organ transplantation becomes the management of choice for many patients with chronic and life threatening heart, liver, kidney, bone marrow, and pancreatic diseases. A new set of side effects unique to this groups of patients has become recognized. Bone disease is one of these complications. It is well known that there is an interplay between the cells in the bone marrow and the surrounding bone tissue. Marrow stromal cells include the progenitors of the osteoblastic lineage are the sources of effector molecules that support and regulate both hematopoiesis and bone remodeling. But little is known about the effects of myeloablative treatment followed by bone marrow transplantation(BMT) on bone metabolism. METHODS: We have investigated prospectively in 29 patients undergoing BMT(4 autologous, 25 allogenic) for hematologic diseases(19 leukemia, 9 severe aplastic anemia, 1 myelodyspoietic syndrome). Serum concentrations of calcium, phosphorus, creatinine, gonadotropins, sex hormones and biochemical markers of bone turnover(osteocalcin and carboxyterminal cross-linked telopeptide of type I collagen(ICTP)] were measured. The samples were collected before BMT and 1, 2, 3, 4, 12 weeks, 6 months and 1 year thereafter. Bone mineral density was measured with DEXA(Dual Energy X-ray Absorptiometry) before and after 1 year of BMT. RESULTS: 1. ICIP was progressively increased until 4 weeks after BMT when peak values were reached. And then decreased thereafter and basal values were regained after 1 year. Osteocalcin was progressively decreased until 3 weeks after BMT when nadir values were reached. And then increased thereafter and basal values were regained after 3 months. No distinct differences were observed in serum biochemical turnover marker between both sexes and between patients who received total body irradiation and those who did not. 2. Lumbar BMD was 2.1% decreased from 1.113 +/- 0.132 g/cm to 1.089 +/- 0.137 g/cm, and femoral BMD was 6.2% decreased fiom 1.078 +/- 0.156 g/cm to 1.011 +/- 0.157 g/cm. 3. 92% of the women (11/12) became menopausal manifested by high gonadotropin and low estradiol levels immediately after BMT. In contrast to women, gonadotropins and testosterone levels were not changed significantly in men after BMT. CONCLUSION: The rapid impairment of bone formation and also increase in bone resorption, as mirrored by the biochemical markers in this study, might play a role for the post-BMT bone loss. Further studies over many patients with a longer follow up will be needed.

A Case of Traumatic Nonfuctional Adrenal Pseudocyst.: Soon Jib Yoo, Kwang Woo Lee, Ho Young Son, Sung Koo Kang, Bong Yeon Cha, Ho Jin Song, Jin No Park, Hyung Joon Kim, Jin Ah Kim, Il Young Park; J Korean Endocr Soc. 1998;13(4):659-664. Published online January 1, 2001

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Abstract PDF: The adrenal glands are rarely injured by blunt trauma, because they are well protected by the ribs, paraspinal muscles, and the overlying abdominal contents. Although most of adrenal cysts are clinically silent, the number of incidentally detected adrenal cysts have increased due to advanced and widespread application of various sensitive imaging methods. Recently, we have encountered a case of a 62-year-old man who have developed a left adrenal pseudoeyst one and a half months after the blunt trauma from a pedestrian traffic accident. The pseudocyst was non-functional and measured about 5 * 4 cm in size with the same fluid density of a gall bladder in abdominal computerized tomography(CT). Turbid cystic fluid was aspirated by CT-guided method, and the aspirate was composed of degenerated old blood cells without any malignant cells. Since the cyst was developed following trauma and its microscopic content showed blood cells, impending rupture was anticipated. Hence, a laparoscopic adrenalectomy was performed.

A Case of Autoimmune Hemolytic Anemia & Pericardial Effusion Developed in Hashimoto's Thyroiditis Patient.: Soon Jib Yoo, Moo Il Kang, Kwang Woo Lee, Ho Young Son, Sung Koo Kang, Bong Yeon Cha, Joo Yeon Choi, Kyung Ah Yoh, Ji Won Park, Jong Ryool Jin; J Korean Endocr Soc. 1998;13(4):622-628. Published online January 1, 2001

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Abstract PDF: Hashimotos thyroiditis has been associated with a various autoimmune disorders. The immunologic mechanisms involved in the pathogenesis of these disorders have not always been thought to be the same. Although it was demonstrated that there were high prevalence of abnormal thyroid function and autoantibody in autoimmune hemolytic anemia(AIHA) and Fisher-Evans syndrome(FES), AIHA combined with Hashimotos thyroiditis is rare in Korean literature. It was suggested that a common immunologic mechanism may be involved in the pathogenesis of both disease and the possibility of multiple autoimmune syndrome might present in autoimmune hematologic disorders. We experienced a 74-year old woman with a 12-year history of a hypothyroidism due to Hashimotos thyroiditis was hospitalized with sudden development of warm AIHA with positive Direct & Indirect Coombs test and pericardial effusion. Her thyroid function test showed subclinical hypothyroidism with the maintenance dosage of levothyroxine(100pg/day). With glucocorticoid and plasmapheresis, AIHA and pericardial effusion were corrected successfully. It is suggested that the prudent immunologic study is needed for the anemia developed in patients with Hashimotos thyroiditis with or without hypothyroidism.

A Case of Alstrom Syndrome.: Kun Ho Yoon, Ho Young Son, Sung Koo Kang, Yoon Hee Choi, Bong Yeon Cha, Hwan Suk Cho, Ki Bum Kim, Ji Ho Kang, Young Mi Choo, Sang Soo Bae; J Korean Endocr Soc. 1998;13(3):501-508. Published online January 1, 2001

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Abstract PDF: The Alstrom syndrome is inherited autosomal recessive disorder, characterized by obesity, diabetes mellitus, pigmentary retinal degeneration, normal intelligence, sensorineural hearing loss, baldness, acanthosis nigricans, male hypogonadism, hyperuricemia and hypertriglyceridemia. There is no reported case of Alstrom syndrome in Korea yet. We experienced a 29-year-old female patient with clinical characteristics similar to Alstrom syndrome who was admitted due to poorly controlled diabetes mellitus and diabetic retinopathy with hemorrhage. We report this case with the review of literatures.

A Case of Atypical Retroperitonealk Paraganglioma: Fatal paroxysmal adrenergic crisis and geart failure after sonographically guided biopsy of unsuspected paraganglioma.: Sung Koo Kang, Jong Min Lee, Sung Ro Yoon, Seok Young Kim, Jin Sung Moon, Hye Soo Kim, Young Jae Lee, Hye Kyung Bae, Hye Kyung Lee, Hyun Kim; J Korean Endocr Soc. 1998;13(2):280-287. Published online January 1, 2001

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Abstract PDF: Paraganglioma is an extraadrenal pheochromocytoma originating from chromaffin ceIls distributed in sympathetic nervous systems. This tumor often can produce catecholamines and induce sustained or paroxysmal hypertension, with or without the typical symptams of headache, palpitation and sweating. Paraganglioma without the usual clinical manifestations is not easy to suspect and diagnose. Herein, we report a case of atypical retroperitoneal paraganglioma which was thought to be the pancreas tail mass and result in a paroxysmal adrenergic crisis and fatal dilated cardiomyopathy after the sonographically guided percutaneous biopsy. This rare case warns against the usual practice of percutaneous biopsy for the preoperative diagnosis of intraabdominal or retmperitoneal tumors.

A Case of SIADH Related to Drug-indeced Generalized Maculopapular Rash.: Soon Jib Yoo, Kwang Woo Lee, Ho Young Son, Sung Koo Kang, Bong Yeon Cha, Ho Jin Song, Joo Yeon Choi, Jin No Park, Dong Huh; J Korean Endocr Soc. 1998;13(2):240-246. Published online January 1, 2001

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Abstract PDF: Syndrome of inappropriate antidiutetic hormone(SIADH) secretion is the most common cause of hyponatremia in clinical medicine. Before diagnosis of the SIADH is made, other causes for a decreased diluting capacity and nonosmotic stimuli for AVP release need to be rule out. Disorders associated with SIADH can be divided into 4 major etiologic groups: malignancies, pulmonary diseases, central nervous disorders, and drugs. A 45-year-old woman was admitted due to maculopapular skin eruption and fever after taking medications for fever and myalgia. Generalized tonic clonic seizure was developed nine days later, and laboratory results showed marked hyponatremia. During the evaluation, treatment, and subsequent follow-up, the diagnosis of SIADH was confirmed, but the definitive cause was obscure. With fluid restriction, sodium replacement and demeclocycline therapy, she recovered completely 6 months later. We suggest that the SIADH might be related to drug-induced generalized maculopapular rash via menmgitis-like reaction in CSF as one of systemic adverse side effects to drugs rather than direct effect of related drugs.

A Case of Type II Autoimmune Polyglandular Syndrome: Acute adrenal crisis presented as the first manifestation of Addison's disease in a patient with diabetic ketoacidosis and hypgonadism.: Young Sook Lee, Jong Min Lee, Hyun Ok Park, Sung Kyu Park, Sung Ro Yoon, Seok Young Kim, Bong Yeon Cha, Kwang Woo Lee, Ho Young Son, Sung Koo Kang; J Korean Endocr Soc. 1998;13(1):115-120. Published online January 1, 2001

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Abstract PDF: Type II autoimmune polyglandular syndrome typically presents in adulthood. Insulin dependent diabetes mellitus and thyroid dysfunction are the most frequent manifestations. Addison's disease is the third major endocrine component of this disorder. In this report, we described a thirty-two year-old male patient who had hypogonadism, insulin dependent diabetes mellitus, and mild Addison's disease presenting its first manifestation as an acute adrenal crisis due to diabetic ketoacidosis. The ACTH concentration will be elevated early in the course of Addisons disease even before a significant reduction in the basal cortisol level or its response to exogenous ACTH occurs. Therefore, plasma ACTH measurements serve as a valuable screening study for Addisons disease.

A Case of Pheochromocytoma with Acute Myocardial Infarction.: Yoo Bae Ahn, Moo Il Kang, Kwang Woo Lee, Ho Young Son, Sung Koo Kang, Bong Yeon Cha, Baek Jong Seo, Ki Yook Jang, In Jae Yoon, Sang Jun Lee, Sun Sook Park, Yong Seok Oh; J Korean Endocr Soc. 1997;12(4):655-660. Published online January 1, 2001

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Abstract PDF: Pheochromocytoma, the catecholamine-producing tumor of chromaffin tissue, is associated with a curable form of hypertension. Recently we report the case of a 59 year-old male admitted for an acute myocardial infarction and who subsequently developed late recurrent severe ventricular arrhythmia coincident with transient hypertensive episodes. A pheochromocytoma was diagnosed on the basis of the urinary concentration of catecholamines and computerized tomography of the adrenal glands. After stabilization of his cardiac rhythm and blood pressure with alpha adrenergic blockade, the left adrenal gland, which contained the tumor, was subsequently resected. The diagnosis of a pheochromocytoma should be considered when recurrent ventricular arrhythmia are associated with intermittent hypertension after acute myocardial infarction.

A Case of Thyroid Abscsess in Subacute Thyroiditis During Glucocorticoid Therapy.: Soon Jib Yoo, Bong Yun Cha, Kwang Woo Lee, Ho Young Son, Sung Koo Kang, Young Hwan Kim, Mi Ja Kang, Seung Hyeon Ko, Ki Uk Chang; J Korean Endocr Soc. 1997;12(3):468-472. Published online January 1, 2001

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Abstract PDF: Subacute thyroiditis is a frequent benign thyroid disease associated with previous viral upper respiratory tract infection. Known complications of this disease are long-standing subclinical hypothyroidism, persistent anterior neck pain and rarely Graves disease. In general, thyroid abscess is an uncommon disease because of anatomic isolation of the gland and its rich system of drainage for blood and lymph. Especially, development of thyroid abscess in subacute thyroiditis is extremely rare phenomenan, but significant bad outcomes can be resulted. Its clinical BACKGROUND containes immune-suppressed state, anatomic defect, presence of underlying other thyroid disease and of non-thyroidal infectious foci. We experienced a case of subacute thyroiditis complicated with streptococcal thyroid abscess during glucocorticoid therapy. The patient was a 19-year-old female who was admitted due to anterior neck pain for 1 month. Typical subacute thyroiditis was suggested from initial laboratory findings including CBC, erythrocyte sedimentation rate, serum T3, T4, TSH levels, thyroid scan & thyroid uptake. But during oral prednisolone therapy, unexpected bacterial thyroid abscess was developed. We report this unusual case with review of literatures.

A Case of Central Diabetes Insipidus Developed during Puerperium.: Soon Jib Yoo, Kwang Woo Lee, Ho Young Son, Sung Koo Kang, Myung Hee Chung, Bum Soon Choi, Bong Yeon Cha; J Korean Endocr Soc. 1997;12(2):315-320. Published online January 1, 2001

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Abstract PDF: Diabetic insipidus may first present before, during or immediately after pregnancy. Pregnancy serves as a physiologic provocation test that unmasks latent diabetes insipidus. It may explain the very rare first occurrence of diabetes insipidus in the pureperium. Central diabetes insipidus occurring after delivery associated with a catastrophic delivery and postpartum hypopituitarism is more frequent entity. We recently experienced central diabetes insipidus patient, aggrevated polyuria and polydipsia after total hysterectomy due to cervical carcinoma, who had interesting past history of severe polyuria and polydipsia developed during puerperium of 1st pregnancy, 14 years ago. She have had quiet normal pregnancy and there was no definite postpartum complication of pregnancy at that time. There were no change of polyuria and polydipsia during and after second pregnancy and 2 another pregnancy terminated artificially compare to puerperium of 1st delivery. She has intact anterior pituitary gland functinally and anatomically, but the posterior pituitary hyperintense signal with pre-enhance Tl-weighted imaging was absent on MRI.

A Case of Partial Hypopituitarism and Central Diabetes Insipidus Developed after Tuberculous Meningitis.: Soon Jib Yoo, Kun Ho Yoon, Moo Il Kang, Bong Yun Cha, Kwang Woo Lee, Ho Young Son, Sung Koo Kang, Myung Hee Chung, Yoon Shin, Hyuk Sang Kwon, Seung Won Jin; J Korean Endocr Soc. 1997;12(2):308-314. Published online January 1, 2001

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Abstract PDF: Complications related to tuberculous menngitis (TBM) is frequently encountered in medical field during, just after treatment and long time later. Hypothalamo-pituitary dysfunctions such as diabetes incipidus, dwarfism, hypogonadism, growth failure, and hypopituitarism are one of rare complication secondary to TBM and of which obesity with hypogonadism is most commonly documented. Several pathologic mechanics like a granuloma in hypothalamus, or pituitary stalk, organization and progressive scarring of the purulent exudate in the basal cistern or progressive obliterative endarteritis that supplying the hypothalamo-hypophyseal system is well-defined in hypothalamopituitary dysfunction in neurotuberculosis. We recently experienced a diabetic patient with short stature and sexual infantilism who shows polyuria and polydipsia. Detailed endocrinological evaluation showed partial hypopituitarism and central diabetes incipidus secondary to tuberculous meningitis. Polyuria and polydipsia was improved with dDAVP and height increased 5 cm for 11 month with HGH, libido increased with oxadrolone but his extemal sexual characteristics was not changed until now. We present this case with a review of literature.

A Case of Multiple Endocrine Neoplasia Type 1.: Soon Jib Yoo, Bong Yun Cha, Kwang Woo Lee, Ho Young Son, Sung Koo Kang, Jong Man Won, Young Seok Cho, Yong Jik Sung, Kyung Sub Song, Jin Young Yoo, Chul Woo Lee; J Korean Endocr Soc. 1997;12(1):111-119. Published online January 1, 2001

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Abstract PDF: Multiple endocrine neoplasia type 1 (MEN 1) is the association of neoplastic transformation of parathyroid, pituitary, and pancreatic islet cells. This syndrome is inherited as an autosomal dominant trait. A 38-year-old woman presented with general weakness and mental changes. She had experienced same symptoms 7 years ago, after then her weight gradually increased. Insulinoma was suspected by markedly decreased blood glucose level (20mg/dL) and the increased insulin/glucose ratio (0.43) that sampled in emergency room at the time of mental change. Unusually large pancreatic tail mass and Lt, adrenal gland mass were detected by abdominal CT. Percutaneous transhepatic portal vein catheterization with insulin sampling showed sudden step up of insulin/glucose ratio at the middle portion of pancreas. Measuring of basal pituitary hormones as a screening procedure of MEN showed increased basal prolactin level. Combined pituitary stimulation test showed blunted response of prolactin to TRH and sellar magnetic resonance imaging showed intrasellar mass. Thyroid nodule was palpated on her anterior neck. Thyroid scintigram showed cold nodule, and there was no lymphadenopathy around the nodule by the thyroid sonogram. Fine needle aspiration cytology showed benign hyperplastic follicular cells only. Serum ionized calcium and parathyroid hormone level were normal. Under the impression of MEN type I, the distal pancreatectomy, splenectomy, Lt. thyroid lobectomy and Lt. adrenalectomy was performed at the same time. Histologic examination of the surgically removed tissues revealed pancreas islet cell tumor, adrenal cortical adenoma and thyroid adenoma. Transient hyperglycemia was developed after surgical intervention, but thereafter she never felt any symptoms of hypoglycemia till now and her blood glucose showed completely normal level with oral glucose tolerance tests. We present this case with a review of literature.

A Case of Cushing's syndrome due to Primary Pimary Pigmented Nodular Adrenal Dysplasia ( PPNAD ): A Case of Carney's Complex.: Soon Jib Yoo, Bong Yun Cha, Kwang Woo Lee, Ho Young Son, Sung Koo Kang, Youn Sik Kim, Jong Min Lee, Jong Man Won; J Korean Endocr Soc. 1997;12(1):90-98. Published online January 1, 2001

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Abstract PDF: Primary Pigmented Nodular Adrenal Dysplasia (PPNAD) is a rare cause of Cushing's syndrome in infants and young adults. The familial occurrence, it may be variably associated with a complex of other pathologic characteristics that manifests extraadrenal disorders (includes cardiac myxomas, lentigines, mammary myxoid lesions, testicular tumors, pituitary adenomas, and neuroectodermal tumors) was considered indicative of Carneys complex. This was based on the failure of cortisol suppression by high-dose dexamethasone, either normal or suppressed basal adrenocorticotropic hormone (ACTH) levels, and normal radiographic studies of the sellar turcica, and adrenals glands is almost normal or slightlg eulaged.. Bilateral adrenalectomy has thus the only effective means of cure. The disease may be a component of a rare, but potentially dangerous complex of abnormalities that follow an autosomal-dominant mode of inheritance. Recently we experienced a case of Carney's complex composed by Cushings syndrome due to PPNAD with familial purple colored lentigines on their lips and report it with reviews of the literatures.

A Case of Mediastinal parathyroid adenoma localized by technetium-99m sestamibi scanning.: Bong Yun Cha, Kwang Woo Lee, Ho Young Son, Sung Koo Kang, Ki Ho Song, Sung Hee Lee, Won Hee Han, Hyung Sun Sohn; J Korean Endocr Soc. 1996;11(2):227-232. Published online November 7, 2019

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Abstract PDF: We present a patient with primary hyperparathyroidism in whom preoperative Tc-99m sestarnibi scanning cleary demonstrated mediastinal parathyroid adenoma. After resectian of tumor through median sternotomy, he was restored to the normocalcemia. This case suggests that Tc-99m sestamibi scanning may be a useful method in the preoperative localization of mediastinal parathyroid adenoma.

A Case of Pituitary Feedback Adenoma Caused by Primary Hypothyroidism.: Soon Jib Yoo, Sang A Chang, Yoo Bae Ahn, Hyun Sik Son, Kun Ho Yoon, Moo Il Kang, Bong Yun Cha, Kwang Woo Lee, Ho Young Son, Sung Koo Kang, Myung Hee Chung; J Korean Endocr Soc. 1996;11(2):199-206. Published online November 7, 2019

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Abstract PDF: A 14-year-old girl presented with severe headache and grand mal seizure. A magnetic resonance imaging(MRI) of brain showed a pituitary mass(1.0X1.5X1.3cm) incidentally during seizure evaluation. On physical examination, nodular goiter was detected on her anterior neck. The hormone study showed markdly increased basal thyroid stimulating hormone(TSH) level compared to thyroid hormone level, hyperprolactinemia and decreased basal growth hormone level. TSH and prolactin showed exaggerated response to thyrotropin releasing hormone(TRH) and the growth hormone showed delayed and blunted response to insulin-induced hypoglycemia. With the results of thyroid autoantibody and thyroid scan, the diagnosis of Hashimoto's thyroiditis was possible. Thyroid hormone and anticonvulsant drug were started with close observation of clinical status under the impression of pituitary feedback adenoma caused by hypothyroidism. After 3 months replacement therapy of levothyroxine sodium, she achieved euthyroid state with disappearance of headache and nodular goiter. After continuous replacement therapy for 9 months more, the pituitary mass was successfully regressed on follow up MRI with normalization of basal prolactin level. Grand mal seizure was developed after withholding anticonvulsant drug even though continuous admmistration of thyroid hormone. Because of similarity among pituitary adenoma discovered incidentally, careful hormonal study and high index of suspicion should be maintained to achieve correct diagnosis in order to avoid unnecessary pituitary surgery in these patients.

A Case of Pheochromocytoma Diagnosed as Preeclampsia during Prenancy.: Bong Yun Cha, Ho Young Son, Soon Jip Yoo, Ki Hyun Baik, Myung Hoon Kim, Moo Il Kang, E Jin Choi, Kwang Woo Lee, Sung Koo Kang, Uk Kim, Jong Man Won, Jin Young Yoo; J Korean Endocr Soc. 1994;10(3):295-299. Published online November 6, 2019

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Abstract PDF: A case of a pregnant woman with an undiagnosed pheochromocytoma is presented. Gestational hypertension was developed at 33 weeks' gestation. Also she experienced intermittent chest discomfort, headache and irritability during those period. Normal vaginal delivery was successfully performed with close observation. Even though experiencing same symptoms for two years after delivery, she had been treated as neurosis. Uncatched pheochromocytoma was detected and the tumor was resected successfully. It seems to be that many cases of pheochromocytoma with pregnancy still go unrecognized because of close similarity between pheochromocytoma and toxemia. High index of suspicion should be maintained to achieve early diagnosis because antenatal diagnosis can lower the mortality in both mother and fetus.

A Case of Thyroid Hemiagenesis with Papillary Adenocarcinoma.: Je Ho Han, Bong Yun Cha, Ho Young Son, Yoo Bae Ahn, Kwang Woo Lee, Sung Koo Kang, Se Jeong Oh, Jong Soon Na, Sang Ah Jang, Moo Il Kang; J Korean Endocr Soc. 1994;9(4):385-389. Published online November 6, 2019

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Abstract PDF: Variation in the gross anatomy of the thyroid is relatively common. Although thyroid hemiagenesis is considered to be a rare congenital anomaly, its incidence is probably underestimated because the diagnosis is usually incidental.We present the case of a 26-year-old woman with right thyroid hemiagenesis associated with papillary adenocarcinoma. The diagnosis of hemiagenesis was established by isotope imaging, which showed hot nodule, thyroid ultrasonography and surgical exploration for proper management of a nodule in the left lobe of thyroid gland. As she was diagnosed to have papillary adenocarcinoma, total thyroidectomy was performed and at present she remains disease-free.

Expression of Epidermal Growth Factor Receptor mRNA by In Situ Hybridization in Normal and Abnormal Thyroid Tissue.: Hyun Sik Son, Kun Ho Yoon, Bong Yun Cha, Jong Min Lee, Kwang Woo Lee, Moo Il Kang, Ho Young Son, Sung Koo Kang, Se Jeong Oh, Jin Han Kang, An Hee Lee; J Korean Endocr Soc. 1994;9(4):337-343. Published online November 6, 2019

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Abstract PDF: Growth factors are polypeptide molecules that regulate cell growth and function by binding with high affinity to specific receptor molecules in the plasma membrane and stimulating receptor mediated action of intracellular signal transduction pathway.Epidermal growth factor(EGF) and their receptors(EGFR) regulate normal cellular growth, proliferation, and differentiation of various cells in vivo and in tissue cultures. And also may contribute directly to oncogenesis.Overexpression of EGFR and autocrine stimulation of growth involving this receptor system has been identified in several types of human neoplasia. There is evidence that the EGF and receptor system is involved in the regulation of follicular cell growth in the thyroid gland especially with immunohistochemical technic. But there was a challenge about the validity of previously performed immunohistochemical studies.In the study we investigated the relationship between EGFR mRNA expression and tumorigenesis by rapid in situ hybridization method. Formalin-fixed, paraffin embedded tissue sections of 10 normal, 17 nodular hyperplasia, 6 follicular adenoma, and 15 papillary cancer were examined. The results were as follows:1) EGFR mRNA positivity were 20%(2/10) in normal thyroid, 70%(12/17) in nodular hyperplasia, and 100% in follicular adenoma and papillary cancer.2) There was a significantly increased EGFR mRNA expression in papillary cancer compare to normal and nodular hyperplasia(p<0.05). But no difference was found with papillary cancer and follicular adenoma.3) There was a significantly increased EGFR mRNA expression in follicular adenoma compare to normal (p<0.05). But no difference was found with follicular adenoma and nodular hyperplasia. These results suggest that an overexpression of EGFR mRNA may play an important role in the tumorigenesis of thyroid tissue.

A Case of Primary Hyperparathyroidism Associated with Proximal Renal Tubular Acidosis and Postoperative Hungry Bone Syndrome.: Je Ho Han, Kun Ho Yoon, Bong Yun Cha, Ho Young Son, Kwang Woo Lee, Hae Ok Jung, Chang Sup Kim, Moo Il Kang, Chul Soo Cho, Ho Yun Kim, Sung Koo Kang; J Korean Endocr Soc. 1994;9(2):141-149. Published online November 6, 2019

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Abstract PDF: Primary hyperparathyroidism is a generalezed disorder of calcium, phosphorus and bone metabolism due to an increased secretion of parathyroid hormone. Single parathyroid adenoma is the most common cause of primary hyperparathyroidism. Because parathyroid hormone has been proposed as an important inhibitor of renal bicarbonate reabsorption of proximal tubule, proximal renal tubular acidosis is not rare in primary hyperparaphyroidism. After parathyroid resection, significant hypocalcemia and hypophosphatemia requiring prolonged medical management may develop, termed hungery bone syndrome. We experienced a case of primary hyperparathyroidism associated with proximal renal tubular acidosis, and severe hungry bone syndrome after resection of the adenoma of parathyroid gland.

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