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Volume 13(3); September 1998
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Original Articles
Role of Peroxisome Proloferator-activated Receptor in the Lipid Metabolism.
Young Seol Kim
J Korean Endocr Soc. 1998;13(3):303-307.   Published online January 1, 2001
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No abstract available.
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Imaging of Hyperparathyroidism.
Sung Soo Koong, Tae Geun Oh
J Korean Endocr Soc. 1998;13(3):308-312.   Published online January 1, 2001
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No abstract available.
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Involvement of Polyamine in Growth Hormine Secretion from the GH3 Cells.
Ji Young Lee, Byoung Ki Kim
J Korean Endocr Soc. 1998;13(3):313-323.   Published online January 1, 2001
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BACKGROUND
S: Polyamines are known to be essential for cell growth and differentiation. Recently, possible roles of the polyamine in signal transduction as neurotransmitter, modulator, or second messenger are suggested in many studies. Furthermore, it is widely studied that possible roles of polyamine are involved in the action of hormone. Thus, it was to investigate the effect of polyamines in the cell proliferation and secretion of GH from the GH cells. METHODS: Cells(5*10 cells/mL) were incubated for 3 days in DMEM containing test drugs and labeled with 20pCi/mL of [S]-methionine for 2 hr. Proteins secreted into the medium were separated by 13% SDS-gel electrophoresis, then autoradiography was performed to identify radiolabeled proteins. [S]-methionine labelled GH was identified by radioimmuno-precipitation. Total protein synthesis was determined from the radioactivity of the cell homogenate by liquid scintillation counter. The intracellular polyamine content was determined by HPLC. RESULTS: Externally added polyamines(putrescine, spermidine, spermine) induced cell proliferation in a dose-dependent manner at proper concentrations, specifically 50pM putrescine increased GH secretion, DFMO or MGBG, which is polyamine biosynthetic inhibitor, inhibited GH secretion in a dose-dependent fashion, In the cells treated with 20mM or 0.01mM MGBG, total protein synthesis were decreased only to 90 or 76% of the control levels and cell proliferation was also slightly inhibited. However the secretion of GH was severely blocked to 37% or 35% of the control. Hydrocortisone at 5 pM stimulated the secretion of GH to 153% of basal secretion, also doubled intracellular putrescine content. CONCLUSION: The present data show that externally added polyamines induced cell proliferation and GH secretion. Also, extemally added putrescine stimulated GH secretion significantly. GH secretion was inhibited by polyamine metabolic inhibitor in a dose-dependent manner and polyamine metabolic inhibitors, at proper concentrations, specifically blocked GH secretion without any significant influence on the total protein synthesis. The above results imply the involvement of polyamine in GH secretion.
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Comparison of Immunohistochemical and Clinical Characteristics in Pituitary Adenoma with Acromegaly.
Jae Hoon Chung, Eun Mi Koh, Kwang Won Kim, Byoung Joon Kim, Sung Hoon Kim, Kyung Ah Kim, Myung Sik Lee, Moon Gyu Lee, Yong Ki Min, Yeon Rim Seo, Dong Kyu Na, Jong Hyun Kim, Kyu Jeong Ahn, Jin Seok Kim
J Korean Endocr Soc. 1998;13(3):324-330.   Published online January 1, 2001
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BACKGROUND
It assumed that plurihormonal pituitary adenomas in acromegaly, which were immunohistochemically stained with other pituitary hormones in addition to GH and prolactin, would be originated from poorly differentiated cells. Therefore, we speculated that they might have higher growth rates and worse prognosis than monohormonal adenomas. To verify this speculation, we analyzed the frequency of plurihormonal adenomas and compared the clinical parameters and radiological invasiveness between plurihormonal adenoma and GH-prolactin adenoma in acromegaly. METHODS: We studied 38 patients with acromegaly (22 males and 16 females, mean age 40.7 years) who were underwent surgical removal of pituitary adenomas by TSA from January 1995 to February 1998. We performed immunohistochemical staining in these tumors using avidinbiotin peroxidase complex method. An adenoma was considered as immunoreactive when above 50 percents of tumor cells were stained with anti-hormonal antibodies. Invasiveness of tumors were evaluated by preoperative MRI findings on the basis of Hardys classification. RESULTS: The frequencies of plurihormonal and GH-prolactin adenomas were 42% and 58%, respectively. Plurihormonal adenoma included an adenoma which was not stained with prolactin, but with GH and other hormones. Prolactin immunoreactivity was found in 97%(37/38) of the tumors. Immunoreactivities to FSH, ACTH, LH, and TSH were found in 37.8%, 13.1%, 2.6% and 2.7%, respectively. There were no significant differences in age, basal serum GH and IGF-1 concentrations between plurihormonal and GH-prolactin adenomas. There were also no significant differences in response to TRH & LH stimulation tests and somatostatin & bromocriptine suppression tests between two groups. There were no differences in radiological invasiveness between two groups (plurihormonal adenoma, grade I 2, grade II 3, grade III 7, grade IV 4; GH-prolactin adenoma, grade I 3, grade II 6, grade III 9, grade IV 4). CONCLUSION: Plurihormonal adenomas were 44% and immunoreactivity to prolactin was 97% in pituitary adenomas in acromegaly. There were no significant differences in clinical parameters and radiological invasiveness between plurihormonal and GH-prolactin adenomas in acromegaly.
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Comparison of Anterior Pituitary Function between Patients with GH-secreting Macroadenoma and those with Nonfunctioning Macroadenoma.
Kyung Soo Park, Hyung Kyu Park, Jae Seok Jun, Jae Jun Koh, Sung Yeon Kim, Hong Gyu Lee
J Korean Endocr Soc. 1998;13(3):331-338.   Published online January 1, 2001
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BACKGROUND
Some of the deficiencies in anterior pituitary function identified in subjects with macroadenomas appear to represent irrevemible necrosis of normal pituitary cells, and in addition reversible damage to viable glandular tissue and/or incomplete interruption of local circulation by compression of pituitary stalk may also contribute significantly to hypopituitarism. So anterior pituitary function may actually improve in some patients undergoing successful tumor resection or reduction in tumor size. Although direct comparisons of pituitary function among the various pituitary tumors are not presently available it was reported that there is some difference in the degree of pituitary impairment between patients with nonfunctioning macroadenoma(NFMA) and those with GH-secreting macroadenoma(GHMA).In this study, to investigate the difference in the degree of hypopituitarism we compared anterior pituitary function in subjects with NFMA to that in patients with GHMA. METHODS: In this retrospective study, preoperative and postoperative anterior pituitary function was assessed by clinical findings, basal hormone levels and/or combined pituitary stimulation test in 29 subjects with NFMA and in 24 subjects with GHMA. RESULTS: 1. There was no difference in age, sex, tumor size distribution between the two groups. 2. Preoperatively, NFMA patients had a higher prevalence of secondary hypothyroidism(34% vs. 5%; p(0.02) compared to subjects with GHMA. Patients with NFMA also had a higher prevalence of more severe pituitary failure compared with acromegalic patients; 48% of the patients in this group had more than one pituitary hormone axis impaired compared to 17% in the acromegalic group(p0.03). 3. Postoperatively, NFMA patients also had a higher prevalence of secondary hypoadrenalism (52% vs. 11%; p 0.01) compared with acromegalic patients. Additionally, the prevalence who had more than one pituitary hormone axis impaired was still greater in NFMA patients than in the acromegalic group(57% vs. 22%; p=0.054). 4. No correlation was found between the severity of pituitary failure and tumor size or extension in both groups before and after surgery. CONCLUSION: These findings suggest that anterior pituitary function is relatively better preserved in patients with GHMA than those with NFMA and that this difference is independent of tumor size and extension. The mechanism underlying the lower rate of hypopituitarism in acromegalics with macroadenoma remains to be elucidated.
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The Incidence of Postpartum Thyroiditis and Effect of High Iodine Intake on it in Korean Women.
Won Bae Kim, Chang Hoon Yim, Kyung Soo Park, Byoung Sool Moon, Jae Hoon Lee, Hye Won Jun, Ho Jun Jin, Sung Yeon Kim, Bo Yeon Cho, Hong Gyu Lee
J Korean Endocr Soc. 1998;13(3):339-350.   Published online January 1, 2001
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BACKGROUND
Postpartum thyroiditis(PPT) is one of syndromes of thyroid dysfunction that occurs in the first year after parturition. Reported incidence of PPT is 3.9-8.2% of postpartum women in several studies from different countries. The fact that 52-100% of patients with PPT have thyroid autoantibodies, and that lymphocytic infiltration of thyroid gland is the characteristic pathological feature of PPT suggest that PPT is an autoimmune disease. High iodine intake in short term period is known to aggrevate the experimental autoimmune thyroiditis. This study was performed to investigate the incidence and clinical features of PPT in Korean postpartum women who usually ingest excessive amount of idine in immediate postpartum period and to investigate the predictive value of thyroid autoantibodies in the development of PPT in them. METHOD: Between March 1996 and February 1997, 99 women without previous history of any thyroid disease who delivered babies at Boramae hospital were enrolled. Thyroid function parameters(T3, T4, free T4, TSH), thyroid autoantibodies(anti-microsomal antibody, anti-thyroglobulin antibody) and urinary iodine excretion were measured prospectively before and 1, 3 months after delivery. Dietary iodine intake during postpartum period was evaluated by questionnaire, and clinical parameters were followed up. RESULTS: During 3 months of observation, PPT developed in 8.1%(8/99) of postpartum women. Five cases had typical course having thyrotoxic phase and the other 3 cases had hypothyroid phase without toxic phase. However, only one of those required thyroid hormone replacement therapy in the latter group. There were no differences in age, baseline thyroid function parameters, parity, percent cases with family history of thyroid disease between those developed PPT (n=8) and those did not develop PPT(n=91). Duration of high iodine intake(3.8 +- 0.5 wk. vs. 3.7 +- 0.8 wk., p>0.05), total ingested amount of high iodine diet(77 +- 28 vs. 79 +- 24 bowels of miyokguk, p)0.05), and the urinary iodine excretion(1.9 +- 1.4 mg/g creatinine vs. 3.7 +- 3.7mg/g creatinine, p0.05) at 1 month postpartum were not different between two groups. Of 99 total subjects, anti-microsomal antibody(AMA) was present in 13.1%(13/99) before delivery in their sera. Positive predictive value of the presence of AMA before delivery in predicting the development of PPT was 30.8%. CONCLUSION: The fact that incidence of PPT in normal Korean postpartum women who usually have high iodine intake in immediate postpartum period is not higher than those of other countries, and that there was no difference in the amount of iodine intake between those developed PPT and those did not suggest that high iodine intake in immediate postpartum period do not influence on the incidence of PPT. The presence of AMA before delivery had low specificity in prediction of development of PPT, so the measurement of AMA seems not to be a useful screening test.
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A Frequency of Hypothyroidism in a Population of Hypercholesterolemin Subjects.
Jae Hoon Chung, Kwang Won Kim, Byoung Joon Kim, Sung Hoon Kim, Kyung Ah Kim, Myung Sik Lee, Moon Gyu Lee, Yong Ki Min, Yun Ho Choi, Myung Hee Shin
J Korean Endocr Soc. 1998;13(3):351-358.   Published online January 1, 2001
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BACKGROUND
Hypothyroidism is a treatable cause of secondary hyperlipidemia. The lipid profile usually seen is an increased total and low density lipoprotein(LDL) cholesterol, and the plasma triglyceride may also be increased. Hypercholesterolemia associated with hypothyroidism is an important factor in the pathogenesis of coronary artery disease(CAD). And the hyperchole-sterolemia caused by hypothyroidism is potentially reversible by thyroid hormone replacement therapy. Hypothyroidism should be ruled out by routine laboratory screening as a treatable cause of secondary hyperlipidemia and increased CAD risk. We carried out this study aimed at evaluating the frequency of hypothyroidism and its relationship with serum cholesterol concentration in Koreans. METHODS: We investigated 15028(men 8273, women 6755) Korean subjects who visited our hospital center for health promotion during an one year period(from January 1, 1996, to December 31, 1996). Among them, we analyzed 6756 hypercholesterolemic subjects whose serum cholesterol levels were greater than 200 mg/dL. They performed thyroid function tests(total T, T4, and TSH) and lipid profiles(total cholesterol, triglyceride and HDL-cholesterol) were measured by enzyme assay. We defined hypothyroidism by serum thyrotropin values greater than 5 U/mL. RESULTS: The observed prevalence of hypothyroidism was 2.4%(163/6756). Among those with high TSH levels, 17(10.4%) had overt hypothyroidism with a low T4 (below 6 g/dL) level. As we analyzed the frequency of hypothyroidism according to cholesterol range by 20 mg/dL, the frequency was significantly increased in the group whose serum cholesterol levels were greater than 300 mg/dL, especially in women over 50 years of age. Analysis of lipid parameters showed that hypertriglyceridemia was frequent and hyperHDLaemia was observed in hypothyroidic populations. CONCLUSION: Screening for hypothyroidism by measurement of thyrotropin values is of particular importance in patients with hypercholesterolemia. And the frequency of hypothyroidism was more significantly increased in whose serum cholesterol levels were greater than 300 mg/dL, especially in the group of women over 50 years of age.
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The Expression of the Bcl-2 Family Proteins in Thyroid Neoplasms.
Il Min Ahn, Eun Sook Kim, Seok Jun Hong, Kyung Yub Gong, Tae Jin Lee, Jin Yub Kim, Sung Bae Kim, Sang Hee Kim
J Korean Endocr Soc. 1998;13(3):359-365.   Published online January 1, 2001
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BACKGROUND
Proteins of the Bcl-2 family are intracellular membrane-associated proteins that regulate programmed cell death either positively or negatively by as yet unknown mechanism. Bcl-2 family proteins have an antiapoptotic function, such as the Bcl-2, the long form of Bcl-x and Mcl-l, or a proapoptotic function, like the short form of Bcl-x and Bax. To investigate the potential role of Bcl-2 family proteins in thyroid tumorigenesis, the authors examined the pattern of expression of the Bel-2 family proteins in various thyroid neoplasms. METHODS: Bcl-2 family proteins, including Bcl-2, Bcl-x, Mcl-1 and Bax proteins were immunohistochemically stained in 57 cases of various thyroid neoplasms using formalin-fixed and paraffin embedded tissues; 18 cases of papillary carcinoma, 6 cases of medullary carcinoma, 4 cases of anaplastic carcinoma, 10 cases of follicular adenoma, 9 cases of adenomatous goiter, and 10 autopsy cases of fetal thyroid galnd. The intensity and frequency of the immunostaining were evaluated with the program of Image-Pro Plus Version 3.0 for image analysis. RESULT: Consistent expression of Bcl-2, Mcl-1, and Bax proteins were present in the surrounding normal thyroid tissue, however the expression of Bcl-x protein was not observed. Compare to the expression patterns of adenomatous goiter, and fetal and surrounding normal thyroid tissues, papillary and anaplastic carcinomas showed the decreased Bcl-2 and increased Bcl-x protein expressions(p (0.05). Medullary carcinoma revealed the increased Bcl-x protein expression only(p 0.05). CONCLUSION: These data suggest that combined patterns of decreased Bcl-2 and increased Bcl-x protein expressions may eontribute to the carcinogenesis of thyroid cancers originated from thyroid follicular cells, and an increased expression of Bcl-x protein may be related to the pathogenesis of medullary carcinoma from parafollicular C cells.
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Prevalence Thyroid Cancer in Patients with Cold Thyroid Nodules in Relation to Sex, Age, And Multinodularity.
Won Bae Kim, Hyun Kyung Chung, Chang Hoon Yim, Do Joon Park, Sung Yeon Kim, Bo Yeon Cho, Hong Gyu Lee
J Korean Endocr Soc. 1998;13(3):366-372.   Published online January 1, 2001
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BACKGROUND
We evaluated the prevalence of thyroid cancer in patients with cold thyroid nodules and the impact of sex, age, hardness of nodule, and multinodularity as factors able to predict the probability of malignancy in patients with nodular thyroid diseases. METHODS: We examined a 728 patients who visited Seoul National University Hospital with one or more cold thyroid nodules between Jan. 1996 and Dec. 1997. After clinical evaluations including medical history, physical examinations(size, hardness and multiplicity of nodule), fine needle aspiration biopsies and cytologic examinations were carried out. RESULTS: Among the 728 cases, 76 cases(10.4%) were diagnosed as cancer and 602 cases (82.6%) were diagnosed as benign nodule. The prevalence of cancer was significantly lower in female patients with cold nodules(9.4%, 62/662) than in males(17.5%, 11/63)(p=0.041). Age was an important factor in both sexes. The proportion of nodules that were malignant was lower in patients of 20-60 years old(8,9%, 56/632) than patients younger than 20 years old(1S.1%, 2/11) or older than 60 years old(18.3%, 15/82)(p=0.019). The prevalence of cancer was significantly higher in hard nodules(36.3%, 41/113) than firm(5.2%, 30/574) or soft nodules(5.3%, 2/38)(p= 0.001). There was no size difference between malignant(25.2 +- 13.7mm) and benign nodules(25.3 +- 8.9mm)(p=0.9425). The prevalence of thyroid cancer in solitary nodule(10.6%, 63/593) was not different from that in multiple nodules(7.6%, 10/132)(p=0.293). CONCLUSION: Our data suggest that thyroid nodules of the patients who are younger than 20 years old or older than 60 years old, male, as well as hard nodule require more careful evaluation for the risk of thyroid malignancies.
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Percutaneous Ethanol Injection in Benigh Thyroid Nodules.
Hong Kyu Kim, Il Min Ahn, Eun Joo Lee, Jin Yub Kim, Mi Heon Lee, Sung Jin Lee, Ho Kyu Lee
J Korean Endocr Soc. 1998;13(3):373-383.   Published online January 1, 2001
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BACKGROUND
Percutaneous ethanol injection(PEI) performed in guidance of ultrasonography has been used in cases of thyroid cyst and autonomous functiong thyroid nodule(AFTN). We performed this study to determine the feasibility of PEI on the various type of benign cold nodules(solid, pure cyst, complex cyst) and AFTN. METHOD: Ninety patients(age 41+12 years; 83 women and 7 men) with hot and cold nodule were included in this study. All cases were subjected to FNAB, and sono-guided in cases of complex cyst, at least twice with results of colloid nodule. T4 suppression treatment was done for cold solid nodules for at least 6 months and cases which had partial response(50% or more volume reduction but no further volume decrease on T4 suppression) were included in this study. After PEI, we classified AFTN into three different response groups; complete response (normali- zation of TFT and thyroid scan finding), partial response(normalized freeT4 but suppressed TSH or persistently suppressed scan), or failure group. Each subtypes(solid, pure cyst, complex cyst) of cold nodules were also classified into three groups in accordance with volume reduction; complete response(above 90% of volume reduction), partial response(50-90%), and failure(below 50% or increase in size) group. RESULTS: Overall responses rate of PEI for benign thyroid nodule were complete; 70(78%), partial; 18(20%), and failure; 2(2%). In 27 cold solid nodules, complete response was observed in 23(85%) and partial response in 4(15%). In 11 pure cysts, complete response was observed in 7(64%), partial response in 3(27%), and 1 case(9%) of failure was lost after 1 trial of PEI. In 45 cases of complex cyst, complete response was observed in 36(80%), partial response in 8 (18%), and 1 case(2%) of failure was subjected to operation with pathology report of Hiirthle cell adenoma. In 7 cases of AFTN, complete response was observed in 4(57%) and partial response in 3(43%). We observed complications during PEI therapy such as transient neck pain(n=10), transient unilateral vocal cord palsy(n=l), and intracavitary hemorrhage(n=2), transient hypotension during ethanol injection(n 1). CONCLUSION: Our data suggest that efficacy of PEI(57%) in AFTN is inferior to conventional therapies like surgery and radioiodine, but still can be an alternative therapeutic modality in selected cases. In cold nodules, especially of solid type and complex cyst, PEI may have feasibility as a therapeutic modality in restricted cases. Further studies of prolonged follow-up for the possibility of neglecting occult malignancy are warranted.
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Comparison of Double Phase 99mTc-sestamibi Scintigraphy with Evaluation of Hyperparathyroidism.
Jin Chul Park, Jung Hyun Oh, Sang Yub Nam, Ji Sung Yoon, Kyu Jang Won, In Ho Cho, Hyung Woo Lee, Jae Tae Lee
J Korean Endocr Soc. 1998;13(3):384-393.   Published online January 1, 2001
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"BACKGROUND: Between 80 to 85% of patients with hyperparathyroidsm have a solitary adenoma of the parathyroid glands and another 15% have a parathyroid hyperplasia. Preoperative localization of the parathyoid glands is generally accepted as warranted in patients who have failed an initial attempt at parathyroidectomy, ectopic locations and inexperienced surgeons. Different imaging techniques have been used for detection of abnormal parathyroid glands such as high resolution ultrasonography, computerized tomography, arteriography, venous sampling or magnetic resonance imaging and 201Tl/99mTc subtraction scintigraphy. But these methods have had varying rates of success, with low specificity and low sensitivity. Among the several different techniques available for parathyroid radionuclide imaging, the most common is the use of a dualradioisotope procedure combining of Tl with Tc. However, there are some controversies regarding the optimal technical aspects of this procedure, including the relative amount of injected dose of radiotracers, failed detection for small sized and deeper cervical located parathyroids, and not easy procedures. Recently, double phase Tc-sestamibi scintigraphy would be useful to solve these technical limitations, more convenient and have higher sensitivities. The purpose of this study was to compare the diagnostic accuracy of 99mTc-sestamibi with 201Tl/ 99mTc subtraction scintigraphy in the localization of hyperparathyroidism. METHODS: 9 patients with hyperparathyroidism underwent preoperative evaluation with double phase 99mTc-sestamibi scintigraphy and 201Tl/99mTc subtraction scintigraphy for attempted localization of abnormal parathyroid glands and surgical explorations. Imaging results were compared to surgical findings. RESULTS: Of 9 patients, 7 had a solitary parathyroid adenoma, 1 had a carcinoma and 1 had parathyroid hyperplasia. The 201Tl/99mTc subtraction scintigraphy preoperatively localized 8 of 9 patients(sensitivity: S9%) and 99mTc-sestamibi scintigraphy correctly localized all lesions for a sensitivity of 100%. In one case, 201Tl/99mTc subtraction scan show only a hot uptake at left upper parathyroid area, but 99mTc-sestamibi scan was shown the three site of hot uptake at left upper, both inferior parathyroid area. CONCLUSION: In patients with hyperparathyoridism, 99mTc-sestamibi scintigraphy may be used as the single imaging technique as it show a very high sensitivity and specificity in the preoperative localization of pathological parathyroid glands.
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Vitamin D Receptor Gene Polymorphisms and Bone Mineral Density in Korean Women.
Jae Hong Park, Dong Jin Chung, Jung MIn Kim, Ji Yeon Kim, Myung Soo Kim, Seung Won Yang, Min Young Chung, Tae Hee Lee, Jong Tae Park, Min Young Lee, Jae Hyuk Lee, Chan Choi
J Korean Endocr Soc. 1998;13(3):394-409.   Published online January 1, 2001
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BACKGROUND
Bone mineral density(BMD) is thought to be under genetic control. Polymorphisms at the vitamin D receptor(VDR) gene have recently been shown to contribute to the genetic variability in bone mineral density in Caucasians. However, the relationship between VDR-RFLP(restriction fragment length polymorphisms) and bone mineral density is controversial. METHODS: The VDR-RFLP by BsmI, ApaI, and TaqI were studied in 250(77 premenopausal, 173 postmenopausal) Korean women. Bone mineral densities at the lumbar spine(L2-L4), femoral neck, greater trochanter, and Wards triangle were measured by DEXA(Dual Energy X-ray Absorptiometry; Lunar DPX-L, U.S.A.). RESULTS: There were significant differences in VDR gene allele frequency when compared with those in Caucasians. The BsmI polymorphism was consisted of 0.8% BB homozygotes, 12.4% Bb heterozygotes, and 86.8% bb homozygotes. The ApaI polymorphism was 6.8% AA homozygotes, 42.0% Aa heterozygotes, and 51.2% aa homozygotes, and the TaqI polymorphism was 83.2% TT homozygotes, 16.8% Tt heterozygotes, and 0% tt homozygotes. When these three VDR-RFLP were combined, bbaaTT(51.2%), bbAaTT(29.6%), and BbAaTt(10.0%) were found to be most frequent types. There were no significant relationship between VDR-RFLP and BMD measured at the 2nd to 4th lumbar spine in all subjects. But there were significant relationship between VDR-RFLP and BMD at the proxmial femur in all subjects. Compared with bb or bbaaTT(or bbAaTT), women with the Bb or BbAaTt genotypes had significantly lower bone mineral densities at the proximal femur in all subjects. When we restricted the analysis to early postmenopausal women less than 10 years since menopause, these findings were more pronounced. CONCLUSION: These results suggest that VDR-RFLP may affect on BMD at the proximal femur in Korean women. However, the frequencies of B, A, and t alleles are very low in Korean women compared to those of Caucasians, further studies will be needed, with larger sample sizes.
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Clinical Characteristics in Korean Patients with Insulin Receptor Antibody Positive Acanthosis Nigricans.
Hong Seung Kim, Choon Hee Chung, Young Goo Shin, Mi Duk Lee, Young Joon Won
J Korean Endocr Soc. 1998;13(3):410-416.   Published online January 1, 2001
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BACKGROUND
Insulin resistance syndrome shows extreme insulin resistance and is associated with acanthosis nigricans. We can differentiate it into type A insulin resistance that has insulin receptor defect, and type B insulin resistance due to insulin receptor autoantibody. Type B insulin resistance was firstly described by Kahn in 1976. It was often found in adult female and showed autoimmune characteristics. As clinical characteristics, there are hyperglycemia, hypoglycemia, hyperinsulinemia, extreme insulin resistance and acanthosis nigricans. METHODS: We investigated 17 insulin receptor autoantibody positive cases and 8 cases of normal control who had visited Wonju Christian Hospital from October 1994 to December 1995. Among insulin receptor autoantibody positive subject, male was 4 cases and female 13 cases. Their mean age was 42.2. We compared patients who had insulin receptor antibody positive acanthosis nigricans(IRA) with normal controls. IRA patients were 6 cases(35.3%) of nomal glucose tolerance, 11 cases(64.7%) of abnormal glucose tolerance including overt diabetes mellitus. RESULTS: The 11 cases(64.7%) among IRA patrents were obese and 13 cases(76.5%) had hyperininsulinemia. In IRA patients, mean serum insulin concentration during oral glucose tolerance test was 202.1mU/mL and it was greater than 46.3 of normal controls. Insulin sensitivity in 1.79mg/L * mM * xmU * min normal controls was higher than 0.74mg/L * mM * min of IRA patients. CONCLUSION: IRA patients showed abnormal glucose tolerance including overt diabetes millitus, severe insulin resistance, hyperinsulinemia and obesity.
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Case Reports
A Case of Cushing's Disease due to Large Pituitary Adenoma Treated by Surgery in Combination with Radiotherapy.
Jae Hoon Chung, Kwang Won Kim, Myung Sik Lee, Moon Gyu Lee, Yong Ki Min, Jong Hyun Kim, Eun Young Oh, Yun Jae Chung, Jung Ho Park
J Korean Endocr Soc. 1998;13(3):417-422.   Published online January 1, 2001
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Large pituitary adenomas causing Cushings disease are uncommon, and usually present with mild manifestations of Cushings syndrome. Large adenomas may have rapid growth and quickly reach a size large enough to become clinically apparent. These tumors are more frequently invasive than microadenomas, their widespread extensions make radical surgical removal difficult and the ultimate clinical course malignant. We report a case of 37 year-old women presenting amenorrhea, weight gain, and moon face. Sellar magnetic resonance imaging(MRI) demonstrated a large lobulating tumor measuring 3.5cm in diameter, arising from sella turcica, extending up to suprasellar area and invading the cavernous sinuses. Transfrontal adenectomy was performed to remove a mass, but residual mass was remained after surgery. Subsequent external brain radiotherapy(total dose 5400cGy) was performed. Histology revealed an adrenocorticotrophin(ACTH) secreting pituitary adenoma. After treatment, her menstration was started, body weight was reduced, and moon face was disappeared.
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A Case of Acromegaly Caused by Mixed Gangliocytoma-Adenoma of the Pituitary Gland.
Jae Hoon Chung, Kwang Won Kim, Byoung Joon Kim, Sung Hoon Kim, Myung Sik Lee, Moon Gyu Lee, Yong Ki Min, Yeon Rim Seo, Jong Hyun Kim, Sang Jong Park
J Korean Endocr Soc. 1998;13(3):423-431.   Published online January 1, 2001
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The tumors containing ganglion cells are rare in the pituitary gland. These tumors are divided into two groups. The first group is the cases of mixed gangliocytoma-adenoma that contained both gangliocytoma and pituitary adenoma elements in the same tumor and the second group is those of gangliocytoma that contained only gangliocytoma element. Since the first description by Kiyono in 1926, 45 cases have been reported. The most common presentation of these tumors is acromegaly and the cases of Cushings disease and galactorrhea-amenorrhea also have been reported. In immunohistochemical study, hypothalamic-releasing hormones are stained in gangliocytoma cells and adenohypophyseal hormones are stained in adenoma cells. The releasing hormones stained in gangliocytoma element and the pituitary hormones stained in adenoma elements are usually closely related but unrelated cases also have been reported. We report a case of a 41 year-old lady with acromegaly which was diagnosed as mixed gangliocytoma-adenoma after surgical removal of the pituitary tumor.
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Endocrinol Metab : Endocrinology and Metabolism