Endocrinology and Metabolism

Volume 11(1); March 1996

Original Articles

A New Model for the Regulartion of Body Weight.: Yong Seong Kim; J Korean Endocr Soc. 1996;11(1):1-6. Published online November 7, 2019

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Abstract PDF: No abstract available.

Diagnosis of Medullary Thyroid Carcinoma.: Sung Hee Ihm; J Korean Endocr Soc. 1996;11(1):7-10. Published online November 7, 2019

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Abstract PDF: No abstract available.

Clinical Significance of Routine Measurement of Serum Calcitonin in Korean Patients with Thyroid Nodules as a Screening test of Sporadic Thyroid Medullary Carcinoma.: Young Kee Shong, Cheol Soo Choi, Hye Young Park, Bo Youn Cho; J Korean Endocr Soc. 1996;11(1):11-17. Published online November 7, 2019

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Abstract PDF: Background
: It is not easy to diagnose sporadic medullary thyroid carcinoma(MTC) before surgery and this might lead the patient reoperation and/or lowered chance of definite cure. Methods : The prevalence of sporadic MTC in Korean was studied in patients with thyroid nodules. A prospective study of 1048 consecutive patients with thyroid nodules was performed. In all patients, measurements of basal serum calcitonin, thyroid hormones, TSH, anti-thyroglobulin antibody and anti-thyroperoxidase antibody were undertaken along with technetium-99m thyroid scintigraphy and fine needle aspiration cytology. In patients with elevated basal calcitonin levels, calcium stimulated calcitonin level was determined. Results: Two patient had markedly elevated calcitonin levels(over 3,200 pg/mL and 1,763 pg/ mL) and another one slightly elevated calcitoni#n(71.9 pg/mL). Fine needle aspiration cytology was suggestive of MTC in one and nodular hyperplasia in the other two. They underwent surgery and histological examination revealed MTC in those two with markedly elevated calcitonin levels. The patient with slightly elevated calcitonin, who was on the maintenance hemodialysis due to chronic renal failure, had nodular hyperplasia. Conclusion: MTC was found in 0.19% of patients with thyroid nodules, which was not different with the previously reported prevalence in Europe. Routine measurements of serum calcitonin might be of value to detect sporadic MTC; however, the cost-effectiveness of routine measurement of serum calcitonin is not clear, considering the relatively low prevalence of MTC in Koreans.

Difference of Thyroid Stimulating Antidody Activities Measured in Chinese Hamster Ovary Cells Stably Transfected with Human TSH Receptor and in FRTL-5 Cells in Graves Disease and Its Clinical Correlations.: Young Kee Shong Young Kee Shong, Hye Young Park, Bo Youn Cho, Won Bae Kim, Hong Gyu Lee, Chang Soon Koh, Yeon Sang Oh; J Korean Endocr Soc. 1996;11(1):18-29. Published online November 7, 2019

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Abstract PDF: Background
: Thyroid stimulating antibodies result in the development of hyperthyroidism and goiter in Graves disease. However, thyroid stimulating antibody activities do not correlate with the clinical features in many patients with Graves disease. The purpose of this study is to address this discrepancy between thyroid stimulating antibody activities and clinical features of Graves patients. Methods: We measured thyroid stimulating antibody activities simultaneously using human TSH receptor transfected Chinese hamster(hTSHR-CHO) cells and rat thyroid(FRTL-5) cells in 57 untreated patients with Graves disease, and compared their activities with clinical features including thyroid hormone levels. Results : The detection rate of thyroid stimulating antibody measured by hTSHR-CHO cells was 90% in 57 untreated Graves patients and it was higher than that measured by FRTL-5 cells. Thyroid stimulating antibody activity by hTSHR-CHO cells was significantly correlated with that by FRTL-5 cells(r=0.5, p<0.001), however, 18 of 57(32%) patients showed marked discrepancy of thyroid stimulating antibody activity between in hTSHR-CHO and FRTL-5 systems. Thyroid stimulating antibody activity measured by hTSHR-CHO cells was significantly correlated with serum total T3, free T4 levels, and goiter size but not 99mTc-thyroid uptake. On the other hand, thyroid stimulating antibody activity measured by FRTL-5 cells was significantly correlated with goiter size and 99mTc-thyroid uptake but not thyroid hormone levels. The difference between function and goiter size with respect to thyroid stimulating antibody measurement in two cells system is, nevertheless, particularly evident in the free T4/goiter ratio in patients with high hTSHR-CHO and low FRTL-5 cell assay values. Conclusion: These findings suggest that thyroid stimulating antibodies in Graves disease are heterogeneous population in terms of responses to different origin of cells. Further, thyroid stimulating antibody activities measured by FRTL-5 cells tend to correlate better with goiter size and Tc-thyroid uptake, whereas thyroid stimulating antibody activities measured by hTSH-CHO cells correlate better with thyroid hormone levels.

Spontaneous Recovery from Hypothyroidism in Autommune Thyroiditis.: Bo Youn Cho, Jae Hoon Chung, Kwang Won Kim, Kyu Jeung Ahn, Yong Ki Min, Myung Shik Lee, Moon Kyu Lee; J Korean Endocr Soc. 1996;11(1):30-40. Published online November 7, 2019

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Abstract PDF: Background
A lifelong thyroxine therapy is indicated in all patients who have hypothyroidism as a result of autoimmune thyroiditis. However, it has been reported that some hypothyroid patients with autoimmune thyroiditis have spontaneous remission with restriction of iodine intake instead of thyroxine therapy. The purpose of study was to investigate how many hypothyroid patients with autoimmune thyroiditis can recover from hypothyroidism with restriction of iodine intake instead of thyroxine therapy and which factors predict recovery from hypothyroidism. Methods: We studied 64 patients with autoimmune thyroiditis(goitrous autoimmune thyroiditis 56, atrophic autoimmune thyroiditis 8). Thyroxine therapy was discontinued in patients with goitrous autoimmune thyroiditis on the way(group 1, n=32) or from the beginning(group 2, n=24) and atrophic autoimmune thyroiditis on the way(group 3, n-8). All patients were asked to avoid iodine-rich foods and thyroid function was monitored every one to two months for up to 35 months. Serum T3, T4, TSH concentrations, antithyroglobulin and antimicrosomal antibodies were measured by radioimmunoassay(RIA). TSH binding inhibitor immunoglobulin(TBII) was measured in serum using radioreceptor assay. Two hundred micrograms of thyrotropin releasing hormone (TRH) were given as intravenous bolus and TSH levels were measured in blood samples taken at 0, 30, and 60 minutes. All values were expressed as mean+-SEM. Statistical analysis was done with paired or non-paired t-test, ANOVA, and the Chi-square test. Statistical significance was defined as p-value below 0.05. Results: Thirteen(40.6%) of 32 patients in group 1 remained euthyroid after 12-35 months of discontinuation of thyroxine therapy. The other 19(59.4%) patients in group 1 had recurrences of hypothyroidism within 3 months after discontinuation of thyroxine therapy. In 11(45.8%) out of 24 patients in group 2, serum TSH concentrations declined below 5 mU/L within 3 months without thyroxine therapy. The other 13(54.2%) patients in group 2 remained hypothyroid till 2-16 months and the thyroxine was given. In contrast, all 8 patients in group 3 had recurrences of hypothy- roidism within 3 months after stopping thyroxine therapy. When we compared the recovered patients of goitrous autoimmune thyroiditis with the non-recovered patients of goitrous autoimmune thyroiditis, regardless of thyroxine therapy from the beginning, age at onset of disease of the 24 recovered patients was significantly younger than the 32 non-recovered patients(30.1+2.0 years vs. 40.2+ 2.4 years; p=0.004). Concl#usion: These findings suggest that 42.9% of hypothyroid patients with goitrous autoim- mune thyroiditis remain or become spontaneously euthyroid with restriction of iodine intake instead of thyroxine therapy. Young age may be a predicting factor of recovery from hypothyroidism in goitrous autoimmune thyroiditis.

Changes in Serum Lipids and Apolipoproteins Levels According to the Thyroxine Treatment in The Patients with Subclinical Hypothyroidism.: Hye Young Park, Bo Youn Cho, Won Bae Kim, Hong Gyu Lee, Chang Soon Koh, Geon Sang Park, Hyung Kyu Park, Sook Kyung Kim, Chan Soo Shin, Seong Yeon Kim; J Korean Endocr Soc. 1996;11(1):41-51. Published online November 7, 2019

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Abstract PDF: Background
Subclinical hypothyroidism(SCH) is a common biochemical abnormality which can be found in routine screening tests of thyroid function. We are increasingly faced with the question of whether its an indication for thyroxine replacement therapy. The effect of thyroxine replacement on lipid profile in SCH has aroused a great interest because of an association of overt hypothyroidism(OVH) with hyperlipidemia and increased risk of coronary artery disease. Method: We prospectively evaluated the changes in lipids and apoproteins before and after thyroxine replacement therapy in 23 patients with SCH and in 37 patients with OVH. We measured serum total cholesterol and triglyceride using autoanalyzer, high density lipoprotein(HDL) chole-sterol by dextran sulfate method, Apo A1 and Apo B by immunonephelometric assay. Results: Thyroxine replacement therapy significantly decreased total cholesterol, low density lipoprotein(LDL) cholesterol and apo B levels, but did not affect the level of triglyceride, HDL cholesterol or apo AI in patients with OVH. In SCH, thyroxine replacement therapy with the doses to normalize serum TSH concentrations also decreased significantly the level of cholesterol and LDL cholesterol albeit apo B levels did not change. Moreover, in most of patients with OVH (11 of 12) and in all of patients with SCH(5 of 5) who had had hyperchlesterolemia before treatment, thyroxine replament normalized their cholesterol and LDL cholesterol levels. Conclusion: In regard to the beneficial changes in blood lipid levels, patients with SCH should be treated, especially in cases who have other risk factors for the development of atherosclerosis. If thyroxine replacement only will reduce the incidence of coronary artery disease in SCH remains to be elucidated by long-term prospective studies.

Serum Insulin-like Growth Factor-1(IGF-1) and Insulin-like Growth Factor Binding Proteins in Hyperthyroidism and Hypothyroidism.: Hyun Mo Song, Sang Seok Park, Tae Seon Park, Hong Sun Baek, Dae Yeol Lee; J Korean Endocr Soc. 1996;11(1):52-60. Published online November 7, 2019

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Abstract PDF: Background
s: Thyroid hormones play a fundamental role in the initiation and maintenance of somatic growth in mammalian species, and the insulin-like growth factors(IGFs) occupy a position of central importance in the growth of all tissues. To evaluate the changes in serum insulin-like growth factor-I(IGF-I) and insulin-like growth factor binding proteins in hyperthyroid and hypothyroid patients, sera was obtained from 19 hyperthyroid patients, 9 hypothyroid patients, and 10 healthy volunteers. Methods: IGF-I concentration was determined by radioimmunoassay, and changes in IGFBPs were assesed by Western Ligand Blotting. To evaluate the binding pattern of IGF-I & IGFBPs, autoradiographs were obtained. Results & Conclusion: IGF-I levels were increased significantly in hyperthyroid patients(mean ±SE, 267.88±9.80 ng/ml, p<0.05) and decreased significantly in hypothyroid patients(154.81±1.43 ng/ml, p<0.01) compaired to healthy control group(209.45±.60 ng/ml). Autoradiograph of serum IGFBPs from patients with hyperthyroidism and hypothyroidism did not show any change in the intensity of IGFBP-3 bands(40-45 KD) and IGFBP-1 bands, but in hyperthyroid patients, it showed increased intensity of IGFBP-2 band compared to healthy control group and hypothyroid patients.

Autoantigenic Role of Variant Thyroperoxidase.: Young Kee Shong, Dae Hyuk Moon, Ghi Su Kim; J Korean Endocr Soc. 1996;11(1):61-67. Published online November 7, 2019

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Abstract PDF: Background
Thyroperoxidase(TPO) is one of the most important autoantigens in autoimmune thyroid disorders and autoantibody to TPO is found in almost every patients with various autoimmune thyroid diseases. Human TPO was already cloned and the completed nucleotide sequences are well known. In human thyroid tissues, several variants mRNA's of TPO are found in addition to the wild type. Especially the variants lacking exon 10(TPOΔexon10) and exon 16(TPOΔ exon16) are found in very large amount in both normal and Graves thyroid tissues. The significance of these variants TPO mRNAs are largely unknown. The authors tried to investigate the autoantigenic role of these variant TPO. Methods : To produce variant TPO cDNAs, oligonucleotide directed mutagenesis was performed using cDNA for wild type human TPO as template. The produced variants cDNAs were transfected into Cos-7 cells and variants TPO proteins were tested against patients sera showing high titers of anti-TPO antibody. Results: Seven of 12 Graves sera reacted with TPOΔexon 10 and 8 Graves sera with TPOΔ exonl6. Eight of 15 Hashimoto sera reacted TPOΔexon16 and 9 with TPOΔexon16. The reactivity with variants TPO was not related to clinical findings. Conclusion: These two variant TPOs, that is TPOexon10 and TPOΔexon16, could act as an autoantigen if they were translated in vivo, and could play a role in autoimmune thyroid disease. Their exact role in the pathogenesis of autoimmune thyroid disorders are to be clarified.

Clinical Characteristics of Graves' Disease Patients with Undetectable Thyrotropin Binding Inhibitor Immunoglubulin (TB2).: Bo Youn Cho, Won Bae Kim, Hong Gyu Lee, Chang Soon Koh, Seong Yeon Kim, Seok In Lee, Jae Seok Chun, Kyung Soo Park; J Korean Endocr Soc. 1996;11(1):68-74. Published online November 7, 2019

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Abstract PDF: Background
Graves disease is an autoimmune disease caused by TSH receptor antibodies. Thyrotropin binding inhibitor immunoglobulins(TBII) are detected in most Graves patients, but some patients have no TBII activities in their sera. It is unknown whether the clinical features of TBII-positive patients are different from those of TBII-negative patients. Methods: To evaluate the prevalence of TBII-negative Graves' patients and its clinical differences from TBII-positive patients, we examined TBII by radioreceptor assay in 686 consecutive untreated Graves patients. We found 84 TBII-negative patients(15 men and 69 women, mean age ±EM: 40.9±.4 years) and compared their clinical characteristics with 87 TBII-positive patients (22 men and 65 women, mean age±EM: 39.9±.5 years) who were selected randomly from the same patients group. Results: In this study, TBII was undetectable in 12.2% of patients with Graves' disease(84 of 686). TBII-negative group had a less weight loss than TBII-positive group. However, there was no significant differences in age, sex ratio, prevalence of ophthalmopathy, duration of illness and positive rate of family history for thyroid diseases between TBII-negative and -positive groups. Serum total T or T levels were not different from each other, but T3-uptake was significantly higher in TBII-positive group than that in TBII-negative group, suggesting that the free hormone levels in TBII-negative group might be lower. The thyroid uptake of 99mTcO4 was significantly higher in TBII positive group than that in TBII-negative group. Thyroid autoantibodies, including antimicrosomal and antithyroglobulin antibodies were detected in almost all patients but there were no differences in titers and positive rate between TBII-negative and -positive groups. Conclusion: Although TBII-negative Graves patients showed less weight loss and low 99mTc04 thyroidal uptake compare to TBII-positive patients, the clinical and immunological characteristics of TBII-negative patients are not different from TBII-positive one.

Efficacy of Fluvastatin in Patients with Hypercholesterolemia.: Moon Ho Kang, Sung Gwang Lee, Jung Ho Youn, Tae Suk Kim, Seung Woon Ahn; J Korean Endocr Soc. 1996;11(1):75-84. Published online November 7, 2019

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Abstract PDF: Background
Fluvastatin is the first entirely synthetic 3-hydroxy-3-methylglutaryl-coenzyme A(HMG-CoA) reductase inhibitor. Clinical data indicate that this agent exhibits the proven efficacy of its class and also has some theoretical advantages in safety for long-term use because of its unique pharmacololgic property consistent with hepatoselectivity(i.e., low systemic exposure). This study is to evaluate efficacy and safety of fluvastatin in hypercholesterolemic patients in Korea. Methods: An open clinical trial with fluvastatin was conducted in 31 subjects who continued to have high blood cholesterol levels of 6.21 mmol/L(240 mg/dl) or greater after 1 month of lipid-lowering diet plus single blind placebo period. Fluvastatin was administered for 8 weeks with the initial dose of 20 mg per day and if serum cholesterol levels did not fall below 5.20 mmol/L(200 mg/dl) after 4 weeks the dose was increased to 40 mg per day for the second 4 weeks. On each visit every 4 weeks they underwent interview and laboratory tests about side effects and tolerability. Results: The mean % changes in plasma total cholesterol and LDL-cholesterol from baseline were -14.6% and -20.2% at 4 week, and -19.5% and -24.7% at 8 week respectively(p<0.001). No significant change in plasma triglyceride was found in the overall group, but when analysis is confined to those with hypertriglycedemia combined(TG>- 2.26 mmol/L or 200 mg/dl), plasma triglyceride levels were significantly reduced by 23.3% at 8 week(p<0.05). There was no significant change in HDL-cholesterol during fluvastatin treatment. Three patients had mild gastrointestinal symptoms and one patient developed drowsiness, no symptoms were severe enough to discontinue the medication. Notable laboratory abnormalities including serum transaminase and creatine kinase elevations were not observed. Conclusion: This study suggests that fluvastatin is an effective, safe, and well-tolerated lipid lowering agent in the treatment of hypercholesterolemia. Controlled clinical studies on large scale and long-term basis should be followed.

Case Reports

Two cases of 111Indium Pentetreotide Scan for the Pre- and Post-Operative Evaluation of Localization and Metastasis in Medullary Thyroid Carcinoma.: Jae Hoon Chung, Kwang Won Kim, Kyu Jeung Ahn, Yong Ki Min, Myung Shik Lee, Moon Kyu Lee, Kyoung Ah Kim, Yeun Sun Kim, Eun Mi Koh; J Korean Endocr Soc. 1996;11(1):85-92. Published online November 7, 2019

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Abstract PDF: Medullary carcinoma of the thyroid gland(MTC) constitutes approximatesly 3% to 10% of all malignant thyroid tumors. It appears in both familial and sporadic forms. Metastases are frequently present at diagnosis and are resistant to chemotherapy and radiotherapy. Surgical resection of the primary tumor and the metastases is the mainstay of treatment. Although MTC can be detected by elevated serum calcitonin, localization of residual or metastatic foci may be difficult. Many scintigraphic methods have been used for identification of the residual tumor or metastasis. However, most of them have either low sensitivity or low specificity. MTC frequently secretes somatostatin and may express somatostatin receptors. Recently, somatostatin-receptor imaging has been known to be useful for the detection of residual and recurrent medullary thyroid carcinoma. A 25 year-old woman who was dignosed as medullary carcinoma by biopsy of thyroid mass is presented. Thirteen years ago, she underwent left thyroidectomy due to thyroid cancer(MTC). Laboratory tests revealed an increase in the levels in serum CEA(CEA=557.6 ng/ml) and calcitonin(calcitonin= 720 pg/ml). The second patient, a 30 year-old female, complained of a palpable mass in the left anterior neck. Ten years ago, she underwent a right lobectomy of thyroid gland due to adenomatous goiter. Laboratory tests revealed an increase in the levels in serum CEA(CEA=617 ng/ml) and Calcitonin (Calcitonin=2,300 pg/ml). In both cases, pre- and postoperative In-111 pentetreotide scintigraphy were done and compared with "'I scintigraphy. In-111 pentetreotide scan may be useful for the localization of residual or metastatic medullary thyroid carcinoma. Further study is warranted to define the sensitivity and specificity of the technique.

A Case of Adult Fanconi Syndrome with Hypophosphatemic Osteomalacia.: Ji Hyun Lee, Young Sup Byun, Bong Soo Cha, Moon Suk Nam, Young Duk Song, Sung Kil Lim, Kyung Rae Kim, Hyun Chul Lee, Kap Bum Huh, Jin Kim, Jong In Yook; J Korean Endocr Soc. 1996;11(1):93-101. Published online November 7, 2019

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Abstract PDF: The Fanconi syndrome is characterized by generalized disturbance of tubular function. It leads to excessive losses of amino acids, glucose, phosphate, bicarbonate, and other organic and inorganic substrates handled by the proximal tubules. The metabolic consequences are acidosis, hypophosphatemia, hypocalemia, dehydration, rickets, osteomalacia, osteoporosis, and growth retardation. This syndrome may either be congenital or acquired, primary or secondary. Acquired Fanconi syndrome may result from multiple myeloma, Wilsons disease, primary amyloidosis, light chain nephropathy, and heavy metal poisoning such as lead, mercury, and cadmium. A 33-year-old female presented with multiple bone pain, and progressive proximal muscle weakness for 15 months. The blood urea nitrogen, creatinine, calcium, phosphate, and uric acid were 12.1 mg/dL, 1.5 mg/dL, 8.4 mg/dL, 1.8 mg/dL, and 1.7 mg/dL, respectively. The urine volume, protein, calcium, phosphate, and creatinine clearance were 2,330 ml, 343.7 mg, 146 mg, 424 mg, and 44.6 ml/min, respectively in 24 hour collection urine study. The tubular reabsorption rate of phosphate was decreased. In arterial blood gas analysis study, pH was 7.348, bicarbonate was 17.6 mmol/L, which means metabolic acidosis. In chest X-ray, fracture was seen in eighth and ninth left ribs. The whole body bone scan revealed hot uptake at both first and second ribs, right third rib, both eighth and ninth ribs, left sacroiliac joint and right hip joint. Bone densitometry showed moderate osteopenia in spine and femur neck. After NE4Cl loading, the urine pH was decreased below 5.0 at two and third hour, which means proximal renal tubular acidosis. Amino acid such as, hydroxyproline, threonine, serine, asparagine, glutamine excreted much more than normal in 24 hour urine. Bone biopsy showed the presence of increased osteoid volume and osteoid seam width and marked decreased mineral appositional rate as evidence for osteomalacia. The patients symptoms, including bone pain and proximal muscle weakness, were relieved after supplement of calcitonin, Vitamin D and calcium carbonate. We report a case of Fanconi syndrome with hypophosphatemic osteomalacia with brief review of literature.

A Case of 17a-Hydroxylase Deficiency in 17-Year-Old Girl.: Keun Yong Park, Ki Lack Park, Jung Ho Rhee; J Korean Endocr Soc. 1996;11(1):102-107. Published online November 7, 2019

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Abstract PDF: The single enzyme P-450c17 hydroxylase catalyzes the 17a-hydroxylation of both pregnenolone and progesterone and the side-chain cleavage of 17a-hydroxypregnenolone and 17a-hydroxypro- gesterone to dehydroepiandrosterone and androstenedione. This enzyme is located in the endoplasmic reticulum and consists of a P-450c17 and a specific flavoprotein NADPH-cytochrome P-450 reductase. The clinical picture and hormonal pattern in 17a-hydroxylase deficiency have been consistent in both genotypic sexes with hypergonadotropic hypogonadism in whom the virtual absence of gonadal steroids results in a female phenotype with primary amenorrhea and pseudohermaphro- ditism in the male and underdeveloped secondary sex characteristics and hypermineralocorticoidism with hypertension, hypokalemia, suppressed renin-angiotensin system and extremely reduced aldo-sterone production. A 17-year-old girl visited endocrine clinic because of amenorrhea, absence of pubic and axillary hair, and hypertension. she had elevated levels of serum corticosterone, deoxycorticosterone(DOC), 18-hydroxycorticosterone(18-OHB). Stumulation with ACTH effected minimal increase in the elevated steroids and the ACTH-stimulated 18-OHB to aldosterone ratio was more than 280. These hormonal patterns appear to be homozygote in 17a-hydroxylase deficiency.

A Case of Diabetes Insipidus in Patient with Sheehan's Syndrome.: Hye Young Park, Moon Ho Kang, Sung Gwang Lee, Jung Ho Youn, Yeoung Sook Kang, Deuk Jo Kim, Yun Young Choi, Hee Young Hwang; J Korean Endocr Soc. 1996;11(1):108-113. Published online November 7, 2019

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Abstract PDF: Sheehans syndrome is a known complication of pregnancy, It was described as a syndrome of hypopituitarysm due to acute ischemic necrosis of the anterior pituitary gland secondary to severe postpartum bleeding and shock. The neurophysis is usually preserved. But it can be involved in severe cases manifesting as diabetes insipidus. Because of its rare coexistence with Sheehans syndrome, diabetes insipidus is seldom recognized as a potential postpartum complication. The report describes a patient who developed Sheehans syndrome and diabetes insipidus immediately following delivery. Diabetes insipidus resolved spontaneously after 15 months, while panhypopituitarysm is persistent.

A Case of Turner Syndrome Associated with Autoimmune Thyroiditis and Empty Sella.: Hong Seung Kim, Joo Won Byun, Do Sik Yoon, Byung Gi Seo, Young Goo Shin, Choon Hee Chung; J Korean Endocr Soc. 1996;11(1):114-118. Published online November 7, 2019

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Abstract PDF: No abstract available.

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