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Volume 28(1); March 2013
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Preface
2013 Preface: On the Occasion of Publishing the Endocrinology and Metabolism in English
Kyungjin Kim, Moo-Il Kang
Endocrinol Metab. 2013;28(1):1-2.   Published online March 25, 2013
DOI: https://doi.org/10.3803/EnM.2013.28.1.1
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  • 28 Download
  • 1 Crossref
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  • Contribution of subcutaneous abdominal fat on ultrasonography to carotid atherosclerosis in patients with type 2 diabetes mellitus
    Chan-Hee Jung, Bo-Yeon Kim, Kyu-Jin Kim, Sang-Hee Jung, Chul-Hee Kim, Sung-Koo Kang, Ji-Oh Mok
    Cardiovascular Diabetology.2014;[Epub]     CrossRef
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Review Articles
Adrenal gland
Role of Reactive Oxygen Species in Hypothalamic Regulation of Energy Metabolism
Sabrina Diano
Endocrinol Metab. 2013;28(1):3-5.   Published online March 25, 2013
DOI: https://doi.org/10.3803/EnM.2013.28.1.3
  • 3,739 View
  • 42 Download
  • 20 Crossref
AbstractAbstract PDFPubReader   

To understand the etiology of metabolic disorders, including obesity and type II diabetes, it is essential to gain better insight into how stored and available energy sources are monitored by the central nervous system. In particular, a comprehension of the fine cellular interplay and intracellular mechanisms that enable appropriate hypothalamic and consequent endocrine and behavioral responses to both circulating hormonal and nutrient signals remains elusive. Recent data, including those from our laboratories, raised the notion that reactive oxygen species (ROS) generation is not merely a by-product of substrate oxidation, but it plays a crucial role in modulating cellular responses involved in the regulation of energy metabolism. These review summarizes the published recent data on the effect of ROS levels in the regulation of neuronal function, including that of hypothalamic melanocortin neurons, pro-opiomelanocortin and neuropeptide Y-/agouti related peptide-neurons, in the modulation of food intake.

Citations

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  • The melanocortin pathway and control of appetite-progress and therapeutic implications
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    Geir Bjørklund, Salvatore Chirumbolo
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  • DRP1 Suppresses Leptin and Glucose Sensing of POMC Neurons
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  • Trimetazidine attenuates pressure overload-induced early cardiac energy dysfunction via regulation of neuropeptide Y system in a rat model of abdominal aortic constriction
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    BMC Cardiovascular Disorders.2016;[Epub]     CrossRef
  • Corosolic acid ameliorates acute inflammation through inhibition of IRAK-1 phosphorylation in macrophages
    Seung-Jae Kim, Ji-Young Cha, Hye Suk Kang, Jae-Ho Lee, Ji Yoon Lee, Jae-Hyung Park, Jae-Hoon Bae, Dae-Kyu Song, Seung-Soon Im
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    Murli Mishra, Hong Jiang, Lisha Wu, Hedy A. Chawsheen, Qiou Wei
    Cancer Letters.2015; 366(2): 150.     CrossRef
  • Effects of methanolic extracts of edible plants on RAGE in high-glucose-induced human endothelial cells
    Mizue Okada, Yoshinori Okada
    Bio-Medical Materials and Engineering.2015; 25(3): 257.     CrossRef
  • Reactive oxygen species are physiological mediators of the noradrenergic signaling pathway in the mouse supraoptic nucleus
    Ronald St-Louis, Caroline Parmentier, Valérie Grange-Messent, Sakina Mhaouty-Kodja, Hélène Hardin-Pouzet
    Free Radical Biology and Medicine.2014; 71: 231.     CrossRef
  • Reactive oxygen species play a role in muscle wasting during thyrotoxicosis
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    Cell and Tissue Research.2014; 357(3): 803.     CrossRef
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    Won-Young Lee
    Endocrinology and Metabolism.2014; 29(3): 251.     CrossRef
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Obesity and Metabolism
Role of Autophagy in the Control of Body Metabolism
Wenying Quan, Myung-Shik Lee
Endocrinol Metab. 2013;28(1):6-11.   Published online March 25, 2013
DOI: https://doi.org/10.3803/EnM.2013.28.1.6
  • 3,703 View
  • 51 Download
  • 26 Crossref
AbstractAbstract PDFPubReader   

Autophagy plays a crucial role in the maintenance of cellular nutrient balance and the function of organelles such as mitochondria or the endoplasmic reticulum, which are important in intracellular metabolism, insulin release, and insulin sensitivity. In the insulin-producing pancreatic β-cells, autophagy is important in the maintenance of β-cell mass, structure, and function. Mice with deficiencies in β-cell-specific autophagy show reduced β-cell mass and defects in insulin secretion that lead to hypoinsulinemia and hyperglycemia but not diabetes. However, these mice developed diabetes when bred with ob/ob mice, suggesting that autophagy-deficient β-cells have defects in dealing with the increased metabolic stress imposed by obesity. These results also imply that autophagy deficiency in β-cells could be a factor in the progression from obesity to diabetes. Another important function of autophagy is in hypothalamic neurons for the central control of energy expenditure, appetite, and body weight. In addition, mice with autophagy deficiencies in the target tissues of insulin have yielded diverse phenotypes. Taken together, these results suggest that autophagy is important in the control of whole body energy and nutrient homeostasis, and its dysregulation could play a role in the development of metabolic disorders and diabetes.

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Close layer
Bone Metabolism
Vitamin D Status in Korea
Han Seok Choi
Endocrinol Metab. 2013;28(1):12-16.   Published online March 25, 2013
DOI: https://doi.org/10.3803/EnM.2013.28.1.12
  • 4,303 View
  • 30 Download
  • 35 Web of Science
  • 42 Crossref
AbstractAbstract PDFPubReader   

The majority of the vitamin D in our body is produced by cutaneous synthesis in response to sunlight. As more and more people live in cities and spend the bulk of their time indoors, it can be difficult to get sufficient sun exposure for adequate cutaneous production of vitamin D. Therefore, vitamin D insufficiency has become a very common health problem worldwide. The Korea National Health and Nutrition Examination Survey IV 2008 showed that the prevalence of vitamin D insufficiency, defined as a serum 25-hydroxyvitamin D [25(OH)D] level below 50 nmol/L, was 47.3% in males and 64.5% in females. Only 13.2% of males and 6.7% of females had a serum 25(OH)D level of greater than 75 nmol/L. In Korea, vitamin D insufficiency was more prevalent in young adults than in elderly people, likely due to the indoor lifestyle of younger people. Compared with the United States and Canada, Korea has a lower mean 25(OH)D level and a higher prevalence of vitamin D insufficiency. To improve the vitamin D status of the Korean population, more aggressive policies on food fortification and vitamin D supplementation are needed.

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Close layer
Editorial
Obesity and Metabolism
Serum Albumin Levels: A Simple Answer to a Complex Problem? Are We on the Right Track of Assessing Metabolic Syndrome?
Sohee Kim, Shinae Kang
Endocrinol Metab. 2013;28(1):17-19.   Published online March 25, 2013
DOI: https://doi.org/10.3803/EnM.2013.28.1.17
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PDFPubReader   

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Original Articles
Adrenal gland
Clinical Characteristics for 348 Patients with Adrenal Incidentaloma
Jongho Kim, Kwi Hyun Bae, Yeon Kyung Choi, Ji Yun Jeong, Keun Gyu Park, Jung Guk Kim, In Kyu Lee
Endocrinol Metab. 2013;28(1):20-25.   Published online March 25, 2013
DOI: https://doi.org/10.3803/EnM.2013.28.1.20
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AbstractAbstract PDFPubReader   
Background

Adrenal incidentaloma is an adrenal neoplasm frequently encountered in clinical practice for which detection rates have recently increased. We describe here the clinical characteristics of adrenal incidentalomas.

Methods

A retrospective study was performed examining the age, sex, location, size, function, and the histological findings for 348 patients with an adrenal mass discovered incidentally on computed tomography (CT) undertaken for health examination or nonadrenal disease from August 2005 to May 2012.

Results

Patients consisted of 156 males (44.8%) and 192 females (55.2%), aged between 20 and 86. Adrenal masses were most commonly found in patients in their sixth decade (32.5%). Regarding the location of the masses, 62.0% were found in the left adrenal gland, 30.2% were found in the right, and 7.8% were found bilaterally. Of all of the masses analyzed, 87.1% were 1 to 4 cm in size, and an adenoma-like appearance was the most common finding (75.3%) seen on CT scans. Hormonal analysis showed that 82.2% of the masses were nonfunctioning, 6.0% were diagnosed as subclinical Cushing's syndrome, 4.6% were aldosterone-producing adenomas, and 7.2% were pheochromocytomas. Adrenalectomy was performed in a total of 69 patients having adenoma (50.7%), pheochromocytoma (24.6%), and carcinoma (4.3%).

Conclusion

The characteristics of benign, malignant, nonfunctional, and functional adrenal masses that were incidentally found at our hospital were similar to those presented in other studies.

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Obesity and Metabolism
Association between Serum Albumin, Insulin Resistance, and Incident Diabetes in Nondiabetic Subjects
Ji Cheol Bae, Sung Hwan Seo, Kyu Yeon Hur, Jae Hyeon Kim, Myung-Shik Lee, Moon Kyu Lee, Won Young Lee, Eun Jung Rhee, Ki Won Oh
Endocrinol Metab. 2013;28(1):26-32.   Published online March 25, 2013
DOI: https://doi.org/10.3803/EnM.2013.28.1.26
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AbstractAbstract PDFPubReader   
Background

Serum albumin has been suggested to be associated with insulin resistance. We evaluated the association between serum albumin concentration and insulin resistance. We also investigated whether serum albumin level has an independent effect on the development of diabetes.

Methods

In our study, 9,029 subjects without diabetes, who underwent comprehensive health check-ups annually for 5 years, were categorized into tertiles based on their serum albumin levels at baseline. The odds ratio (OR) for the prevalence of insulin resistance, defined as the top quartile of homeostasis model assessment of insulin resistance and the presence of impaired fasting glucose and nonalcoholic fatty liver disease, was evaluated cross-sectionally. Also, the hazard ratio (HR) for incident diabetes was estimated longitudinally, according to the baseline albumin tertiles using Cox proportional hazard analysis respectively.

Results

From the lowest to the highest tertile of albumin, the multivariable-adjusted ORs of insulin resistance increased significantly in both men and women. During the mean follow-up period of nearly 4 years, 556 (6.1%) subjects progressed to diabetes. The multivariable-adjusted HR (95% confidence interval [CI]) of diabetes in men were 1, 1.09 (95% CI, 0.86 to 1.40), and 1.10 (95% CI, 0.86 to 1.41), respectively, from the lowest to the highest tertiles of baseline albumin. Corresponding values for women were 1, 1.21 (95% CI, 0.66 to 2.21), and 1.06 (95% CI, 0.56 to 2.02), respectively.

Conclusion

Our study showed that increased serum albumin level was associated with insulin resistance. However, serum albumin did not have an independent effect on the development of diabetes.

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Close layer
Obesity and Metabolism
The Relationship of Body Composition and Coronary Artery Calcification in Apparently Healthy Korean Adults
Jung-Hee Yu, Seo Hyoung Yim, Su Hyeon Yu, Ji Yong Lee, Jong Dae Kim, Mi Hae Seo, Won Seon Jeon, Se-Eun Park, Cheol-Young Park, Won-Young Lee, Ki-Won Oh, Sung-Woo Park, Eun-Jung Rhee
Endocrinol Metab. 2013;28(1):33-40.   Published online March 25, 2013
DOI: https://doi.org/10.3803/EnM.2013.28.1.33
  • 3,590 View
  • 29 Download
  • 24 Crossref
AbstractAbstract PDFSupplementary MaterialPubReader   
Background

We investigated the association of coronary artery calcium score (CACS) with body composition and insulin resistance in apparently healthy Korean adults.

Methods

Nine hundred forty-five participants (mean age, 48.9 years; 628 men) in a medical check-up program were selected for analysis. Body composition was assessed by bioelectrical impedance analysis (BIA). Insulin resistance was evaluated using the homeostasis model assessment of insulin resistance (HOMA-IR). The CACS was assessed by multidetector computed tomography.

Results

One hundred forty-six subjects (15.4%) showed coronary artery calcification and 148 subjects (15.7%) had metabolic syndrome. CACS showed a significant positive correlation with age, fasting glucose level, waist circumference (WC), blood pressure, hemoglobin A1c, HOMA-IR, and waist-hip ratio (WHR) assessed by BIA. CACS had a negative correlation with high density lipoprotein cholesterol (HDL-C). Subjects with high CACS showed significantly higher mean WHRs and lower mean values for lean body mass compared with subjects without coronary artery calcification. In logistic regression analyses with coronary artery calcification as the dependent variable, the highest quartile of WHR showed a 3.125-fold increased odds ratio for coronary artery calcification compared with the lowest quartile after adjustment for confounding variables. When receiver operating characteristics analyses were performed with coronary artery calcification as the result variable, WHR showed the largest area under the curve (AUC) value among other variables except for age and WC in women (AUC=0.696 for WHR, 0.790 for age, and 0.719 for WC in women).

Conclusion

In our study population of apparently healthy Korean adults, WHR was the most significant predictor for coronary artery calcification among other confounding factors, suggesting that it may have implication as a marker for early atherosclerosis.

Citations

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Obesity and Metabolism
Tumor Necrosis Factor-α as a Predictor for the Development of Nonalcoholic Fatty Liver Disease: A 4-Year Follow-Up Study
Yun Yong Seo, Yong Kyun Cho, Ji-Cheol Bae, Mi Hae Seo, Se Eun Park, Eun-Jung Rhee, Cheol-Young Park, Ki-Won Oh, Sung-Woo Park, Won-Young Lee
Endocrinol Metab. 2013;28(1):41-45.   Published online March 25, 2013
DOI: https://doi.org/10.3803/EnM.2013.28.1.41
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AbstractAbstract PDFPubReader   
Background

Tumor necrosis factor (TNF)-α is associated with insulin resistance and systemic inflammatory responses. The aim of this study was to investigate the relationship between TNF-α and the development of nonalcoholic fatty liver disease (NAFLD) in a longitudinal study.

Methods

Three hundred and sixty-three apparently healthy subjects (mean age, 40.5±6.1 years; male, 57.6%) without NAFLD were enrolled in 2003. Anthropometric and laboratory measurements were performed. The participants were grouped into tertiles according to their serum TNF-α levels from samples taken in 2003. At a 4-year follow-up, we compared the odds ratios (ORs) of the development of NAFLD according to the tertiles of TNF-α levels measured in 2003.

Results

At the 4-year follow-up, the cumulative incidence of NAFLD was 29.2% (106/363). The group that developed NAFLD had higher levels of TNF-α than those in the group without NAFLD (3.65±1.79 pg/mL vs. 3.15±1.78 pg/mL; P=0.016). When the 2003 serum TNF-α levels were categorized into tertiles: incidence of NAFLD observed in 2007 was significantly higher with increasing tertiles (22.6%, 35.8%, and 41.5%, respectively; P<0.05). The risk of developing NAFLD was significantly greater in the highest tertile of TNF-α than in the lowest tertile after adjusting for age, smoking, and BMI (OR, 2.20; 95% confidence interval, 1.12 to 4.01; P<0.05).

Conclusion

Higher serum TNF-α levels in subjects without NAFLD were associated with the development of NAFLD. The results of study might suggest a pathologic role of inflammation in NAFLD.

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    Zhi Zhu, Shuofeng Li
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    Eun-Jung Rhee
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Case Reports
Long-Term Survival of a Patient with Pulmonary Artery Intimal Sarcoma after Sequential Metastasectomies of the Thyroid and Adrenal Glands
Yun Mi Choi, Eun Kyung Jang, Seong Hee Ahn, Min Ji Jeon, Ji Min Han, Seong Chul Kim, Duck Jong Han, Gyungyup Gong, Tae Yong Kim, Young Kee Shong, Won Bae Kim
Endocrinol Metab. 2013;28(1):46-49.   Published online March 25, 2013
DOI: https://doi.org/10.3803/EnM.2013.28.1.46
  • 3,477 View
  • 28 Download
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AbstractAbstract PDFPubReader   

Cancer metastases to the thyroid or adrenal gland are uncommon. Furthermore, cases showing long-term survival after surgical resection of those metastatic tumors are rare. We report a case of pulmonary artery intimal sarcoma with metastases to the thyroid and adrenal glands sequentially that was successfully treated with sequential metastasectomies. A 62-year-old woman presented with a 4-week history of dyspnea on exertion and facial edema in November 1999. Echocardiography and chest computed tomography (CT) revealed an embolism-like mass in the pulmonary trunk. Pulmonary artery endarterectomy with pulmonary valve replacement was performed, and histopathology revealed pulmonary artery intimal sarcoma. A thyroid nodule was found by chest CT in November 2001 (2 years after initial surgery). During follow-up, this lesion showed no change, but we decided to obtain fine needle aspiration cytology (FNAC) in August 2004 (4.7 years after initial surgery). FNAC revealed atypical spindle cells suggestive of metastatic intimal sarcoma. She underwent total thyroidectomy. During follow-up, a right adrenal gland mass was detected by chest CT in March 2006 (6.3 years after initial surgery), and adrenalectomy was done, which also revealed metastatic sarcoma. She has been followed up without any evidence of recurrent disease until May 2012 (12.5 years after initial surgery).

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Close layer
Thyroid
A Case of Acute Suppurative Thyroiditis with Thyrotoxicosis in an Elderly Patient
Bo Sang Kim, Kil Woo Nam, Jeong Eun Kim, Ji Hoon Park, Jun Sik Yoon, Jung Hwan Park, Sang Mo Hong, Chang Bum Lee, Yong Soo Park, Woong Hwan Choi, You Hern Ahn, Dong Sun Kim
Endocrinol Metab. 2013;28(1):50-54.   Published online March 25, 2013
DOI: https://doi.org/10.3803/EnM.2013.28.1.50
  • 4,541 View
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AbstractAbstract PDFPubReader   

Acute suppurative thyroiditis (AST) is a rare condition, as the thyroid gland is relatively resistant to infection. Thyroid function tests are usually normal in AST. A few cases of AST associated with thyrotoxicosis have been reported in adults. We report a case of AST that was associated with thyrotoxicosis in a 70-year-old woman. We diagnosed AST with thyroid ultrasonography and fine needle aspiration of pus. The patient improved after surgical intervention and had no anatomical abnormality. Fine needle aspiration is the best method for the difficult task of differentiating malignancy and subacute thyroiditis from AST with thyrotoxicosis. Earlier diagnosis and proper treatment for AST might improve the outcome.

Citations

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    Inês Damásio, Joana Maciel, Maria Manuel Costa, Luisa Raimundo
    Archives of Endocrinology and Metabolism.2023;[Epub]     CrossRef
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    Zeynab Seyedjavadeyn, Seyed Amir Miratashi Yazdi, Alireza Samimiat, Matin Vahedi
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    Christian Trummer, Verena Theiler-Schwetz, Stefan Pilz
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    Jung Kyu Park, Eon Ju Jeon
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    Won-Young Lee
    Endocrinology and Metabolism.2014; 29(3): 251.     CrossRef
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Thyroid
Two Cases of Methimazole-Induced Insulin Autoimmune Syndrome in Graves' Disease
Eun Roh, Ye An Kim, Eu Jeong Ku, Jae Hyun Bae, Hye Mi Kim, Young Min Cho, Young Joo Park, Kyong Soo Park, Seong Yeon Kim, Soo Heon Kwak
Endocrinol Metab. 2013;28(1):55-60.   Published online March 25, 2013
DOI: https://doi.org/10.3803/EnM.2013.28.1.55
  • 6,155 View
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  • 15 Crossref
AbstractAbstract PDFPubReader   

We report here the cases of two females with Graves' disease who developed insulin autoimmune syndrome after treatment with methimazole. The patients exhibited a sudden altered mental state after treatment with methimazole for approximately 4 weeks. Patients had hypoglycemia with serum glucose below 70 mg/dL, and laboratory findings showed both high levels of serum insulin and high titers of insulin autoantibodies. The two women had never been exposed to insulin or oral antidiabetic agents, and there was no evidence of insulinoma in imaging studies. After glucose loading, serum glucose, and total insulin levels increased abnormally. One of the patient was found to have HLA-DRB1*0406, which is known to be strongly associated with methimazole-induced insulin autoimmune syndrome. After discontinuation of methimazole, hypoglycemic events disappeared within 1 month. Insulin autoantibody titer and insulin levels decreased within 5 months and there was no further development of hypoglycemic events. We present these cases with a review of the relevant literature.

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Thyroid
Anaplastic Thyroid Carcinoma Following Radioactive Iodine Therapy for Graves' Disease
Sun Hwa Kim, Hee Young Kim, Kwang Yoon Jung, Dong Seop Choi, Sin Gon Kim
Endocrinol Metab. 2013;28(1):61-64.   Published online March 25, 2013
DOI: https://doi.org/10.3803/EnM.2013.28.1.61
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AbstractAbstract PDFPubReader   

Radioactive iodine (RAI) therapy has been used as a treatment option for Graves' disease, and it has been widely accepted to be safe. On the other hand, some evidence suggests that RAI therapy is possibly associated with a small increased risk of thyroid cancer. Herein, we report a rare case of anaplastic thyroid carcinoma (ATC) associated with Graves' disease, following RAI treatment. A 42-year-old woman had been diagnosed with Graves' disease and although she was treated with an antithyroid drug, she remained in a hyperthyroid state, which led to two RAI treatments. More than 10 years later, the patient revisited our clinic due to hoarseness, dysphagia, and dyspnea, which had lasted for 2 months. Neck computed tomography suggested thyroid carcinoma and a lymph node biopsy showed metastatic papillary carcinoma. The patient underwent total thyroidectomy and was finally diagnosed as having an ATC. It is not clear if the occurrence of ATC reported here was influenced by the RAI therapy or alternatively, it may only represent the delayed recognition of a rare change in the natural history of Graves' disease. Nevertheless, this report is worthwhile since it presents a very rare case of ATC that occurred eleven years after the RAI therapy for Graves' disease.

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  • Evaluation of ultrasonographical and cytological features of thyroid nodules in patients treated with radioactive iodine for hyperthyroidism
    Muhammet C. Bilginer, Didem Ozdemir, Fatma N. C. Seyrek, Nilufer Yildirim, Aylin K. Yazgan, Mehmet Kilic, Reyhan Ersoy, Bekir Cakir
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    Won-Young Lee
    Endocrinology and Metabolism.2014; 29(3): 251.     CrossRef
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Thyroid
Steroid Responsive Xanthomatous Hypophysitis Associated with Autoimmune Thyroiditis: A Case Report
Ji Young Joung, Hyemin Jeong, Yoon Young Cho, Kyoungmin Huh, Yeon-Lim Suh, Kwang-Won Kim, Ji Cheol Bae
Endocrinol Metab. 2013;28(1):65-69.   Published online March 25, 2013
DOI: https://doi.org/10.3803/EnM.2013.28.1.65
  • 3,317 View
  • 30 Download
  • 16 Crossref
AbstractAbstract PDFPubReader   

We report the case of a 36-year-old woman who presented with headache, fever, and amenorrhea. Laboratory analysis revealed hypopituitarism and autoimmune thyroiditis, while a cerebrospinal fluid study suggested concurrent aseptic meningitis. A magnetic resonance image (MRI) scan revealed a 1.0×0.9 cm cystic mass enlarging the sella turcica. Surgical resection via an endoscopic transsphenoidal route was performed. The histological finding of the excised tissue revealed foamy histiocytes with vacuolated cytoplasm, supporting the diagnosis of xanthomatous hypophysitis. Although a residual soft lesion was observed on the MRI image postoperatively, the patient's headache and fever improved. Ten months after surgery, the patient complained of visual impairment and headache, and the residual mass had enlarged into the suprasellar area. High dose (500 mg intravenous) methylprednisolone was administered for 3 days. During the methylprednisolone pulse therapy, the patient's visual acuity and headache improved. A follow-up MRI taken after methylprednisolone therapy showed a marked mass reduction. Our case supports an autoimmune pathophysiology for xanthomatous hypophysitis and suggests that high dose glucocorticoid therapy as a treatment option.

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Obesity and Metabolism
Olanzapine-Induced Diabetic Ketoacidosis and Neuroleptic Malignant Syndrome with Rhabdomyolysis: A Case Report
Young Kyoung Sa, Hyeon Yang, Hee Kyoung Jung, Jang Won Son, Seong Su Lee, Seong Rae Kim, Bong Yeon Cha, Ho Young Son, Chi-Un Pae, Soon Jib Yoo
Endocrinol Metab. 2013;28(1):70-75.   Published online March 25, 2013
DOI: https://doi.org/10.3803/EnM.2013.28.1.70
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  • 37 Download
  • 7 Crossref
AbstractAbstract PDFPubReader   

Atypical antipsychotics have replaced conventional antipsychotics in the treatment of schizophrenia because they have less of a propensity to cause undesirable neurologic adverse events including extrapyramidal symptoms, tardive dyskinesia, and neuroleptic malignant syndrome (NMS). However, atypical antipsychotics have been known to result in various metabolic complications such as impaired glucose tolerance, diabetes and even diabetic ketoacidosis (DKA). In addition, a number of NMS cases have been reported in patients treated with atypical antipsychotics, although the absolute incidence of neurologic side effects is currently significantly low. Here, we report a patient who simultaneously developed DKA, acute renal failure and NMS with rhabdomyolysis after olanzapine treatment. Olanzapine-induced metabolic complications and NMS were dramatically improved with cessation of the olanzapine treatment and initiation of supportive management including fluid therapy, hemodialysis, and intensive glycemic control using insulin. At short-term follow-up, insulin secretion was markedly recovered as evidenced by a restoration of serum C-peptide level, and the patient no longer required any hypoglycemic medications. Despite the dramatic increase in the use of atypical antipsychotics treatment, individualized treatments along with careful monitoring may be prudent for high risk or vulnerable patients in order to avoid the development of metabolic side effects.

Citations

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