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Volume 19(1); February 2004
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Review Articles
PET Application in Thyroid Cancer.
June Key Chung
J Korean Endocr Soc. 2004;19(1):1-9.   Published online February 1, 2004
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No abstract available.
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Advance in Estrogen Signaling through Estrogen Receptor.
Jung Yoon Cho, Young Joo Lee
J Korean Endocr Soc. 2004;19(1):10-18.   Published online February 1, 2004
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  • 16 Download
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No abstract available.
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Editorial
Low Dose and High Dose ACTH Test in Adrenal Insufficiency.
Yong Seong Kim
J Korean Endocr Soc. 2004;19(1):19-23.   Published online February 1, 2004
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No abstract available.
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Original Articles
Response to the Combined Pituitary Stimulation Test by CRH, GHRH, GnRH and TRH in Normal Human According to Age and Gender.
Sanghoon Lee, Sung Woon Kim, Gwanpyo Ko, Seungjoon Oh, Jeong taek Woo, Inmyung Yang, Jin Woo Kim, Young Seol Kim
J Korean Endocr Soc. 2004;19(1):24-32.   Published online February 1, 2004
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BACKGROUND
It has been already known that each trophic hormone in combined pituitary responsiveness according to gender and age brings about variable response, but in Korea, there has been no actual data. In this study, in order to assess the pituitary responsiveness, a combined pituitary stimulation test was performed in Korean subjects with the variation in CRH, GHRH, GnRH, and TRH according to their age and gender. Were these the variables that were changed according to age and gender? Clarify that. Also, it might be good to write out the abbreviations.) METHOD: Fourteen physically and mentally healthy male subjects and fourteen female subjects, also physically and mentally healthy, underwent the combined anterior pituitary stimulation test by CRH, GHRH, LHRH, and TRH. Each gender group was divided further into young(meanSE; male: 231, female: 221) and old (mean; male: 513, female: 522) groups. RESULTS: There were significant differences between the gender and age groups. The Peak GH level and maximal GH increment were significantly increased in young men compared to old men. The Peak ACTH level and maximal ACTH increment were significantly increased in old men as opposed to young men. The Peak PRL level, maximal PRL increment, Peak TSH level, and maximal TSH increment were significantly increased in old women compared to old men. The Peak FSH level was significantly increased in the two old groups compared to the young groups, which showedindependence in gender, and the maximal FSH increment was significantly increased in old men when compared with the young men. CONCLUSION: These results show that in order to for accurate interpretation of the response from the combined pituitary stimulation test, it is necessary to consider age and gender of the subjects. We suggest response values of the combined pituitary stimulation test in terms of age and gender in healthy Korean subjects.
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Diagnostic Value of 1microgram Rapid ACTH Stimulation Test According to the Timing of Sampling of Serum Cortisol in Patients with Suspected Central Adrenal Insufficiency.
Sang Wan Kim, Young Min Cho, Do Joon Park, Chan Soo Shin, Kyung Soo Park, Seong Yeon Kim, Bo Youn Cho, Hong Kyu Lee
J Korean Endocr Soc. 2004;19(1):33-41.   Published online February 1, 2004
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BACKGROUND
Traditional testing of the hypothalamic-pituitary-adrenal axis function has essentially relied upon the insulin tolerance test or the metyrapone test(both tests are not only uncomfortable, but are also dangerous). The standard ACTH stimulation test uses an extremely supra-physiologic amount(250f microgram) of ACTH to evaluate a physiological response, which may result in a false normal response. The 1microgram rapid ACTH stimulation test is more physiological and more sensitive than the standard test, but there exist much controversy about when the serum cortisol should be measured or what the most appropriate cut-off point is for normality or whether the 1microgram ACTH commercial solution is needed. The aims of this study were to investigate 1) whether 1microgram of ACTH is an appropriate amount to stimulate the adrenal gland of patients that have suspected central adrenal insufficiency compared with insulin tolerance test(ITT) and 2) the diagnostic value of the 1microgram rapid ACTH stimulation test according to timing of sampling of serum cortisol. METHODS: In order to evaluate the dose-response relationship between ACTH and cortisol, we performed the ITT in 77 patients with suspected central adrenal insufficiency with serial measurements of serum cortisol and plasma ACTH. We drew the blood samples in 10 min intervals between 10 and 60 min after the administration of 1microgram ACTH in 39 patients with central adrenal insufficiency and in 38 pituitary control patients with pituitary. ITT was used to confirm the diseases for the patients of central adrenal insufficiency, but for pituitary control patients, the ITT indicated normality in the patients. Also, all subjects underwent the 250microgram rapid ACTH stimulation test, and we compared the diagnostic value of the 1microgram ACTH stimulation test with the 250microgram test. RESULTS: 1) The plasma ACTH level after the 1microgram ACTH stimulation test, even if it was be assumed as approximately 300pg/mL, was expected to be sufficient enough to stimulate the adrenal cortex normally(serum cortisol levels >18microgram/dL) compared to the plasma ACTH level in the ITT. 2) The sensitivity and specificity of the 1microgram rapid ACTH stimulation test was highest with 92.3% and 84.2%, respectively, when serum cortisol levels were measured at 20, 30, and 40 min after the ACTH injection. The 1microgram rapid ACTH stimulation test was more sensitive than the 250microgram ACTH test(sensitivity: 92.3%, specificity: 71.8%). CONCLUSION: The 1microgram rapid ACTH stimulation test was more sensitive test in patients with suspected central adrenal insufficiency, and blood samples for cortisol levels should be drawn at 20, 30, and 40 min after ACTH administration.
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Influence of Anti-thyroglobulin Antibody on the Measurement of Thyroglobulin using the Immunoradiometric Assay.
Byeong Cheol Ahn, Jin Ho Bae, Shin Young Jeong, Ho Yong Park, Jung Guk Kim, Sung Woo Ha, Jaetae Lee, Bo Wan Kim, Kyu Bo Lee
J Korean Endocr Soc. 2004;19(1):42-47.   Published online February 1, 2004
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  • 24 Download
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BACKGROUND
Serum thyroglobulin(Tg) is a valuable and sensitive tool needed in the follow-up of patients with differentiated thyroid cancer(DTC), but antithyroglobulin antibody(Anti-Tg), common in patients with DTC, can interfere with the assay for Tg. In this study, we evaluated the influence of Anti-Tg on the measurement of Tg using the immunoradiometric assay(IRMA). METHODS: In using ELSA-hTg in vivo test(CIS international, Schering, France), a solid phase two-site IRMA was used to measure Tg(23.5ng/mL, 62.5ng/mL) under the absence or presence of three concentrations of Anti-Tg(25U/mL, 50U/mL, 100U/mL). We also performed Tg measurement using patients serum that was mixed with patients serum containing high Anti-Tg. ANOVA and Scheffe tests were performed to evaluate the effect of Anti-Tg on Tg IRMA, and an inverse regression was made to calculate the level of Tg from measured Tg and used Anti-Tg levels and also to assess the degree of effect of anti-Tg on Tg IRMA. RESULTS: In measuring Tg using the standard solution, the presence of Anti-Tg resulted in a falsely suppressed Tg value. The IRMAs for 23.5ng/mL of the standard Tg solution resulted in 24.5+/-.1 ng/mL under no Anti-Tg, 11.8+/-.4ng/mL under 25U/mL of Anti-Tg, 7.7+/-.1ng/mL under 50U/mL of Anti-Tg, and 4.5+/-.4ng/mL under 100U/mL of Anti-Tg. IRMAs 62.5ng/mL of the standard Tg solution resulted in 65.9+/-.7ng/mL under no Anti-Tg, 36.3+/-.2ng/mL under 25U/mL of Anti-Tg, 23.7+/-.7ng/mL under 50U/mL of Anti-Tg, and 14.0+/-.0ng/mL under 100U/mL of Anti-Tg. (ANOVA test, p=0.000). The degree of suppression of the measured Tg value was positively correlated with the Anti-Tg level (Quadratic model regression, Sig T=0.000). The presence of Anti-Tg also resulted in a falsely suppressed Tg value for the Tg measurement using patient's serum. CONCLUSION: The presence of Anti-Tg could consist of the use of Tg as a tumor, therefore Anti-Tg should be measured in all patients diagnosed with DTC. The interpretation of the Tg level must be performed with extreme caution in patients with Anti-Tg.
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Sex Hormone-Binding Globulin and Oxidative Stress in Korean Premenopausal Women.
Young Ju Choi, Jee Young Oh, Young Sun Hong, Yeon Ah Sung
J Korean Endocr Soc. 2004;19(1):48-57.   Published online February 1, 2004
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BACKGROUND
Low levels of sex hormone-binding globulin(SHBG), an indirect index of androgenicity, are associated with insulin resistance and cardiovascular risk factors. The risk factors of the cardiovascular disease are known to be related to oxidative stress. In recent reports, sex hormones were associated with oxidative stress in women with polycystic ovarian syndrome(PCOS), which is characterized by increased androgenicity and insulin resistance. METHODS: To investigate the relationship between sex hormones and oxidative stress, we examined the association of malondialdehyde(MDA), total antioxidant status(TAS), oxidized low density lipoprotein cholesterol(ox-LDL), and SHBG in 46 Korean premenopausal women. RESULTS: 1. SHBG and MDA levels were not significantly different among the women with NGT and IGT. But, TAS was significantly lower(p=0.034) in the subjects with IGT than in the subjects with NGT. 2. The SHBG level was significantly lower(p=0.036) in obese women than in non-obese women. 3.The SHBG level was significantly inversely correlated with BMI(r=-0.394, p=0.007), post challenge glucose(r=-0.326, p=0.027), waist size(r=-0.323, p=0.029), waist-to-thigh ratio(WTR) (r=-0.308, p=0.037), fasting insulin level(r=-0.387, p=0.008), visceral fat area(VFA)(r=-0.339, p=0.021), and was significantly positively correlated with SI(r=0.397, p=0.008). 4. The SHBG level was significantly inversely correlated with levels of MDA(r=-0.357, p=0.015) and ox-LDL(r=-0.367, p=0.014). 5. In a multiple linear regression analysis, the SHBG level was a significant and independent factor for both MDA and ox-LDL. For TAS, the fasting insulin level and post challenge glucose were significant and independent factors. CONCLUSION: Increased androgenicity assessed by the decrease in serum SHBG levels is associated with the increase in MDA and ox-LDL. These results suggest that increased androgenicity in premenopausal women can contribute to the development of cardiovascular diseases via increased oxidative stress.
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Case Reports
A Case of Congenital Adrenal Hyperplasia due to 11beta-Hydroxylase Deficiency.
Ohk Hyun Ryu, Hye Jin Yoo, Soo Yeon Park, Soon Beom Kwon, Sang Soo Park, Hee Young Kim, Kye Won Lee, Ji A Seo, Jeong Heon Oh, Sin Gon Kim, Nan Hee Kim, Kyung Mook Choi, Sei Hyun Baik, Dong Seop Choi
J Korean Endocr Soc. 2004;19(1):58-63.   Published online February 1, 2004
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Congenital adrenal hyperplasia refers to a group of autosomal recessive disorders that is defective in the synthesis of cortisol. The enzymes most often affected are 21-hydroxylase and 11beta hydroxylase. The low levels of cortisol stimulate the pituitary gland to release ACTH. Chronic elevation of the ACTH level causes bilateral adrenal hyperplasia and a secondary increase in androgen formation. We examined a 19 year-old woman presented with clitoral hypertrophy and vaginal spotting. The subjects basal level of serum cortisol was low, but the serum levels of ACTH, 17a-hydroxyprogesterone, deoxy-corticosterone were elevated. The urinary excretions of 17-ketosteroids and 17-hydroxycorticosteroids were also increased. The karyotyping study and transrectal ultrasonography showed normal findings. The patient underwent clitoris reduction surgery and received hydrocortisone. To the best of our knowledge, this is the first case of 11beta-Hydroxylase deficiency in Korea.
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A Case of Hypercalcemia Associated with Hepatic Tuberculosis.
So Young Park, Eun Seok Kang, So Hun Kim, Mi Young Do, Kyu Yeon Hur, Bong Soo Cha, Sung Kil Lim, Hyun Chul Lee, Sang Hoon Ahn, Young Myoung Moon, Young Nyun Park
J Korean Endocr Soc. 2004;19(1):64-68.   Published online February 1, 2004
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  • 19 Download
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In this report, a 70-year-old female patient was detected with laboratory findings of hypercalcemia. The most common causes of hypercalcemia are primary hyperparathyroidism and malignant disease. Her laboratory tests did not show any evidence for neither primary hyperparathyroidism nor malignant diseases. Thus, granulomatous disease was suspected as the cause of the hypercalcemia. Liver MRI (magnetic resonance image) was performed on the subject, which suggested the presence of hepatic tuberculosis and sarcoidosis. Because the chest x-ray did not show a definite tuberculous lesion, we performed a laparoscopic liver biopsy for a final diagnosis. Findings from the biopsy specimen showed typical tuberculosis. After treatment with tuberculosis medication, hypercalcemia of the subject was resolved. Hypercalcemia is a well recognized as a possible complication of active pulmonary tuberculosis. But one should consider hepatic tuberculosis without pulmonary tuberculosis as a cause of hypercalcemia.
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A Case of Acute Suppurative Thyroiditis Caused by Pyriform Sinus Fistula with Thyrotoxicosis.
Kyung Won Kim, Young Joo Park, Tae Yong Kim, Min Kyung Moon, Sae Won Han, Cheon Jung Eun, Young A Kim, Tae Hoon Jin, Hee Soon Chung, Do Joon Park, Bo Youn Cho
J Korean Endocr Soc. 2004;19(1):69-75.   Published online February 1, 2004
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This is the first case report about acute suppurative thyroiditis with thyrotoxicosis and pyriform sinus in Korea. A female patient, who was previously healthy, visited our hospital for the treatment of common cold symptoms and neck pain which developed 2 weeks before the visit. The condition of the patient did not improve through the use of antipyretics and even worsened. The patient was admitted to the hospital and was diagnosed with acute suppurative thyroiditis. The culture result of the drained fluid revealed group D Streptococcus. The patients condition was improved after using antibiotics and drainage. After recovery from acute thyroiditis, esophagography was performed and the pyriform sinus was found to be obliterated by chemical cauterization. It is very important yet difficult to differentiate acute thyroiditis with thyrotoxicosis from subacute thyroiditis. In this study, we discussed the differential diagnosis between acute thyroiditis and subacute thyroiditis with a review of literature.
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A Case of Ectopic ACTH Syndrome Associated with Bronchial Carcinoid.
Young Jin Choi, Sang hyen Joo, Sun Hye Shin, Ok Nyu Kong, Jun Hyeop An, Young Dae Kim, Seok Man Son, In Joo Kim, Yong Ki Kim
J Korean Endocr Soc. 2004;19(1):76-81.   Published online February 1, 2004
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Fifteen percent of patients with Cushing's syndrome could be accompanied with nonpituitary tumors that secrets ACTH-the ectopic ACTH syndrome. Among them, bronchial carcinoid is one of the rare causes of the ectopic ACTH syndrome. We experienced a 60-year-old woman who showed conditions of weight gain, generalized edema, hypokalemia, diabetes mellitus, and right middle lung mass. Histologically, the tumor was diagnosed with bronchial carcinoid and was confirmed as an ectopic ACTH syndrome through immunohistochemical staining of ACTH. After resection of the lung mass, blood sugar, electrolytes, generalized weakness, and blood pressure improved.
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A Case of Adrenocortical Oncocytoma.
Seong Jin Lee, Ho Gwon Lee, Cheol young Park, In Kyung Jeong, Eun Gyung Hong, Gi Weon Oh, Hyeon Kyu Kim, Doo Man Kim, Jae Myung Yoo, Sung Hee Ihm, Moon Gi Choi, Hyung Joon Yoo, Sung Woo Park
J Korean Endocr Soc. 2004;19(1):82-89.   Published online February 1, 2004
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Oncocytomas are neoplasms, histologically are composed of epithelial cells, with abundant, acidophilic and granular cytoplasm. Electron microscopic studies of oncocytomas have shown that the cytoplasm of oncocytes is packed with mitochondria. The adrenal gland is a very rare anatomical site for oncocytomas, and to the best of our knowledge, only thirty-six cases of adrenal oncocytomas have been described. Herein, a case of a large adrenal mass in a forty-year-old man, which was incidentally detected by abdominal ultrasonography, is presented. This patient demonstrated no clinical manifestation associated with adrenal hyperfunction. Hormonal studies showed no abnormal findings, except for a mild elevation of the 24-hour urinary VMA level. Abdominal computed tomography with enhancement revealed a large, well-defined left adrenal mass, measuring 5.0x.2 x.0cm. The patient underwent a left adrenalectomy, and a light microscopic examination confirmed an adrenocortical oncocytoma, with characteristic oncocytes and polygonal, abundant, eosinophilic and granular cytoplasm. The tumor cells were positive for cytokeratin and vimentin as well as S-100, but negative for chromogranin on immunohistochemical staining. An electron microscopic examination demonstrated closely packed mitochondria, containing intramitochondrial inclusions. After surgery, there was no evidence of a recurrent or distant metastatic disease at the 5 month follow-up. In summary, an extremely rare case of a man with an adrenocortical oncocytoma is reported, which was confirmed by histological examinations, including electron microscopy.
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Endocrinol Metab : Endocrinology and Metabolism