Endocrinology and Metabolism

Review Article

Hypothalamus and pituitary gland
New Sparks and Spots: Molecular Imaging with Positron Emission Tomography Will Change Management of Cushing’s Disease: Martin Reincke, Tugce Apaydin, Mariam Kakashvili, Nathalie L. Albert, Jun Thorsteinsdottir, Júnia R. O. L. Schweizer, Marily Theodoropoulou, Katharina Schilbach, Friederike Völter; Endocrinol Metab. 2026;41(1):49-56. Published online February 3, 2026; DOI: https://doi.org/10.3803/EnM.2025.2728

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Abstract PDF PubReader ePub: Cushing’s disease is caused by corticotroph tumors of the pituitary gland, resulting in adrenocorticotropic hormone hypersecretion and cortisol excess. The majority of the tumors are microadenomas. Magnetic resonance imaging (MRI) imaging is able to detect up to 70% of the corticotroph tumors. In the remaining patients, no tumor is detectable on MRI or there are equivocal changes without a clear demarcation of a tumor. Hence, the cure rates following transsphenoidal pituitary surgery are far from being satisfactory, with around 60% to 90% short-term remission in expert centers. Positron emission tomography (PET) has recently emerged as a potent method for the localization of small corticotroph adenomas and corticotroph adenomas without demarcation on the MRI. This review analyzes the radiopharmaceuticals most commonly used in evaluating pituitary disorders and explores the potential utilization of new PET tracers for personalized management of patients with Cushing’s disease. Especially ¹¹C-methionine and ¹⁸F-fluorethyltyrosine PET have recently been reported to be highly sensitive methods to detect MRI-undetectable corticotropinomas in 80% to 100% of patients. If confirmed in randomized controlled trials, PET imaging could be a major break-through towards targeted, individualized surgical therapy.

Original Articles

Mineral, Bone & Muscle
Protein Signatures of Parathyroid Adenoma according to Tumor Volume and Functionality: Sung Hye Kong, Jeong Mo Bae, Jung Hee Kim, Sang Wan Kim, Dohyun Han, Chan Soo Shin; Endocrinol Metab. 2024;39(2):375-386. Published online March 21, 2024; DOI: https://doi.org/10.3803/EnM.2023.1827

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Background
Parathyroid adenoma (PA) is a common endocrine disease linked to multiple complications, but the pathophysiology of the disease remains incompletely understood. The study aimed to identify the key regulator proteins and pathways of PA according to functionality and volume through quantitative proteomic analyses.
Methods
We conducted a retrospective study of 15 formalin-fixed, paraffin-embedded PA samples from tertiary hospitals in South Korea. Proteins were extracted, digested, and the resulting peptides were analyzed using liquid chromatography-tandem mass spectrometry. Pearson correlation analysis was employed to identify proteins significantly correlated with clinical variables. Canonical pathways and transcription factors were analyzed using Ingenuity Pathway Analysis.
Results
The median age of the participants was 52 years, and 60.0% were female. Among the 8,153 protein groups analyzed, 496 showed significant positive correlations with adenoma volume, while 431 proteins were significantly correlated with parathyroid hormone (PTH) levels. The proteins SLC12A9, LGALS3, and CARM1 were positively correlated with adenoma volume, while HSP90AB2P, HLA-DRA, and SCD5 showed negative correlations. DCPS, IRF2BPL, and FAM98A were the main proteins that exhibited positive correlations with PTH levels, and SLITRK4, LAP3, and AP4E1 had negative correlations. Canonical pathway analysis demonstrated that the RAN and sirtuin signaling pathways were positively correlated with both PTH levels and adenoma volume, while epithelial adherence junction pathways had negative correlations.
Conclusion
Our study identified pivotal proteins and pathways associated with PA, offering potential therapeutic targets. These findings accentuate the importance of proteomics in understanding disease pathophysiology and the need for further research.

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Aberrant Histone Methylation Profile in Patients with Sporadic Primary Hyperparathyroidism
Poonam Kumari, Sanjay Kumar Bhadada, Ashutosh Kumar Arya, Jyotdeep Kaur, Naresh Sachdeva, Uma Nahar Saikia, Divya Dahiya, Anoop Kumar, Chirag Kharbanda, Sudhaker D Rao
The Journal of Clinical Endocrinology & Metabolism.2025;[Epub] CrossRef

Hypothalamus and pituitary gland
Clinical Characteristics, Diagnosis, and Treatment of Thyroid Stimulating Hormone-Secreting Pituitary Neuroendocrine Tumor (TSH PitNET): A Single-Center Experience: Jung Heo, Yeon-Lim Suh, Se Hoon Kim, Doo-Sik Kong, Do-Hyun Nam, Won-Jae Lee, Sung Tae Kim, Sang Duk Hong, Sujin Ryu, You-Bin Lee, Gyuri Kim, Sang-Man Jin, Jae Hyeon Kim, Kyu Yeon Hur; Endocrinol Metab. 2024;39(2):387-396. Published online February 5, 2024; DOI: https://doi.org/10.3803/EnM.2023.1877

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Background
Thyroid-stimulating hormone (TSH)-secreting pituitary neuroendocrine tumor (TSH PitNET) is a rare subtype of PitNET. We investigated the comprehensive characteristics and outcomes of TSH PitNET cases from a single medical center. Also, we compared diagnostic methods to determine which showed superior sensitivity.
Methods
A total of 17 patients diagnosed with TSH PitNET after surgery between 2002 and 2022 in Samsung Medical Center was retrospectively reviewed. Data on comprehensive characteristics and treatment outcomes were collected. The sensitivities of diagnostic methods were compared.
Results
Seven were male (41%), and the median age at diagnosis was 42 years (range, 21 to 65); the median follow-up duration was 37.4 months. The most common (59%) initial presentation was hyperthyroidism-related symptoms. Hormonal co-secretion was present in four (23%) patients. Elevated serum alpha-subunit (α-SU) showed the greatest diagnostic sensitivity (91%), followed by blunted response at thyrotropin-releasing hormone (TRH) stimulation (80%) and elevated sex hormone binding globulin (63%). Fourteen (82%) patients had macroadenoma, and a specimen of one patient with heavy calcification was negative for TSH. Among 15 patients who were followed up for more than 6 months, 10 (67%) achieved hormonal and structural remission within 6 months postoperatively. A case of growth hormone (GH)/TSH/prolactin (PRL) co-secreting mixed gangliocytoma-pituitary adenoma (MGPA) was discovered.
Conclusion
The majority of the TSH PitNET cases was macroadenoma, and 23% showed hormone co-secretion. A rare case of GH/TSH/PRL co-secreting MGPA was discovered. Serum α-SU and TRH stimulation tests showed great diagnostic sensitivity. Careful consideration is needed in diagnosing TSH PitNET. Achieving remission requires complete tumor resection. In case of nonremission, radiotherapy or medical therapy can improve the long-term remission rate.

Citations

Citations to this article as recorded by

Glucose metabolism in anterior pituitary adenomas
Valeria Hernández-Brito, Stephanie Lemoni Casco-Morales, Andrés Vega-Rosas
Clinica Chimica Acta.2026; 578: 120587. CrossRef
Clinical, Pathological, and Imaging Study of Pilomatrixoma: A Retrospective Study
Qi Hao, Cong‐Gai Huang, Chao‐Ying Wu, Rong Kuang, Meng‐Ze Li
Health Science Reports.2026;[Epub] CrossRef
TSH-secreting pituitary adenomas and bone
Marco Losa, Alberto Vassallo, Stefano Frara, Pietro Mortini, Andrea Giustina
Pituitary.2024; 27(6): 752. CrossRef

Adrenal Gland
Clinical and Molecular Characteristics of PRKACA L206R Mutant Cortisol-Producing Adenomas in Korean Patients: Insoon Jang, Su-jin Kim, Ra-Young Song, Kwangsoo Kim, Seongmin Choi, Jang-Seok Lee, Min-Kyeong Gwon, Moon Woo Seong, Kyu Eun Lee, Jung Hee Kim; Endocrinol Metab. 2021;36(6):1287-1297. Published online December 2, 2021; DOI: https://doi.org/10.3803/EnM.2021.1217

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Background
An activating mutation (c.617A>C/p.Lys206Arg, L206R) in protein kinase cAMP-activated catalytic subunit alpha (PRKACA) has been reported in 35% to 65% of cases of cortisol-producing adenomas (CPAs). We aimed to compare the clinical characteristics and transcriptome analysis between PRKACA L206R mutants and wild-type CPAs in Korea.
Methods
We included 57 subjects with CPAs who underwent adrenalectomy at Seoul National University Hospital. Sanger sequencing for PRKACA was conducted in 57 CPA tumor tissues. RNA sequencing was performed in 13 fresh-frozen tumor tissues.
Results
The prevalence of the PRKACA L206R mutation was 51% (29/57). The mean age of the study subjects was 42±12 years, and 87.7% (50/57) of the patients were female. Subjects with PRKACA L206R mutant CPAs showed smaller adenoma size (3.3±0.7 cm vs. 3.8±1.2 cm, P=0.059) and lower dehydroepiandrosterone sulfate levels (218±180 ng/mL vs. 1,511±3,307 ng/mL, P=0.001) than those with PRKACA wild-type CPAs. Transcriptome profiling identified 244 differentially expressed genes (DEGs) between PRKACA L206R mutant (n=8) and wild-type CPAs (n=5), including five upregulated and 239 downregulated genes in PRKACA L206R mutant CPAs (|fold change| ≥2, P<0.05). Among the upstream regulators of DEGs, CTNNB1 was the most significant transcription regulator. In several pathway analyses, the Wnt signaling pathway was downregulated and the steroid biosynthesis pathway was upregulated in PRKACA mutants. Protein-protein interaction analysis also showed that PRKACA downregulates Wnt signaling and upregulates steroid biosynthesis.
Conclusion
The PRKACA L206R mutation in CPAs causes high hormonal activity with a limited proliferative capacity, as supported by transcriptome profiling.

Citations

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Sexual dimorphism in benign adrenocortical tumours
Onnicha Suntornlohanakul, Cristina L Ronchi, Wiebke Arlt, Alessandro Prete
European Journal of Endocrinology.2025; 192(5): R1. CrossRef

Review Articles

Adrenal Gland
Adrenal Venous Sampling for Subtype Diagnosis of Primary Hyperaldosteronism: Mitsuhide Naruse, Akiyo Tanabe, Koichi Yamamoto, Hiromi Rakugi, Mitsuhiro Kometani, Takashi Yoneda, Hiroki Kobayashi, Masanori Abe, Youichi Ohno, Nobuya Inagaki, Shoichiro Izawa, Masakatsu Sone; Endocrinol Metab. 2021;36(5):965-973. Published online October 21, 2021; DOI: https://doi.org/10.3803/EnM.2021.1192

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Adrenal venous sampling (AVS) is the key procedure for lateralization of primary hyperaldosteronism (PA) before surgery. Identification of the adrenal veins using computed tomography (CT) and intraoperative cortisol assay facilitates the success of catheterization. Although administration of adrenocorticotropic hormone (ACTH) has benefits such as improving the success rate, some unilateral cases could be falsely diagnosed as bilateral. Selectivity index of 5 with ACTH stimulation to assess the selectivity of catheterization and lateralization index (LI) >4 with ACTH stimulation for unilateral diagnosis is used in many centers. Co-secretion of cortisol from the tumor potentially affects the lateralization by the LI. Patients aged <35 years with hypokalemia, marked aldosterone excess, and unilateral adrenal nodule on CT have a higher probability of unilateral disease. Patients with normokalemia, mild aldosterone excess, and no adrenal tumor on CT have a higher probability of bilateral disease. Although no methods have 100% specificity for subtype diagnosis that would allow bypassing AVS, prediction of the subtype should be considered when recommending AVS to patients. Methodological standardization and strict indication improve diagnostic quality of AVS. Development of non-invasive imaging and biochemical markers will drive a paradigm shift in the clinical practice of PA.

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Adrenal Venous Sampling Aids in Distinguishing 17-Hydroxyprogesterone Hypersecreting Adrenal Cortical Adenomas from Non-Classical 21-Hydroxylase Deficiency
Ruojun Qiu, Tian Yang, Chengxin Shang, Weifen Zhu, Fenping Zheng
Diagnostics.2026; 16(2): 202. CrossRef
Bilateral adrenal artery embolization for the treatment of idiopathic hyperaldosteronism: A proof-of-principle single center study
Guo Ji, Changqiang Yang, Jixin Hou, Yaqiong Zhou, Tao Luo, Yi Yang, Dan Wang, Sen Liu, Jindong Wan, Gaomin He, Anping Zeng, Xinquan Wang, Peijian Wang
Hypertension Research.2025; 48(1): 200. CrossRef
Adrenal vein sampling: accuracy of earlier sampling post adrenocorticotropic hormone (ACTH) administration
Q.X. Tee, J.C.G. Doery, A. Desra, P.J. Fuller, J. Yang, K.K. Lau
Clinical Radiology.2025; 84: 106861. CrossRef
Long-term Efficacy and Safety of Unilateral Adrenal Artery Embolization in Patients with Idiopathic Hyperaldosteronism: A 24-month Cohort Study
Guo Ji, Sen Liu, Jindong Wan, Yaqiong Zhou, Changqiang Yang, Xinquan Wang, Gaomin He, Anping Zeng, Lingling Zhang, Tao Luo, Yi Yang, Dan Wang, Kaige Feng, Jixin Hou, Peijian Wang
American Journal of Hypertension.2025; 38(9): 675. CrossRef
Expert Consensus on the Primary Aldosteronism Severity Classification and its strategic application in indicating adrenal venous sampling
Masanori Murakami, Mitsuhide Naruse, Hiroki Kobayashi, Mirko Parasiliti-Caprino, Fabio Bioletto, Denise Brüdgam, Isabel Stüfchen, Martin Reincke, Matthieu St-Jean, Ivana Kraljevic, Darko Kastelan, Pasi I Nevalainen, Marta Araujo-Castro, Norlela Sukor, Mic
European Journal of Endocrinology.2025; 193(1): 85. CrossRef
A controlled trial of percutaneous adrenal arterial embolization for hypertension in patients with idiopathic hyperaldosteronism
Yaqiong Zhou, Xinquan Wang, Jixin Hou, Jindong Wan, Yi Yang, Sen Liu, Tao Luo, Qiting Liu, Qiang Xue, Peijian Wang
Hypertension Research.2024; 47(2): 311. CrossRef
Correlation of Histopathologic Subtypes of Primary Aldosteronism with Clinical Phenotypes and Postsurgical Outcomes
Chang Ho Ahn, You-Bin Lee, Jae Hyeon Kim, Young Lyun Oh, Jung Hee Kim, Kyeong Cheon Jung
The Journal of Clinical Endocrinology & Metabolism.2024; 109(8): e1582. CrossRef
Screening and diagnosis of primary aldosteronism. Consensus document of all the Spanish Societies involved in the management of primary aldosteronism
Marta Araujo-Castro, Jorge Gabriel Ruiz-Sánchez, Paola Parra Ramírez, Patricia Martín Rojas-Marcos, Almudena Aguilera-Saborido, Jorge Francisco Gómez Cerezo, Nieves López Lazareno, María Eugenia Torregrosa Quesada, Jorge Gorrin Ramos, Josep Oriola, Esteba
Endocrine.2024; 85(1): 99. CrossRef
Temporal trends in clinical features of patients with primary aldosteronism over 20 years
Seung Shin Park, Chang Ho Ahn, Sang Wan Kim, Jung-Min Koh, Seung Hun Lee, Jung Hee Kim
Hypertension Research.2024; 47(8): 2019. CrossRef
Primary aldosteronism: An underdiagnosed clinical entity
Peeyush Jain, Atul Kaushik, Nilashish Dey, Ashwani Mehta, Shaloo Kapoor, Chhavi Agrawal
Journal of Current Cardiology.2024; 2(2): 65. CrossRef
Diagnostic accuracy of using multiple cytokines to predict aldosterone-producing adenoma
Fei Qin, Hong Wen, Xiaoge Zhong, Yajin Pan, Xiaomei Lai, Tingting Yang, Jing Huang, Jie Yu, Jianling Li
Scientific Reports.2023;[Epub] CrossRef
A clinical assessment of portable point-of-care testing for quick cortisol assay during adrenal vein sampling
Ko Aiga, Mitsuhiro Kometani, Shigehiro Karashima, Seigo Konishi, Takuya Higashitani, Daisuke Aono, Xurong Mai, Mikiya Usukura, Takahiro Asano, Ayako Wakayama, Yuko Noda, Wataru Koda, Tetsuya Minami, Satoshi Kobayashi, Toshinori Murayama, Takashi Yoneda
Scientific Reports.2023;[Epub] CrossRef
2023 Korean Endocrine Society Consensus Guidelines for the Diagnosis and Management of Primary Aldosteronism
Jeonghoon Ha, Jung Hwan Park, Kyoung Jin Kim, Jung Hee Kim, Kyong Yeun Jung, Jeongmin Lee, Jong Han Choi, Seung Hun Lee, Namki Hong, Jung Soo Lim, Byung Kwan Park, Jung-Han Kim, Kyeong Cheon Jung, Jooyoung Cho, Mi-kyung Kim, Choon Hee Chung
Endocrinology and Metabolism.2023; 38(6): 597. CrossRef
Adrenal Venous Sampling in Primary Aldosteronism: Single-Centre Experience from Western India
Krantikumar Rathod, Saba S. Memon, Punit Mahajan, Anurag Lila, Dhaval Thakkar, Hemant Deshmukh, Tushar Bandgar
Indian Journal of Endocrinology and Metabolism.2023; 27(1): 80. CrossRef
The Entity of Connshing Syndrome: Primary Aldosteronism with Autonomous Cortisol Secretion
Mara Carsote
Diagnostics.2022; 12(11): 2772. CrossRef

Adrenal gland
The Genotype-Based Morphology of Aldosterone-Producing Adrenocortical Disorders and Their Association with Aging: Xin Gao, Yuto Yamazaki, Yuta Tezuka, Kei Omata, Yoshikiyo Ono, Ryo Morimoto, Yasuhiro Nakamura, Fumitoshi Satoh, Hironobu Sasano; Endocrinol Metab. 2021;36(1):12-21. Published online February 24, 2021; DOI: https://doi.org/10.3803/EnM.2021.101

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Primary aldosteronism (PA) is the most common cause of secondary hypertension, and is associated with an increased incidence of cardiovascular events. PA itself is clinically classified into the following two types: unilateral PA, mostly composed of aldosteroneproducing adenoma (APA); and bilateral hyperaldosteronism, consisting of multiple aldosterone-producing micronodules (APMs) and aldosterone-producing diffuse hyperplasia. Histopathologically, those disorders above are all composed of compact and clear cells. The cellular morphology in the above-mentioned aldosterone-producing disorders has been recently reported to be closely correlated with patterns of somatic mutations of ion channels including KCNJ5, CACNA1D, ATP1A1, ATP2B3, and others. In addition, in non-pathological adrenal glands, APMs are frequently detected regardless of the status of the renin-angiotensin-aldosterone system (RAAS). Aldosterone-producing nodules have been also proposed as non-neoplastic nodules that can be identified by hematoxylin and eosin staining. These non-neoplastic CYP11B2-positive nodules could represent possible precursors of APAs possibly due to the presence of somatic mutations. On the other hand, aging itself also plays a pivotal role in the development of aldosterone-producing lesions. For instance, the number of APMs was also reported to increase with aging. Therefore, recent studies indicated the novel classification of PA into normotensive PA (RAAS-independent APM) and clinically overt PA.

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Endocrine hypertension in 2025: how AI and multiomics are revolutionizing detection
Jenyfer M. Fuentes-Mendoza, Marcio J. Concepción-Zavaleta, Jeny J. Mendoza-Godoy, Juan Eduardo Quiroz-Aldave, Juan Carlos Morón-Siguas, José L. Paz-Ibarra
Expert Review of Cardiovascular Therapy.2026; 24(3): 159. CrossRef
Subtype-specific Body Composition and Metabolic Risk in Patients With Primary Aldosteronism
Seung Shin Park, Chang Ho Ahn, Sang Wan Kim, Ji Won Yoon, Jung Hee Kim
The Journal of Clinical Endocrinology & Metabolism.2024; 109(2): e788. CrossRef
Correlation of Histopathologic Subtypes of Primary Aldosteronism with Clinical Phenotypes and Postsurgical Outcomes
Chang Ho Ahn, You-Bin Lee, Jae Hyeon Kim, Young Lyun Oh, Jung Hee Kim, Kyeong Cheon Jung
The Journal of Clinical Endocrinology & Metabolism.2024; 109(8): e1582. CrossRef
Temporal trends in clinical features of patients with primary aldosteronism over 20 years
Seung Shin Park, Chang Ho Ahn, Sang Wan Kim, Jung-Min Koh, Seung Hun Lee, Jung Hee Kim
Hypertension Research.2024; 47(8): 2019. CrossRef
2023 Korean Endocrine Society Consensus Guidelines for the Diagnosis and Management of Primary Aldosteronism
Jeonghoon Ha, Jung Hwan Park, Kyoung Jin Kim, Jung Hee Kim, Kyong Yeun Jung, Jeongmin Lee, Jong Han Choi, Seung Hun Lee, Namki Hong, Jung Soo Lim, Byung Kwan Park, Jung-Han Kim, Kyeong Cheon Jung, Jooyoung Cho, Mi-kyung Kim, Choon Hee Chung
Endocrinology and Metabolism.2023; 38(6): 597. CrossRef
Expression of CYP11B1 and CYP11B2 in adrenal adenoma correlates with clinical characteristics of primary aldosteronism
Chang Ho Ahn, Hee Young Na, So Yeon Park, Hyeong Won Yu, Su‐Jin Kim, June Young Choi, Kyu Eun Lee, Sang Wan Kim, Kyeong Cheon Jung, Jung Hee Kim
Clinical Endocrinology.2022; 96(1): 30. CrossRef
Pathology of Aldosterone Biosynthesis and its Action
Xin Gao, Yuto Yamazaki, Yuta Tezuka, Kei Omata, Yoshikiyo Ono, Ryo Morimoto, Yasuhiro Nakamura, Takashi Suzuki, Fumitoshi Satoh, Hironobu Sasano
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Original Article

Clinical Study
Long-Term Results of Thermal Ablation of Benign Thyroid Nodules: A Systematic Review and Meta-Analysis: Se Jin Cho, Jung Hwan Baek, Sae Rom Chung, Young Jun Choi, Jeong Hyun Lee; Endocrinol Metab. 2020;35(2):339-350. Published online June 24, 2020; DOI: https://doi.org/10.3803/EnM.2020.35.2.339

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Background
Ultrasound-guided thermal ablations have become one of the main options for treating benign thyroid nodules. To determine efficacy of thermal ablation of benign thyroid nodules, we performed a meta-analysis of studies with long-term follow-up of more than 3 years.
Methods
Databases were searched for studies published up to August 25, 2019, reporting patients with benign thyroid nodules treated with thermal ablation and with follow-up data of more than 3 years. Data extraction and quality assessment were performed according to PRISMA guidelines. The analysis yielded serial volume reduction rates (VRRs) of ablated nodules for up to 3 years or more, and adverse effect of ablation during follow-up. Radiofrequency ablation (RFA) and laser ablation (LA) were compared in a subgroup analysis.
Results
The pooled VRRs for ablated nodules showed rapid volume reduction before 12 months, a plateau from 12 to 36 months, and more volume reduction appearing after 36 months, demonstrating long-term maintenance of treatment efficacy. Thermal ablation had an acceptable complication rate of 3.8%. Moreover, patients undergoing nodule ablation showed no unexpected delayed complications during the follow-up period. In the subgroup analysis, RFA was shown to be superior to LA in terms of the pooled VRR and the number of patients who underwent delayed surgery.
Conclusion
Thermal ablations are safe and effective methods for treating benign thyroid nodules, as shown by a long follow-up analysis of more than 3 years. In addition, RFA showed superior VRRs compared with LA for the treatment of benign thyroid nodules, with less regrowth and less delayed surgery.

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The Kaohsiung Journal of Medical Sciences.2026;[Epub] CrossRef
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Mikkel Kaltoft, Jesper Roed Sorensen, Per Karkov Cramon, Tobias Todsen, Christoffer Holst Hahn
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Sium Wolde Sellasie, Maurilio Deandrea, Stefano Amendola, Tommaso Piticchio, Andrea Leoncini, Giorgio Treglia, Luigi Uccioli, Pierpaolo Trimboli
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Shmuel Wechsler, Tanya Shcherbaeva, Jacob Pitaro, Limor Muallem Kalmovich
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Vinay Thondaebhavi Padmaraju, Prafulla TP, Mangerira Chinnappa Uthappa
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Lorant Szabo, Christoph Zech, Hans Steinert, Gerhard F. Huber, Mirjam Faulenbach, Sandra Kilgus, Claudio Redaelli, Oliver Dudeck
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Guoyong Xie, Ruibin Chen, Fuxiao Liu
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Xidong Xu, Ying Peng, Guoxin Han
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Jonathon O. Russell, Kaitlyn M. Frazier
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Chi-Yu Kuo, Chung-Hsin Tsai, Jun Kui Wu, Shih-Ping Cheng, Yi-Hsien Hsieh
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Meghal Shah, Catherine McManus
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Benign Thyroid Nodules Respond Better to Thermal Ablation Retreatment If They Are Smaller
Iram Hussain
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Mattia Rossi, Letizia Meomartino, Loredana Pagano, Giulia Follini, Sara Garberoglio, Mauro Maccario, Ruth Rossetto Giaccherino, Roberto Garberoglio
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Shi Chuanke, Luo Ming, Yan Zhideng, Liu Huan
Frontiers in Endocrinology.2024;[Epub] CrossRef
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Hunjong Lim, Se Jin Cho, Jung Hwan Baek
European Radiology.2024; 35(2): 612. CrossRef
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Sang Ik Park, Jung Hwan Baek, Da Hyun Lee, Sae Rom Chung, Dong Eun Song, Won Gu Kim, Tae Yong Kim, Tae-Yon Sung, Ki-Wook Chung, Jeong Hyun Lee
Thyroid®.2024; 34(8): 990. CrossRef
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Onur Taydas, Erbil Arik, Omer Faruk Sevinc, Ahmet Burak Kara, Mustafa Ozdemir, Hasret Cengiz, Zulfu Bayhan, Mehmet Halil Ozturk
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M. B. Saliba, S. P. Vetshev, A. A. Maksimova, G. A. Zhemerikin, F. P. Vetshev, V. A. Zhivova, K. K. Popov, E. А. Pavlova
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La radiologia medica.2024; 130(1): 111. CrossRef
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Tim Boers, Sicco J. Braak, Nicole E. T. Rikken, Michel Versluis, Srirang Manohar
Journal of Clinical Ultrasound.2023; 51(6): 1087. CrossRef
Ultrasound (US)-Guided Ablation of Thyroid Nodules
Byung Seup Kim
Journal of Surgical Ultrasound.2023; 10(1): 14. CrossRef
Ultrasound-Guided Radiofrequency Ablation versus Thyroidectomy for the Treatment of Benign Thyroid Nodules in Elderly Patients: A Propensity-Matched Cohort Study
L. Yan, X.Y. Li, Y. Li, Y. Luo
American Journal of Neuroradiology.2023; 44(6): 693. CrossRef
Minimally Invasive Ablative Treatments for Benign Thyroid Nodules: Current Evidence and Future Directions
Enrico Papini, Laszlo Hegedüs
Thyroid®.2023; 33(8): 890. CrossRef
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Shiliang Cao, Lijia Wang, Ying Wei, Zhenlong Zhao, Jie Wu, Mingan Yu
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Choice in Ablative Therapies for Thyroid Nodules
Q Lina Hu, Jennifer H Kuo
Journal of the Endocrine Society.2023;[Epub] CrossRef
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Academic Radiology.2023; 30(10): 2172. CrossRef
Radiofrequency ablation for autonomously functioning nodules as treatment for hyperthyroidism: subgroup analysis of toxic adenoma and multinodular goitre and predictors for treatment success
M. M. D. van der Meeren, F. B. M. Joosten, S. H. P. P. Roerink, L. N. Deden, W. J. G. Oyen
European Journal of Nuclear Medicine and Molecular Imaging.2023; 50(12): 3675. CrossRef
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Jung Suk Sim
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Frontiers in Oncology.2022;[Epub] CrossRef
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Frontiers in Endocrinology.2022;[Epub] CrossRef
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Current Oncology Reports.2022; 24(8): 1045. CrossRef
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International journal of health sciences.2022; : 4713. CrossRef
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Frontiers in Endocrinology.2022;[Epub] CrossRef
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Ultrasonography.2022; 41(4): 661. CrossRef
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PLOS ONE.2021; 16(1): e0243864. CrossRef
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Frontiers in Endocrinology.2021;[Epub] CrossRef
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International Journal of Endocrinology.2021; 2021: 1. CrossRef
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Case Reports

A Case of Adrenocortical Adenoma Associated with Incidental Pheochromocytoma.: Sung Jun Hong, Young Sik Choi, Yo Han Park, Byung Cheol Yoon, Young Hwan Bae, Seon Ja Park, Ja Young Koo; J Korean Endocr Soc. 1996;11(4):531-537. Published online November 7, 2019

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Abstract PDF: The coexistence of adrenal cortical tumor and pheochromocytoma was extremely rare. A total of 25 reported cases showing evidence of hyperfuction of the adrenal cortex and pheochromocytoma were noted in the literature. Of those twenty cases were coexistence of pheochromocytoma and adrenocortical hyperplasia and only five cases were coincident pheochromocytoma and adreno-cortical adenoma. Recently, we experienced a case of adrenocortical adenoma associated with incidental pheochrmocytoma. A 55-year-old woman complained of progressive weight gain and epigastric discomfort. Hormonal and radiologic studies revealed Cushings syndrome with a left adrenal tumor. Adrenalectomy was performed and the gland actually had two nodules on its surface, one pheochromocytoma and the other cortical adenoma. This patient was the first case of pheochromocytoma with adrenocortical adenoma in Korea. We report the case with a review of literature.

A Case of Giant Adrenal Adenoma Presenting Primary Aldosteronism.: Ji Hyun Lee, Bong Soo Cha, Moon Suk Nam, Young Duk Song, Sung Kil Lim, Hyun Chul Lee, Kap Bum Huh, Hyung Chan Suh, Young Hwa Choi, Jae Min Park, Jung Soo Park, Soon Won Hong, Dong Hwan Shin; J Korean Endocr Soc. 1996;11(3):348-354. Published online November 7, 2019

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Abstract PDF: Primary aldosteronism is a syndrome chracterized by hypokalemic alkalosis and hypertension. Small sized adrenal cortical adenomas have been the major cause of this syndrome in most of the patients. However, if the adrenal mass is larger than 6cm in diameter and with irregular consistency, malignancy is more favored. We experienced a patient who had a giant adrenal adenoma with primary aldosteronism. A 24-year-old female presented with hypertension, hypokalemia, low plasma renin, and high plasrna aldosterone levels, was found to have a 6×5.5×5 cm sized left adrenal tumor by MRI. Her clinical laboratory feature did not revealed any evidence of Cushing's syndrome or pheochromocytoma. Preoperatively adrenal carcinoma presenting pure adrenal aldosteronism was suspected due to large size and heterogenous signal character of the adrenal mass in radiologic study. At operation well encapsulated, round giant adrenal tumor weighing 65gm(4.5×4×4 cm) was removed. There was no evidence of metastasis with return of adrenal function to normal after surgery. Benign adrenal adenoma was confirmed by the gross morphology and the histologic features.

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

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

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

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

A Case of True Precocious Puberty Associated with Pituitary Microadenoma Treated with LHRH Agonist.: In Kyu Lee, Soon Woo Kim, Heung Sik Kim, Chin Moo Kang; J Korean Endocr Soc. 1994;9(3):244-250. Published online November 6, 2019

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Abstract PDF: Recently Brain CT and MRI have greatly contributed to the discovery of intracranial tumors including cysts which cause precocious puberty. Among many precocious pubetry patients that had previously been diagnosed as idopathic, a number of cases turn out the true precocious puberty caused by intracranial lesion.Authors experienced a case of true precocious puberty in a seven year old female whose vaginal bleeding appeared at age of five and she also had breast enlargement on admission. Pituitary microadenoma was found on her brain MRI and the microadenoma turned to be nonfunctional on hormonal tests.Following three does of decapety1-CR(LHRH Agonist), the vaginal bleeding was ceased and the deceleration of breast enlargement was noted. Her growth velocity was also affected but the further observation for final height would be warranted.

Original Articles

A Clinical Observation of Endocrine Adrenal Tumors.: Hye Young Park, Tae Suk Kim, Soo Jin Lee, Dong Gu Choi, Moon Ho Kang; J Korean Endocr Soc. 1994;9(3):228-238. Published online November 6, 2019

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Abstract PDF: Endocrine adrenal tumors are uncommon but clinically significant because they can be managed successfully by surgical therapy. During pregnancy, adrenal tumors can be a cause of death for both mother and baby, unless they diagnoses antenatally and managed properly. To investigate clinical characteristics of endocrine adrenal tumors, we analyzed 26 cases of adrenal tumor diagnosed and managed in Chung Ang Gil Hospital including cases associated with pregnancy and also a rare case of paraganglioma in liver. 1) There were 7 cases of Cushing's syndrome among which two cases were due to Cushing's disease and five cases were due to adrenal adenoma. Six cases were managed successfully by appropriate surgery. Another one case was associated with pregnancy but the patient expired due to sudden development of pulmonary edema and hypotension during preoperative preparation.2) Among 9 cases of primary aldosteronism, 8 cases were aldosterone-producing adenoma(APA) and 1 case was idiopathic hyperaldosteronism(IHA). In differential diagnosis between APA and IHA, diagnostic accuracy of postural study and adrenal CT was 86%, 78% respectively. In each one case of APA and IHA, adrenal venous aldosterone sampling was used for the differential diagnosis. Six cases of APA were managed by appropriate surgery. One patient with APA who refuses surgery and one patient with IHA were placed on spironolactone with good response.3) Among 10 cases of pheochromocytoma, seven cases were from adrenal gland and three cases were paragangliomas including one case originating from liver and two cases from abdominal ganglia. One patient with pheochromocytoma was diagnosed in 1st trimester of pregnancy and she was successfully treated by surgery.We observed 26 cases of endocrine adrenal tumors which were successfully managed except one case. We think that it is important to pay attention to adrenal tumor for early diagnosis particulary when associated with pregnancy. Paraganglioma in liver, although very rare, should be included in the differential diagnosis of space occupying lesion in liver.

Endocrinological and Morphological Characteristics of Clinically Nonfunctioning Pituitary Adenoma.: Jae Wha Jo, Moon Suk Nam, Hyun Chul Lee, Tae Seung Kim, Kyu Chang Lee, Hyun Joo Jung; J Korean Endocr Soc. 1994;9(3):200-212. Published online November 6, 2019

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Abstract PDF: Forth-nine patients with clinically nonfunctioning pituitary adenomas were evaluated clinically, endocrinologically and morphologically in this study.The results obtained were as follows.1) The mean age was 47.1 years(range 23 to 76 years), and 22 were male(44.9%) and 27(55.1%) female.2) The major clinical manifestations of male patients were visual disturbance(72.7%), headache(54.5%), loss of libido(45.5%), but those of female visual disturbance(59.6%), headache(48.1%), amenorrhea(48.1%), loss of body hair(25.9%), and galactorrhea(22.2%).3) All were macroadenomas evaluated by CT scan, and in the male patients 16(72.7%) were grade III and 6(27.3%) grade IV by Hardy classification, and in the female patients 6(22.2%) were grade II, 12(44.4%) grade III, and 9(33.3%) grade IV.4) The elevation of serum prolactin were observed 7(31.8%) out of male, and 24(88.9%) of female.5) Combined stimulation test revealed that GH insufficiency was 89.6%, ACTH 58.9%, LH 58.7%, FSH 51.1 %, and TSH 50.0% and hormone insufficiency more than 4 pituitary hormone was 54.2%.6) Prolactin response to TRH decreased in 12(70.6%) of 17 patients with normal basal prolactin, and 19(76.0%) of 25 with elevated prolactin.7) Immunohistochemistry revealed that null cell adenoma was 57.1%, gonadotrope adenoma 26.5%, plurihormonal adenoma 8.0%, silent corticotrope adenoma 4.0%, thyrotrope adenoma(2.0%), and lactotrope adenoma(2.0%).8) The ultrastructural characteristics examined by electron-microscopy were similar despite of immunohistochemical differences.In summary, the prevalance of clinically nonfunctioning pituitary adenoma was middle aged men and women, and their main symptoms were visual disturbance and headache. Hyperprolactinemia and pituitary hormone insufficiency more than 4 hormone were observed commonly. Most of them were null cell adenoma and gonadotrope adenoma examined by immunohistochemistry. Further study using modern techniques: cell culture, subunit-immunostaining. And Northern blot analysis of mRNA for pituitary hormone or subunit, will be needed to clarify null cell adenomas.

Case Report

A Case of Thyrotropin - Secreting Pituitary Adenoma.: Seong Yeon Kim, Bo Youn Cho, Hong Kyu Lee, Chang Soon Koh, Woon Bae Kim, Hye Young Park, Jin Sung Kim; J Korean Endocr Soc. 1994;10(2):153-160. Published online November 6, 2019

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Abstract PDF: thyrotropin-secreting(TSH) pituitary adenoma is extremely rare condition causing hyperthyroidism by uncontrolled secretion of thyrotropin. Among total pituitary adenomas, less than 1 percent are thyrotropin-secreting type, and only about 150 cases have been reported till now. However, increasing numbers of cases are being found due to the availability of ultra-sensitive TSH assay. We report here a patient with thyrotropin-secreting pituitay adenoma secreting TSH with production of lutenizing hormone(LH), follicle stimulating hormone(FSH), growth hormone(GH), prolactin(PRL) and free alpha-subunit.A 21-years old man visited thyroid clinic because of palpitation and dyspnea on exertion. He had diffuse goiter and features of mild thyrotoxicosis, and his thyroid function test showed increased T3, T4 and normal TSH. Serum free alpha-subunit concentration was 7420.5pg/ml(24.7mIU/ml) and the molar ratio of free alpha-subunit to TSH was 15.9. Basal pituitary hormone levels except TSH and the response to combined pituitary stimulation test were normal. A large sellar mass extending into frontal lobe was found on sellar MRI, so it was removed surgically leaving residual tumor mass due to the extensive nature of tumor. In immunohistochemical study the tumor tissue was stained with antibodies to TSH, LH, FSH, GH and PRL. His hyperthyroidism and goiter disappeared after partial removal of tumor. Somatostatin analogue(octreotide acetate) were given continuously via subcutaneous route(150 ug/day) using infusion pump to reduce the size of residual tumor. After 4 months of octreotide infusion, the size of tumor decreased slightly, and he is under treatment without any side effect.

Review Article

10 Years Prospective Study for the Surgical Total Removal of Pituitary Tumor; Preliminary Report - 2, 5 Years Follow Up.: Eun Jig Lee, Sung Kil Lim, Kap Bum Huh, Sun Ho Kim, Dong Ik Kim, Byung Hee Lee, Ju Heon Yoon, Su Yeon Choi, Joong Uhn Choi, Sang Seop Chung, Kyu Chang Lee; J Korean Endocr Soc. 1994;10(2):85-94. Published online November 6, 2019

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Abstract PDF: The goal of the pituitary tumor surgery is restoration of the normal endocrine function and releaving the pressure effects of the tumor mass on the adjacent neural structures. The authors had proceeded with the 10 years prospective follow-up study for the endocrine function and recurrence of pituitary tumor in the patients who received the complete total resection of tumor mass by the means of total capsulectomy.The authors will discuss the preliminary result of 2.5 years follow-up of this study.

Case Report

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

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

Original Article

In Situ Hybridization Analysis of Human Growth Hormone and Prolactin Secreting Pitultary Adenomas.: Jae Wha Jo, Eun Jig Lee, Moon Suk Nam, Kyung Rae Kim, Sung Kil Lim, Hyun Chul Lee, Kap Bum Huh, Tae Seung Kim, Sun Ho Kim, Joong Uhn Choi, Kyu Chang Lee, Hyun Joo Jung, Sang Seop Chung; J Korean Endocr Soc. 1994;9(2):82-92. Published online November 6, 2019

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Abstract PDF: A non-isotopic in situ hybridization method with biotin-labelled oligonucleotide probes was used to examine growth hormone(GH) and prolactin(PRL) gene expression in 32 patients with pituitary adenomas; 13 were prolactinomas, 8 GH secreting adenomas, and 11 mixed GH and PRL secreting adenomas.Positive immunostaining for GH was found in all patients with GH secreting adenomas, and mixed GH and PRL secreting adenomas. Positive immunostaining for PRL was found in all patients with prolactinomas and 9(81.8%) of 11 mixed GH and PRL secreting adenomas, 5(62.5%) of 8 GH secreting adenomas. Immunohistochemistry revealed that 13 were lactotrope adenomas, 5 somatotrope adenomas, and 14 GH and PRL cell adenomas.In situ hybridization revealed that GH mRNA expression was found in all the patients with somatotrope adenomas and GH and PRL cell adenomas, and 6(46.1%) of 13 lactotrope adenomas. PRL mRNA expression was 100% in lactotrope and GH and PRL cell adenomas, and 4(80.0%) of 5 somatotrope adenomas.The patients with a clinical diagnosis of acromegaly had detectable PRL mRNA in their neoplasm and it is suggested that the PRL cells in the adenomas did not result from dedifferentiation, but from the neoplastic stimulus for some mixed tumors probably occurred in cells previously committed to produce PRL and GH. In lactotrope adenomas, the PRL cells of the patients without expression of GH mRNA may be arised from cells programmed to secrete PRL or precussor PRL cells rather than from mixed GH-PRL cells. The finding that some patients produced mRNA detectable by in situ hybridization, but no hormone detectable by immunohistochemistry within tumor was suggested of a silent adenoma.These observations indicated that in situ hybridization studies may improve the classification of pituitary adenomas and may provide a precise knowledge of the biology of these neoplasms.

Case Report

A Case of Adrenal adenoma Associated with Pregnancy.: Jung Gyn Kim, Jang Sik Choo, Yang Kyu Lee, Bung Chul Han, Seung Bum Jin, Sang Gi Yang, Chang Sup Song, Me Gyung Sin; J Korean Endocr Soc. 1994;9(1):39-45. Published online November 6, 2019

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Abstract PDF: We experienced a case of aldosterone and cortisol secreting adrenal adenoma associated with pregnancy in a 23 year old female patient.The patient complained of severe thoraco-lumbar pain, weight gain, sweating, anxiety, and mild abdominal discomfort. On physical findings, hypertension, tachycardia, facial plethora, moon face, buffalo hump and truncal obesity were found.

Original Article

Endocrine Research
Effects of Oxytocin on Cell Proliferation in a Corticotroph Adenoma Cell Line: Jung Soo Lim, Young Woo Eom, Eun Soo Lee, Hyeong Ju Kwon, Ja-Young Kwon, Junjeong Choi, Choon Hee Chung, Young Suk Jo, Eun Jig Lee; Endocrinol Metab. 2019;34(3):302-313. Published online September 26, 2019; DOI: https://doi.org/10.3803/EnM.2019.34.3.302

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Background

Oxytocin (OXT) has been reported to act as a growth regulator in various tumor cells. However, there is a paucity of data on the influence of OXT on cell proliferation of corticotroph adenomas. This study aimed to examine whether OXT affects cell growth in pituitary tumor cell lines (AtT20 and GH3 cells) with a focus on corticotroph adenoma cells.

Methods

Reverse transcription polymerase chain reaction and enzyme-linked immunosorbent assay were conducted with AtT20 cells to confirm the effects of OXT on hormonal activity; flow cytometry was used to assess changes in the cell cycle after OXT treatment. Moreover, the impact of OXT on proliferating cell nuclear antigen (PCNA), nuclear factor κB, and mitogen-activated protein kinase signaling pathway was analyzed by Western blot.

Results

OXT treatment of 50 nM changed the gene expression of OXT receptor and pro-opiomelanocortin within a short time. In addition, OXT significantly reduced adrenocorticotropic hormone secretion within 1 hour. S and G2/M populations of AtT20 cells treated with OXT for 24 hours were significantly decreased compared to the control. Furthermore, OXT treatment decreased the protein levels of PCNA and phosphorylated extracellular-signal-regulated kinase (P-ERK) in AtT20 cells.

Conclusion

Although the cytotoxic effect of OXT in AtT20 cells was not definite, OXT may blunt cell proliferation of corticotroph adenomas by altering the cell cycle or reducing PCNA and P-ERK levels. Further research is required to investigate the role of OXT as a potential therapeutic target in corticotroph adenomas.

Citations

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Increased proliferation and neuronal fate in prairie vole brain progenitor cells cultured in vitro: effects by social exposure and sexual dimorphism
Daniela Ávila-González, Italo Romero-Morales, Lizette Caro, Alejandro Martínez-Juárez, Larry J. Young, Francisco Camacho-Barrios, Omar Martínez-Alarcón, Analía E. Castro, Raúl G. Paredes, Néstor F. Díaz, Wendy Portillo
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Letter

Adrenal gland
An Ectopic Cortisol-Producing Adrenocortical Adenoma Masquerading as a Liposarcoma in the Pararenal Space: Sunyoung Kang, Seung Shin Park, Jae Hyun Bae, Kyu Eun Lee, Jung Hee Kim, Chan Soo Shin; Endocrinol Metab. 2018;33(3):423-424. Published online August 14, 2018; DOI: https://doi.org/10.3803/EnM.2018.33.3.423

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Review Articles

CTNNB1 Mutation in Aldosterone Producing Adenoma: Jian-Jhong Wang, Kang-Yung Peng, Vin-Cent Wu, Fen-Yu Tseng, Kwan-Dun Wu; Endocrinol Metab. 2017;32(3):332-338. Published online September 18, 2017; DOI: https://doi.org/10.3803/EnM.2017.32.3.332

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Discoveries of somatic mutations permit the recognition of subtypes of aldosterone-producing adenomas (APAs) with distinct clinical presentations and pathological features. Catenin β1 (CTNNB1) mutation in APAs has been recently described and discussed in the literature. However, significant knowledge gaps still remain regarding the prevalence, clinical characteristics, pathophysiology, and outcomes in APA patients harboring CTNNB1 mutations. Aberrant activation of the Wnt/β-catenin signaling pathway will further modulate tumorigenesis. We also discuss the recent knowledge of CTNNB1 mutation in adrenal adenomas.

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Recent Progress in the Medical Therapy of Pituitary Tumors: Fabienne Langlois, Shirley McCartney, Maria Fleseriu; Endocrinol Metab. 2017;32(2):162-170. Published online May 19, 2017; DOI: https://doi.org/10.3803/EnM.2017.32.2.162

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Management of pituitary tumors is multidisciplinary, with medical therapy playing an increasingly important role. With the exception of prolactin-secreting tumors, surgery is still considered the first-line treatment for the majority of pituitary adenomas. However, medical/pharmacological therapy plays an important role in controlling hormone-producing pituitary adenomas, especially for patients with acromegaly and Cushing disease (CD). In the case of non-functioning pituitary adenomas (NFAs), pharmacological therapy plays a minor role, the main objective of which is to reduce tumor growth, but this role requires further studies. For pituitary carcinomas and atypical adenomas, medical therapy, including chemotherapy, acts as an adjuvant to surgery and radiation therapy, which is often required to control these aggressive tumors. In the last decade, knowledge about the pathophysiological mechanisms of various pituitary adenomas has increased, thus novel medical therapies that target specific pathways implicated in tumor synthesis and hormonal over secretion are now available. Advancement in patient selection and determination of prognostic factors has also helped to individualize therapy for patients with pituitary tumors. Improvements in biochemical and “tumor mass” disease control can positively affect patient quality of life, comorbidities and overall survival. In this review, the medical armamentarium for treating CD, acromegaly, prolactinomas, NFA, and carcinomas/aggressive atypical adenomas will be presented. Pharmacological therapies, including doses, mode of administration, efficacy, adverse effects, and use in special circumstances are provided. Medical therapies currently under clinical investigation are also briefly discussed.

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Case Reports

Adrenal gland
Bilateral Adrenocortical Masses Producing Aldosterone and Cortisol Independently: Seung-Eun Lee, Jae Hyeon Kim, You-Bin Lee, Hyeri Seok, In Seub Shin, Yeong Hee Eun, Jung-Han Kim, Young Lyun Oh; Endocrinol Metab. 2015;30(4):607-613. Published online December 31, 2015; DOI: https://doi.org/10.3803/EnM.2015.30.4.607

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A 31-year-old woman was referred to our hospital with symptoms of hypertension and bilateral adrenocortical masses with no feature of Cushing syndrome. The serum aldosterone/renin ratio was elevated and the saline loading test showed no suppression of the plasma aldosterone level, consistent with a diagnosis of primary hyperaldosteronism. Overnight and low-dose dexamethasone suppression tests showed no suppression of serum cortisol, indicating a secondary diagnosis of subclinical Cushing syndrome. Adrenal vein sampling during the low-dose dexamethasone suppression test demonstrated excess secretion of cortisol from the left adrenal mass. A partial right adrenalectomy was performed, resulting in normalization of blood pressure, hypokalemia, and high aldosterone level, implying that the right adrenal mass was the main cause of the hyperaldosteronism. A total adrenalectomy for the left adrenal mass was later performed, resulting in a normalization of cortisol level. The final diagnosis was bilateral adrenocortical adenomas, which were secreting aldosterone and cortisol independently. This case is the first report of a concurrent cortisol-producing left adrenal adenoma and an aldosterone-producing right adrenal adenoma in Korea, as demonstrated by adrenal vein sampling and sequential removal of adrenal masses.

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Bilateral adrenal adenomas with autonomous cortisol secretion from both glands and autonomous aldosterone secretion from the left adrenal: a case report
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M. S. Annaev, B. I. Geltser, K. V. Stegniy, O. I. Pak, R. A. Goncharuk, S. M. Selyutin, A. M. Morozova, O. G. Tsygankova, E. V. Maslyantsev, V. G. Fisenko
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Rishi Raj, Philip A Kern, Neelima Ghanta, Edilfavia M Uy, Kamyar Asadipooya
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Adrenal Venous Sampling for Subtype Diagnosis of Primary Hyperaldosteronism
Mitsuhide Naruse, Akiyo Tanabe, Koichi Yamamoto, Hiromi Rakugi, Mitsuhiro Kometani, Takashi Yoneda, Hiroki Kobayashi, Masanori Abe, Youichi Ohno, Nobuya Inagaki, Shoichiro Izawa, Masakatsu Sone
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Hypercortisolism and primary aldosteronism caused by bilateral adrenocortical adenomas: a case report
Kaiyun Ren, Jia Wei, Qilin Liu, Yuchun Zhu, Nianwei Wu, Ying Tang, Qianrui Li, Qianying Zhang, Yerong Yu, Zhenmei An, Jing Chen, Jianwei Li
BMC Endocrine Disorders.2019;[Epub] CrossRef

Adrenal gland
Untreated Congenital Adrenal Hyperplasia with 17-α Hydroxylase/17,20-Lyase Deficiency Presenting as Massive Adrenocortical Tumor: Su Jin Lee, Je Eun Song, Sena Hwang, Ji-Yeon Lee, Hye-Sun Park, Seunghee Han, Yumie Rhee; Endocrinol Metab. 2015;30(3):408-413. Published online August 4, 2015; DOI: https://doi.org/10.3803/EnM.2015.30.3.408

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Congenital adrenal hyperplasia (CAH) with 17α-hydroxylase/17,20-lyase deficiency is usually characterized by hypertension and primary amenorrhea, sexual infantilism in women, and pseudohermaphroditism in men. hypertension, and sexual infantilism in women and pseudohermaphroditism in men. In rare cases, a huge adrenal gland tumor can present as a clinical manifestation in untreated CAH. Adrenal cortical adenoma is an even more rare phenotype in CAH with 17α-hydroxylase/17,20-lyase deficiency. A 36-year-old female presented with hypertension and abdominal pain caused by a huge adrenal mass. Due to mass size and symptoms, left adrenalectomy was performed. After adrenalectomy, blood pressure remained high. Based on hormonal and genetic evaluation, the patient was diagnosed as CAH with 17α-hydroxylase/17,20-lyase deficiency. The possibility of a tumorous change in the adrenal gland due to untreated CAH should be considered. It is important that untreated CAH not be misdiagnosed as primary adrenal tumor as these conditions require different treatments. Adequate suppression of adrenocorticotropic hormone (ACTH) in CAH is also important to treat and to prevent the tumorous changes in the adrenal gland. Herein, we report a case of untreated CAH with 17α-hydroxylase/17,20-lyase deficiency presenting with large adrenal cortical adenoma and discuss the progression of adrenal gland hyperplasia due to inappropriate suppression of ACTH secretion.

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Journal of the Endocrine Society.2022;[Epub] CrossRef
17α-hydroxylase Deficiency Mimicking Hyperaldosteronism by Aldosterone-producing Adrenal Adenoma
Yun Kyung Cho, Hyeseon Oh, Sun-myoung Kang, Sujong An, Jin-Young Huh, Ji-Hyang Lee, Woo Je Lee
The Korean Journal of Medicine.2016; 91(2): 191. CrossRef

Review Article

Adrenal gland
Clinical Guidelines for the Diagnosis and Treatment of Cushing's Disease in Korea: Kyu Yeon Hur, Jung Hee Kim, Byung Joon Kim, Min-Seon Kim, Eun Jig Lee, Sung-Woon Kim; Endocrinol Metab. 2015;30(1):7-18. Published online March 27, 2015; DOI: https://doi.org/10.3803/EnM.2015.30.1.7

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Cushing's disease (CD) is a rare disorder characterized by the overproduction of adrenocorticotropic hormone due to a pituitary adenoma that ultimately stimulates excessive cortisol secretion from the adrenal glands. Prior to the detection of pituitary adenomas, various clinical signs of CD such as central obesity, moon face, hirsutism, and facial plethora are usually already present. Uncontrolled hypercortisolism is associated with metabolic, cardiovascular, and psychological disorders that result in increased mortality. Hence, the early detection and treatment of CD are not only important but mandatory. Because its clinical manifestations vary from patient to patient and are common in other obesity-related conditions, the precise diagnosis of CD can be problematic. Thus, the present set of guidelines was compiled by Korean experts in this field to assist clinicians with the screening, diagnoses, and treatment of patients with CD using currently available tests and treatment modalities.

Citations

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Endocrine Journal.2026; 73(2): 355. CrossRef
Consensus on the Diagnosis of Cushing’s Disease: A Collaborative Statement from the Korean Endocrine Society and Japan Endocrine Society
Jeongmin Lee, Hidenori Fukuoka, Seung Shin Park, A Ram Hong, Jung Hee Kim, Sang Ouk Chin, Han-Sang Baek, Dong-Jun Lim, Kazunori Kageyama, Mitsuru Nishiyama, Shigeyuki Tahara, Kenichi Oyama, Akira Sugawara, Miho Yamashita, Naoko Inoshita, Hiroshi Arima, By
Endocrinology and Metabolism.2026; 41(1): 1. CrossRef
Clinical Implications of Molecular and Genetic Biomarkers in Cushing’s Disease: A Literature Review
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Aysun Seker, Dilek Gogas Yavuz
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Sahar Fereidouni, Najmeh Hejazi, Reza Homayounfar, Mojtaba Farjam
Food Science & Nutrition.2023; 11(3): 1563. CrossRef
Role of computed tomography in predicting adrenal adenomas with cortisol hypersecretion
Chan Kyo Kim, Kyung A Kang, Young Lyun Oh, Sung Yoon Park
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British Journal of Nutrition.2022; 128(2): 237. CrossRef
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Endocrinology and Metabolism.2022; 37(6): 851. CrossRef
Pituitary adenomas: current principles of diagnosis and treatment
L. I. Astafyeva, I. V. Chernov, I. V. Chekhonin, E. I. Shults, I. N. Pronin, P. L. Kalinin
Russian journal of neurosurgery.2021; 22(4): 94. CrossRef
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Vestnik nevrologii, psihiatrii i nejrohirurgii (Bulletin of Neurology, Psychiatry and Neurosurgery).2021; (2): 143. CrossRef
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Voprosy neirokhirurgii imeni N.N. Burdenko.2021; 85(4): 111. CrossRef
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Usefulness of prolactin measurement in inferior petrosal sinus sampling with desmopressin for Cushing’s syndrome
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British Journal of Neurosurgery.2020; 34(3): 253. CrossRef
Hormonal aggressiveness according to the expression of cellular markers in corticotroph adenomas
Jung Soo Lim, Mi-Kyung Lee, Eunhee Choi, Namki Hong, Soo Il Jee, Sun Ho Kim, Eun Jig Lee
Endocrine.2019; 64(1): 147. CrossRef
Clinical Parameters to Distinguish Silent Corticotroph Adenomas from Other Nonfunctioning Pituitary Adenomas
Daham Kim, Cheol Ryong Ku, Se Hee Park, Ju Hyung Moon, Eui Hyun Kim, Sun Ho Kim, Eun Jig Lee
World Neurosurgery.2018; 115: e464. CrossRef
Blood Tests for the Diagnosis of Adrenal Diseases
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Choosing wisely: la lista del gruppo di studio Endocrinologia e Malattie del Metabolismo della Società Italiana di Patologia Clinica e Medicina di Laboratorio
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Surgical Management of Adrenocorticotropic Hormone-Secreting Pituitary Adenomas
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International Journal of Endocrine Oncology.2016; 3(1): 41. CrossRef

Original Article

Adrenal gland
Using Growth Hormone Levels to Detect Macroadenoma in Patients with Acromegaly: Ji Young Park, Jae Hyeon Kim, Sun Wook Kim, Jae Hoon Chung, Yong-Ki Min, Myung-Shik Lee, Moon-Kyu Lee, Kwang-Won Kim; Endocrinol Metab. 2014;29(4):450-456. Published online December 29, 2014; DOI: https://doi.org/10.3803/EnM.2014.29.4.450

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Background

The aim of this study was to assess the clinical differences between acromegalic patients with microadenoma and patients with macroadenoma, and to evaluate the predictive value of growth hormone (GH) levels for early detection of macroadenoma.

Methods

We performed a retrospective analysis of 215 patients diagnosed with a GH-secreting pituitary adenoma. The patients were divided into two groups: the microadenoma group and the macroadenoma group, and the clinical parameters were compared between these two groups. The most sensitive and specific GH values for predicting macroadenoma were selected using receiver operating characteristic (ROC) curves.

Results

Compared with the microadenoma group, the macroadenoma group had a significantly younger age, higher body mass index, higher prevalence of hyperprolactinemia and hypogonadism, and a lower proportion of positive suppression to octreotide. However, there were no significant differences in the gender or in the prevalence of diabetes between the two groups. The tumor diameter was positively correlated with all GH values during the oral glucose tolerance test (OGTT). All GH values were significantly higher in the macroadenoma group than the microadenoma group. Cut-off values for GH levels at 0, 30, 60, 90, and 120 minutes for optimal discrimination between macroadenoma and microadenoma were 5.6, 5.7, 6.3, 6.0, and 5.8 ng/mL, respectively. ROC curve analysis revealed that the GH value at 30 minutes had the highest area under the curve.

Conclusion

The GH level of 5.7 ng/mL or higher at 30 minutes during OGTT could provide sufficient information to detect macroadenoma at the time of diagnosis.

Citations

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Growth Hormone Assay-Adjusted Standardization Reveals Distinct Clinical Phenotypes in Acromegaly
Betina Biagetti, Pedro Marques, Roser Ferrer, Luís Miguel Cardoso, Eva Venegas Moreno, Carmen Fajardo-Montañana, Laura Gonzalez-Fernandez, Marta María Pérez Pena, Rogelio García-Centeno, Claudia Lozano-Aida, Iría Novoa-Testa, Eider Pascual-Corrales, Raúl
Endocrine Practice.2026; 32(2): 236. CrossRef
Does size really matter? A closer look at the absolute size of growth hormone-secreting pituitary adenomas
Katharina Schilbach, Gérald Raverot
Pituitary.2024; 27(5): 440. CrossRef
Sex differences in acromegaly at diagnosis: A nationwide cohort study and meta‐analysis of the literature
Jakob Dal, Benedikte G. Skov, Marianne Andersen, Ulla Feldt‐Rasmussen, Claus L. Feltoft, Jesper Karmisholt, Eigil H. Nielsen, Olaf M. Dekkers, Jens Otto L. Jørgensen
Clinical Endocrinology.2021; 94(4): 625. CrossRef
Pretreatment serum GH levels and cardio-metabolic comorbidities in acromegaly; analysis of data from Iran Pituitary Tumor Registry
Leila Hedayati Zafarghandi, Mohammad Ebrahim Khamseh, Milad Fooladgar, Shahrzad Mohseni, Mostafa Qorbani, Nahid Hashemi Madani, Mahboobeh Hemmatabadi, MohammadReza Mohajeri-Tehrani, Nooshin Shirzad
Journal of Diabetes & Metabolic Disorders.2020; 19(1): 319. CrossRef
Increased serum nesfatin-1 levels in patients with acromegaly
Yakun Yang, Song Han, Zuocheng Yang, Pengfei Wang, Chang-Xiang Yan, Ning Liu
Medicine.2020; 99(40): e22432. CrossRef
Articles in 'Endocrinology and Metabolism' in 2014
Won-Young Lee
Endocrinology and Metabolism.2015; 30(1): 47. CrossRef

Case Reports

Adrenal gland
Adrenocorticotropic Hormone-Independent Cushing Syndrome with Bilateral Cortisol-Secreting Adenomas: Eu Jeong Ku, A Ram Hong, Ye An Kim, Jae Hyun Bae, Mee Soo Chang, Sang Wan Kim; Endocrinol Metab. 2013;28(2):133-137. Published online June 18, 2013; DOI: https://doi.org/10.3803/EnM.2013.28.2.133

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A 48-year-old woman was incidentally found to have bilateral adrenal masses, 2.8 cm in diameter on the right, and 2.3 cm and 1.7 cm in diameter on the left, by abdominal computed tomography. The patient had a medical history of hypertension, which was not being controlled by carvedilol, at a dose of 25 mg daily. She presented with signs and symptoms that suggested Cushing Syndrome. We diagnosed adrenocorticotropic hormone (ACTH)-independent Cushing Syndrome based on the results of basal and dynamic hormone tests. Adrenal vein sampling (AVS) was performed to localize a functioning adrenal cortical mass. AVS results were consistent with hypersecretion of cortisol from both adrenal glands, with a cortisol lateralization ratio of 1.1. Upon bilateral laparoscopic adrenalectomy, bilateral ACTH-independent adrenal adenomas were found. The patient's signs and symptoms of Cushing Syndrome improved after surgery just as the blood pressure was normalized. After surgery, the patient was started on glucocorticoid and mineralocorticoid replacement therapy.

Citations

Citations to this article as recorded by

Recent Advances in the Clinical Application of Adrenal Vein Sampling
Shan Zhong, Tianyue Zhang, Minzhi He, Hanxiao Yu, Zhenjie Liu, Zhongyi Li, Xiaoxiao Song, Xiaohong Xu
Frontiers in Endocrinology.2022;[Epub] CrossRef
The role of adrenal venous sampling (AVS) in primary bilateral macronodular adrenocortical hyperplasia (PBMAH): a study of 16 patients
German Rubinstein, Andrea Osswald, Leah Theresa Braun, Frederick Vogel, Matthias Kroiss, Stefan Pilz, Sinan Deniz, Laura Aigner, Thomas Knösel, Jérôme Bertherat, Lucas Bouys, Roland Ladurner, Anna Riester, Martin Bidlingmaier, Felix Beuschlein, Martin Rei
Endocrine.2022; 76(2): 434. CrossRef
Concomitant coexistence of ACTH‐dependent and independent Cushing syndrome
Ach Taieb, Saad Ghada, Gorchène Asma, Ben Abdelkrim Asma, Kacem Maha, Ach Koussay
Clinical Case Reports.2022;[Epub] CrossRef
The Value of Adrenal Androgens for Correcting Cortisol Lateralization in Adrenal Venous Sampling in Patients with Normal Cortisol Secretion
Wenjing Zhang, Keying Zhu, Hongyun Li, Yan Zhang, Dalong Zhu, Xuebin Zhang, Ping Li
International Journal of Endocrinology.2019; 2019: 1. CrossRef
Adrenal venous sampling in patients with ACTH-independent hypercortisolism
Eleni Papakokkinou, Hugo Jakobsson, Augustinas Sakinis, Andreas Muth, Bo Wängberg, Olof Ehn, Gudmundur Johannsson, Oskar Ragnarsson
Endocrine.2019; 66(2): 338. CrossRef
ACTH-independent Cushing’s syndrome with bilateral cortisol-secreting adrenal adenomas: a case report and review of literatures
Jia Wei, Sheyu Li, Qilin Liu, Yuchun Zhu, Nianwei Wu, Ying Tang, Qianrui Li, Kaiyun Ren, Qianying Zhang, Yerong Yu, Zhenmei An, Jing Chen, Jianwei Li
BMC Endocrine Disorders.2018;[Epub] CrossRef
A case of adrenal Cushing’s syndrome with bilateral adrenal masses
Ya-Wun Guo, Chii-Min Hwu, Justin Ging-Shing Won, Chia-Huei Chu, Liang-Yu Lin
Endocrinology, Diabetes & Metabolism Case Reports.2016;[Epub] CrossRef
Bilateral Adrenocortical Masses Producing Aldosterone and Cortisol Independently
Seung-Eun Lee, Jae Hyeon Kim, You-Bin Lee, Hyeri Seok, In Seub Shin, Yeong Hee Eun, Jung-Han Kim, Young Lyun Oh
Endocrinology and Metabolism.2015; 30(4): 607. CrossRef
Brief Review of Articles in 'Endocrinology and Metabolism' in 2013
Won-Young Lee
Endocrinology and Metabolism.2014; 29(3): 251. CrossRef
A Case of Bilateral ACTH-independent Adrenal Adenomas with Cushing's Syndrome Treated by Ipsilateral Total and Contralateral Partial Laparoscopic Adrenalectomy
Seung Ah Park, Dong min Jung, Soon young Kim, Nan Young Choi, Tae-jun Kim, Yong kyun Kim, Seong kyun Na, Chul Sik Kim, Seong Jin Lee, Sung-Hee Ihm, Jun Goo Kang
The Korean Journal of Obesity.2013; 22(4): 254. CrossRef

Two Case of Primary Aldosteronism Induced by Aldosterone Producing Adrenal Adenoma in a Family.: Young Rock Jang, Sei Hyun Kim, Young Sil Eom, Ki Young Lee; Endocrinol Metab. 2012;27(4):329-333. Published online December 20, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.4.329

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Abstract PDF: Primary aldosteronism, is defined as a group of disorders characterized by the excess of aldosteron, with suppressed rennin activity, resulting in hypertension and hypokalemia. In most cases, primary aldosteronism is sporadic due to a unilateral adrenal adenoma or bilateral adrenal hyperplasia. Familial hyperaldosteronism is a rare cause of primary aldosteronism and its prevalence has not been established well. We describe two cases of primary aldosteronism in a family involving a sister and brother due to an aldosterone producing adenoma in the left adrenal gland. Their hypokalemia and hypertension were cured by complete resection of the adrenal adenoma. Genetic analyses could not be done because of patients' rejection.

A Case of Adrenal Cystic Pheochromocytoma with Contralateral Adrenocortical Adenoma Causing Subclinical Cushing's Syndrome.: Chang Jun Park, Joo Wan Seo, Hyeog Gyu Seoung, Jung Hee Koh, Yong Jae Lee, Bo Hyun Kim, In Ju Kim; Endocrinol Metab. 2012;27(4):323-328. Published online December 20, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.4.323

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Abstract PDF

Bilateral adrenal neoplasms are associated with metastatic cancer, pheochromocytoma and lymphoma. The coexistence of a unilateral functioning adrenocortical adenoma with contralateral pheochromocytoma is extremely rare. A 52-year-old woman complained of fatigue, headache, palpitation, and progressive weight gain. Hormonal assessment demonstrated high 24 hours urine epinephrine, norepinephrine, and free cortisol. A dexamethasone suppression test (overnight 1 mg, low dose 2 mg) showed insuppressible cortisol. Computerized tomographic scanning revealed a bilateral adrenal tumor. To preserve adrenal function, right adrenalectomy along with left adrenal tumorectomy was performed. Histological finding of the right adrenal tumor was pheochromocytoma and the left adrenal tumor was adrenocortical adenoma. This patient was the first case of a functional adrenocortical adenoma with contralateral cystic pheochromocytoma in Korea. We report the case with a review of the literature.

Citations

Citations to this article as recorded by

A Case of Bilateral ACTH-independent Adrenal Adenomas with Cushing's Syndrome Treated by Ipsilateral Total and Contralateral Partial Laparoscopic Adrenalectomy
Seung Ah Park, Dong min Jung, Soon young Kim, Nan Young Choi, Tae-jun Kim, Yong kyun Kim, Seong kyun Na, Chul Sik Kim, Seong Jin Lee, Sung-Hee Ihm, Jun Goo Kang
The Korean Journal of Obesity.2013; 22(4): 254. CrossRef

Original Article

Characterization of Incidentally Detected Adrenal Pheochromocytoma.: Ye An Kim, Yul Hwangbo, Min Joo Kim, Hyung Jin Choi, Je Hyun Seo, Yenna Lee, Soo Heun Kwak, Eu Jeong Ku, Tae Jung Oh, Eun Roh, Jae Hyun Bae, Jung Hee Kim, Kyoung Soo Park, Seong Yeon Kim; Endocrinol Metab. 2012;27(2):132-137. Published online June 20, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.2.132

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Abstract PDF

BACKGROUND
In approach to an adrenal incidentaloma, early exclusion of pheochromocytoma is clinically important, due to the risk of catecholamine crisis. The aims of this study are to investigate the characteristics of incidentally detected pheochromocytomas, compared with that of the other adrenal incidentalomas, and to compare these characteristics with those of symptomatic pheochromocytomas. METHODS: In this retrospective study, we reviewed the medical records of 198 patients with adrenal incidentaloma from 2001 to 2010. We analyzed the clinical, laboratory and radiological data of pheochromocytomas, in comparison with those of the other adrenal incidentalomas. We also compared the characteristics of these incidentally detected pheochromocytomas with the medical records of 28 pathologically proven pheochromocytomas, diagnosed based on typical symptoms. RESULTS: Among the 198 patients with adrenal incidentaloma, nineteen patients were diagnosed with pheochromocytoma. Pheochromocytomas showed larger size and higher Hounsfield unit at precontrast computed tomography (CT) than did non-pheochromocytomas. All pheochromocytomas were larger than 2.0 cm, and the Hounsfield units were 19 or higher in precontrast CT. When both criteria of size > 2.0 cm and Hounsfield unit > 19 were met, the sensitivity and specificity for the diagnosis of pheochromocytoma were 100% and 79.3%, respectively. Compared with patients with pheochromocytoma, diagnosed based on typical symptoms, patients with incidentally detected pheochromocytoma were older, presented less often with hypertension, and showed lower levels of 24-hour urine metanephrine. CONCLUSION: Adrenal incidentaloma with < 2.0 cm in size or < or = 19 Hounsfield units in precontrast CT imaging was less likely to be a pheochromocytoma. Patients with incidentally discovered pheochromocytoma showed lower catecholamine metabolites, compared with those patients with symptomatic pheochromocytoma.

Citations

Citations to this article as recorded by

Guidelines for the Management of Adrenal Incidentaloma: the Korean Endocrine Society, Committee of Clinical Practice Guidelines
Jung-Min Lee, Mee Kyoung Kim, Seung-Hyun Ko, Jung-Min Koh, Bo-Yeon Kim, Sang-Wan Kim, Soo-Kyung Kim, Hae-Jin Kim, Ohk-Hyun Ryu, Juri Park, Jung-Soo Lim, Seong Yeon Kim, Young Kee Shong, Soon Jib Yoo
The Korean Journal of Medicine.2017; 92(1): 4. CrossRef
Clinical Guidelines for the Management of Adrenal Incidentaloma
Jung-Min Lee, Mee Kyoung Kim, Seung-Hyun Ko, Jung-Min Koh, Bo-Yeon Kim, Sang Wan Kim, Soo-Kyung Kim, Hae Jin Kim, Ohk-Hyun Ryu, Juri Park, Jung Soo Lim, Seong Yeon Kim, Young Kee Shong, Soon Jib Yoo
Endocrinology and Metabolism.2017; 32(2): 200. CrossRef
Characterization of Incidentally Detected Adrenal Pheochromocytoma
Soon Jib Yoo, Woohyeon Kim
Endocrinology and Metabolism.2012; 27(2): 116. CrossRef

Case Reports

A Case of Primary Hyperparathyroidism Caused by Solitary Parathyroid Adenoma That was Not Detected by Both Ultrasonography and Sestamibi Scan.: Kyong Yong Oh, Byoungho Choi, Yukyung Lee, Do Hwan Kim, Hyon Seung Yi, Kwang Jun Kim, Sihoon Lee, Sung Kil Lim; Endocrinol Metab. 2011;26(2):166-170. Published online June 1, 2011; DOI: https://doi.org/10.3803/EnM.2011.26.2.166

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Abstract PDF

Thanks to advances in assay techniques and routine measurements in serum chemical analysis, primary hyperparathyroidism has become far more frequently detected, and the number of asymptomatic patients has substantially increased. In the majority of patients (85%), a solitary adenoma is the underlying cause of primary hyperparathyroidism. Surgical excision is the treatment of choice for most cases of primary hyperparathyroidism; this procedure has a relatively high success rate. In the past decade, improvements in preoperative imaging have played a major role in a targeted operative approach, which allows for minimally invasive surgery to be performed. The success of parathyroid surgery depends on the accurate preoperative localization of parathyroid adenoma. In this study, we report the case of a 54 year-old woman with primary hyperparathyroidism who presented with left buttock and leg pain. For localization of the parathyroid lesion, an ultrasonography and a 99mTc-sestamibi scan were initially performed, but these attempts failed to localize the lesion. We then carried out contrast-enhanced CT; thereafter, a single parathyroid adenoma was detected. Therefore, in patients with negative results on both ultrasonography and 99mTc-sestamibi scan, contrast-enhanced CT may prove helpful for preoperative parathyroid localization.

Citations

Citations to this article as recorded by

Primary Hyperparathyroidism with Ectopic Parathyroid Adenoma Detected by Both99mTc-MIBI SPECT and Contrast-Enhanced Neck CT
Hye Jin Lim, Dong Geum Shin, Jun Bong Kim, Jin Taek Kim, Hyo Jeong Kim, Man Sil Park, Ho Jeong Lee
Korean Journal of Medicine.2012; 83(5): 641. CrossRef

A Case of Pituitary Adenoma with Simultaneous Secretion of TSH and GH.: Eun Young Lee, Cheol Ryong Ku, Hyun Min Kim, Woo Kyoung Lee, Jung Soo Lim, Sena Hwang, Do Hwan Kim, Dong Yeob Shin, Eun Jig Lee; Endocrinol Metab. 2011;26(2):160-165. Published online June 1, 2011; DOI: https://doi.org/10.3803/EnM.2011.26.2.160

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Abstract PDF

Thyrotropin (TSH)-secreting pituitary adenoma is a very rare disease. In one-quarter of patients suffering from this disease, the pituitary tumor secretes other anterior pituitary hormones. Herein, we report a case of pituitary adenoma with simultaneous secretion of TSH and growth hormone (GH). A 34-year-old female visitied local hospital complaining of sweating, intermittent palpitation, and weight loss of 8 kg within 1 year. The patient had undergone trans-sphenoidal surgery 3 years prior for resolution of a TSH and GH co-secreting pituitary adenoma. She had been administered somatostatin analogue prior to visiting our hospital. The patient's GH levels were suppressed to below 1 ng/mL on the 75 g oral glucose tolerance test, and her basal insulin-like growth factor-I (IGF-I) level was within normal range. Thyroid function tests demonstrated increased levels of both free thyroxine and TSH. Sella-MRI revealed pituitary adenoma at the floor of the pituitary fossa, approximately 2 cm in height. Therefore, she was diagnosed with residual TSH-secreting pituitary adenoma. The patient again underwent trans-sphenoidal surgery and entered complete remission, based on hormone levels and MRI findings.

Citations

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Endoscopic Transsphenoidal Surgery of Pituitary Adenomas: Preliminary Results of the Neurosurgery Service of Hospital Cristo Redentor
Gerson Perondi, Afonso Mariante, Fernando Azambuja, Gabriel Frizon Greggianin, Wanderson William dos Santos Dias, Giulia Pinzetta
Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery.2023; 42(02): e89. CrossRef
A case of a co-secreting TSH and growth hormone pituitary adenoma presenting with a thyroid nodule
Laura Hamilton Adams, Derick Adams
Endocrinology, Diabetes & Metabolism Case Reports.2018;[Epub] CrossRef

A Case of Type Ia Glycogen Storage Disease Diagnosed in the Military Hospital.: Tae Woong Lee, Sang Youl Rhee, Joo Young Kim, Gu Hwan Kim, Han Wook Yoo, Jeong Taek Woo, Byung Ho Kim; Endocrinol Metab. 2011;26(1):84-88. Published online March 1, 2011; DOI: https://doi.org/10.3803/EnM.2011.26.1.84

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Abstract PDF: We report here on a case of genetically confirmed type Ia glycogen storage disease (GSD) that was diagnosed in the military hospital. A twenty-year old soldier was admitted to the hospital with abdominal fullness. He had a past medical history of hepatomegaly that was firstly recognized at six months after birth, and he had been followed-up at an outpatient clinic with the presumptive diagnosis of type III GSD. He also had a history of growth hormone therapy because of growth retardation. However, he arbitrarily refused medical observation from 14 years of age. On the physical examination, the height of the patient was 163.1 cm and significant hepatomegaly was observed. Significantly abnormal liver-associated paramters were observed on the laboratory findings and multiple hepatic adenomas were observed on the CT exam and MRI scan. To determine the proper treatment, we tried to confirm the exact type of GSD in the patient. By mutational analysis, we found the c.648G>T homozygote splicing mutation in the G6PC gene and the patient was confirmed as having the type Ia GSD.

Original Article

Association of the Parathyroid Adenoma Volume and the Biochemical Parameters in Primary Hyperparathyroidism.: Yul Hwang-Bo, Jung Hee Kim, Jee Hyun An, Eun Shil Hong, Jung Hun Ohn, Eun Ky Kim, Ah Reum Khang, Sun Wook Cho, Do Joon Park, Kyong Soo Park, Seong Yeon Kim, Bo Youn Cho, Chan Soo Shin; Endocrinol Metab. 2011;26(1):62-66. Published online March 1, 2011; DOI: https://doi.org/10.3803/EnM.2011.26.1.62

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Abstract PDF

BACKGROUND
The objective of this study is to demonstrate the relationship between the volume of a parathyroid adenoma and the preoperative biochemical parameters in patients undergoing surgery for primary hyperparathyroidism. METHODS: The medical records of 68 patients who underwent a parathyroidectomy for a single parathyroid adenoma were retrospectively reviewed. The volume of the adenoma was estimated using its measured size and a mathematical formula. The correlation between the volume of the parathyroid adenoma and the preoperative laboratory data was assessed. RESULTS: There were no correlations between the estimated volume of the adenoma and the serum calcium, alkaline phosphatase and parathyroid hormone levels. However, the volume of the adenoma was associated with the preoperative level of serum phosphorus. After excluding 5 adenomas with cystic degeneration, a positive correlation was noted between the adenoma volume and the preoperative levels of alkaline phosphatase and parathyroid hormone. CONCLUSION: The preoperative serum levels of calcium, alkaline phosphatase and parathyroid hormone are of limited use to predict the volume of the parathyroid adenoma in patients with a single parathyroid adenoma. We suggest that the absence of a correlation between the volume of the adenoma and the biochemical parameters can be attributed to the cystic degeneration of the adenomas.

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Differentiating pathologic parathyroid glands from thyroid nodules on neck ultrasound: the PARATH-US cross-sectional study
Dolly Yazgi, Carine Richa, Sylvie Salenave, Peter Kamenicky, Amel Bourouina, Lorraine Clavier, Margot Dupeux, Jean-François Papon, Jacques Young, Philippe Chanson, Luigi Maione
The Lancet Regional Health - Europe.2023; 35: 100751. CrossRef
Primer hiperparatiroidide Tc99m-MIBI sintigrafi sonuçlarının biyokimyasal ve histopatolojik bulgular ile ilişkisi
Seda TURGUT, Ezgi Başak ERDOĞAN
OSMANGAZİ JOURNAL OF MEDICINE.2020;[Epub] CrossRef
Letter: Association of the Parathyroid Adenoma Volume and the Biochemical Parameters in Primary Hyperparathyroidism (Endocrinol Metab 26:62-66, 2011, Yul Hwang-Bo et al.)
Dong Jin Chung
Endocrinology and Metabolism.2011; 26(2): 185. CrossRef

Case Report

The Effect of Octreotide LAR on GH and TSH Co-Secreting Pituitary Adenoma.: Nam Keong Kim, Yu Jin Hah, Ho Young Lee, Sang Jin Kim, Mi Kyung Kim, Keun Gyu Park, Ealmaan Kim, Hyukwon Chang, Hye Soon Kim; Endocrinol Metab. 2010;25(4):378-381. Published online December 1, 2010; DOI: https://doi.org/10.3803/EnM.2010.25.4.378

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Abstract PDF: Growth hormone (GH) and thyroid stimulating hormone (TSH)-secreting pituitary adenomas are very rare and they account for only 0.5% for all pituitary adenomas. These adenomas are usually treated with surgery, but this surgery is not easy because the tumor is usually huge and invasive. We reported here on a case of a GH-TSH-secreting adenoma in a 23-year-old male patient who was initially treated with octreotide LAR. He presented with symptoms of headache, palpitation and a visual defect that he had for the 3 months. He had hypertrophy of the frontal bone and enlargement of both the hands and feet. The visual field test showed bitemporal hemianopsia. The laboratory examinations showed high serum levels of free T4, TSH and free alpha-subunit. Additionally, the serum levels of GH and insulin-like growth factor-I (IGF-I) were increased. GH was not suppressed below 1microg/L by an oral 75g glucose loading test, and TSH was not stimulated by thyrotropin-releasing hormone (TRH). Because sellar MRI showed invasive macroadenoma encasing the vessels, we initially tried octreotide LAR for treatment. A year later, the IGF-I and thyroid function tests were normalized and the size of the tumor was reduced with cystic change. The symptoms of palpitation and headache were improved without a change of the visual field defect.

Original Article

Correlation between Pituitary Insufficiency and Magnetic Resonance Imaging Finding in Non-Functioning Pituitary Adenomas.: Hyun Min Kim, Cheol Ryong Ku, Eun Young Lee, Woo Kyung Lee, Jung Soo Lim, Sena Hwang, Mi Jung Lee, Seung Ku Lee, Sun Ho Kim, Eun Jig Lee; Endocrinol Metab. 2010;25(4):310-315. Published online December 1, 2010; DOI: https://doi.org/10.3803/EnM.2010.25.4.310

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Abstract PDF

BACKGROUND
Non-functioning pituitary adenomas (NFPAs) are characterized by the absence of clinical and biochemical evidence of pituitary hormone hypersecretion, and these tumors constitute approximately one third of all the tumors of the anterior pituitary. Recently, hormonal deficiencies have gradually evolved to become the leading presenting signs and symptoms in patients with NFPAs. We investigated pituitary hormonal insufficiencies according to the magnetic resonance imaging (MRI) findings in patients with NFPA. METHODS: We evaluated the patients who were newly diagnosed with NFPA from 1997 through 2009. Among them, we analyzed 387 patients who were tested for their combined pituitary function and who underwent MRI. The severity of the hypopituitarism was determined by the number of deficient axes of the pituitary hormones. On the MRI study, the maximal diameter of the tumor, Hardy's classification, the thickness of the pituitary gland and the presence of stalk compression were evaluated. RESULTS: The mean age was 46.85 +/- 12.93 years (range: 15-86) and 186 patients (48.1%) were male. As assessed on MRI, the tumor diameter was 27.87 +/- 9.93 mm, the thickness of the normal pituitary gland was 1.42 +/- 2.07 mm and stalk compression was observed in 201 patients (51.9%). Hypopituitarism was observed in 333 patients (86.0%). Deficiency for each pituitary hormone was most severe in the patients with Hardy type IIIA. Hypopituitarism was severe in the older age patients (P = 0.001) and the patients with a bigger tumor size (P < 0.001) and the presence of stalk compression (P < 0.001). However, the patients who had a thicker pituitary gland showed less severe hypopituitarism (P < 0.001). Multivariate analysis showed that age, tumor diameter and the thickness of pituitary gland were important determinants for pituitary deficiency (P = 0.004, P < 0.001, P = 0.022, respectively). CONCLUSION: The results suggest that the hormonal deficiencies in patient with NFPA were correlated with the MRI findings, and especially the tumor diameter and preservation of the pituitary gland.

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Clinical Parameters to Distinguish Silent Corticotroph Adenomas from Other Nonfunctioning Pituitary Adenomas
Daham Kim, Cheol Ryong Ku, Se Hee Park, Ju Hyung Moon, Eui Hyun Kim, Sun Ho Kim, Eun Jig Lee
World Neurosurgery.2018; 115: e464. CrossRef

Case Reports

A Case of Recurrent Ectopic Parathyroid Adenoma Developed 22 Years after the Initial Parathyroidectomy.: Yoon Jung Kim, Ji A Seo, Ji Mi Moon, Young Jin Seo, Hae Yoon Choi, Hye Sook Kim, Sin Gon Kim, Kyeung mook Choi, Sei Hyun Baik, Dong Seop Choi, Nan Hee Kim; J Korean Endocr Soc. 2009;24(4):260-264. Published online December 1, 2009; DOI: https://doi.org/10.3803/jkes.2009.24.4.260

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Abstract PDF: Persistent or recurrent primary hyperparathyroidism after initial parathyroid surgery occurs at rates of 1.5~10%. A single missed parathyroid adenoma accounts for the majority of persistent hyperparathyroidism, whereas metachronous parathyroid adenoma is a rare cause of recurrent hypercalcemia. We report a case of a 39-year-old female who presented with recurrent pancreatitis. She had symptoms of hyperparathyroidism such as hypercalcemia, hypophosphatemia, hypercalciuria, nephrocalcinosis, and osteoporosis. She had a 2-cm firm neck mass under the right submandibular area. She was diagnosed with primary hyperparathyroidism 22 years ago. At that time, the right upper and lower parathyroid glands were removed after exploration of all parathyroid glands, and a right upper parathyroid adenoma was diagnosed. Now, she had a second surgery to remove the right submandibular mass with intraoperative PTH monitoring, which was diagnosed as a parathyroid adenoma in an ectopic supernumerary parathyroid gland. Because of hungry bone syndrome, she received calcium carbonate replacement therapy and has no evidence of recurrence. Here, we report a recurrent parathyroid adenoma in the undescended, supernumerary parathyroid gland after a long interval from the initial surgery.

A Case of Persistent Hyperkalemia After Unilateral Adrenalectomy for Aldosterone-Producing Adenoma.: Min Jae Yang, Seung Jin Han, Min Seok Lee, Eun Kyung Kim, Hae Jin Kim, Dae Jung Kim, Yoon Sok Chung, Tae Hee Lee, Jang Hee Kim, Kwan Woo Lee; J Korean Endocr Soc. 2009;24(3):201-205. Published online September 1, 2009; DOI: https://doi.org/10.3803/jkes.2009.24.3.201

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Abstract PDF: Primary aldosteronism is a syndrome characterized by various clinical features that are due to excessive autonomous aldosterone secretion not sustained by the activation of the renin-angiotensin system. Aldosterone-producing adrenal adenoma is found in approximately 35% of the patients who suffer with primary aldosteronism. Laparoscopic adrenalectomy is the standard treatment for aldosterone-producing adrenal adenoma, and the result of this operation is normalization of the serum potassium and plasma aldosterone concentrations, as well as correcting the plasma renin activity in most cases. However, it is known that some of the patients with aldosterone-producing adrenal adenoma show transient hyperkalemia postoperatively due to the reversible suppression of the renin-aldosterone axis. We recently experienced the case of a 54-year-old woman with an aldosterone-producing adrenal adenoma, and she presented with severe hyperkalemia after unilateral adrenalectomy. Compared with the previously reported cases that showed transient suppression of the rennin-aldosterone axis for less than 7 months, our patient revealed a prolonged episode of hyperkalemia for 8 months postoperatively, and this required continuous mineralocorticoid replacement.

Original Article

Pituitary Hormonal Changes after Transsphenoidal Tumor Removal in Non-Functioning Pituitary Adenoma.: Min Suk Lee, Seung Jin Han, Eun Kyung Kim, Joo An Hwang, Yoon Sok Chung, Se Hyuk Kim, Kyung Gi Cho, Nae Jung Rim, Ho Sung Kim; J Korean Endocr Soc. 2009;24(3):181-188. Published online September 1, 2009; DOI: https://doi.org/10.3803/jkes.2009.24.3.181

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Abstract PDF

BACKGROUND
The present study investigated the rates and the potential predictors of either new pituitary loss or recovery of hormonal function after transsphenoidal removal of a non-functioning pituitary adenoma. METHODS: Patients who underwent transsphenoidal removal of a non-functioning pituitary adenoma from January 2003 to December 2007 at Ajou University Medical Center were included in this retrospective analysis. Patients were excluded if they had a history of previous pituitary tumor surgery, or did not have preoperative pituitary hormonal data. RESULTS: Of 42 patients included in the analysis, 36 patients had hypopituitarism, 21 patients had "stalk compression" hyperprolactinemia, and 2 patients had normal pituitary function. At long term follow-up (longer than 6 months), 13 patients showed postoperative pituitary hormonal recovery in at least 1 hormonal axis, while 6 patients had developed postoperative hormonal loss in at least 1 hormonal axis. On analysis, neither preoperative serum prolactin level nor tumor size was related to postoperative pituitary hormonal changes. CONCLUSION: More than 1/3 of patients who underwent transsphenoidal surgery showed postoperative pituitary hormonal recovery.

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Childhood Onset Pituitary Adenoma: Clinical Presentations and Outcomes of 24 Cases
Hwa Young Kim, Hae Woon Jung, Jieun Lee, Ju Young Yoon, Young Ah Lee, Choong Ho Shin, Sei Won Yang
Annals of Pediatric Endocrinology & Metabolism.2012; 17(2): 82. CrossRef

Case Reports

Non-functional Pituitary Adenoma Detected on (18)F-fluorodeoxyglucose Positron Emission Tomography ((18)F-FDG-PET) in a Patient with Mucosa-associated Lymphoid Tissue Lymphoma.: Jin Ha Lee, Seung Jin Han, Se Eun Park, Mi Ae Cho, June Won Cheong, Mijin Yun, Yumie Rhee, Eun Jig Lee, Sung Kil Lim; J Korean Endocr Soc. 2008;23(2):137-141. Published online April 1, 2008; DOI: https://doi.org/10.3803/jkes.2008.23.2.137

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Abstract PDF

Magnetic resonance imaging (MRI) is the modality of choice for the detection and characterization of a pituitary adenoma. Uptake of (18)F-fluorodeoxyglucose (FDG) by intrasellar tumors, including pituitary adenomas, has been reported in several previous studies. We report a case where a pituitary adenoma was detected on FDG-positron emission tomography (PET), but the tumor was not detected with the use of sellar MRI. A 31-year-old woman was referred to the clinic due to a focal increase of FDG uptake at the pituitary fossa seen on whole body FDG-PET. The patient was receiving chemotherapy due to a recurred B-cell lymphoma of the mucosa-associated lymphoid tissue type. Subsequently, sellar MRI was performed, and images showed a small non-enhancing heterogenous cystic lesion in the midline of the pituitary gland, radiologically suggestive of a Rathke's cleft cyst. However, sellar MRI failed to identify a lesion consistent with a pituitary tumor that corresponded to the site of increased FDG uptake detected by the use of PET, despite the inclusion of a dynamic contrast enhanced sequence. Despite the negative findings of the MRI examination, basal and stimulated levels of the GnRH free alpha-subunit were profoundly increased. Therefore, we suspected the presence of a non-functional pituitary tumor in addition to a Rathke's cleft cyst, rather than pituitary involvement of a lymphoma, based on the hormone levels and PET scan findings.

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Citations to this article as recorded by

Clinical Characteristics of 16 Patients with Pituitary Tumor Incidentally Detected by18F-Fluorodeoxyglucose PET-CT (18F-FDG PET-CT)
Hyung Jin Kim, Gi Jeong Cheon, A Ra Cho, Chang Hoon Lee, Sang Min Youn, Se jin Ahn, Sang Eon Jang, Jung Min Kim, Yun Yong Lee, Ka Hee Yi
Endocrinology and Metabolism.2010; 25(4): 321. CrossRef

A Case of Parathyroid Adenoma Manifested as Acute Pancreatitis Accompanied Subclinical Cushing's Syndrome due to an Adrenal Adenoma.: Sang Hoon Leigh, Dong Sik Jo, Si Woo Kim, Yu Jin Jo, Sung Chul Cha, Jung Kwon Kim, Sun Hee Park, Hang Ji Kang; J Korean Endocr Soc. 2007;22(5):353-358. Published online October 1, 2007; DOI: https://doi.org/10.3803/jkes.2007.22.5.353

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Abstract PDF: The manifestation of primary hyperparathyroidism by acute pancreatitis is a rare event. Furthermore, an asymptomatic adrenal mass may incidentally be detected by abdominal computed tomography. A mass that autonomously secretes glucocorticoid without any symptom is called subclinical Cushing's syndrome. In this study, we report a rare case of a parathyroid adenoma manifested as acute pancreatitis accompanied with subclinical Cushing's syndrome due to an incidental adrenal mass. A 47-year-old female patient presented with acute pancreatitis and hypercalcemia had a parathyroid mass detected by neck ultrasonography and a Tc(99m)-sestamibi scan. An abdominal computed tomography revealed a 3.1 x 4.3 cm mass which was detected in the left adrenal gland. The hormonal levels showed a high serum cortisol level, low ACTH level, and a high 24 h urine free cortisol level. The low and high dose dexamethasone suppression test showed no suppression. The parathyroid and adrenal masses were resected and the laboratory findings were normalized.

A Case of Primary Hyperparathyroidism due to Cystic Parathyroid Adenoma Presenting as Hypercalcemic Crisis Associated with Intracranial Hemorrhage.: Jin Ook Chung, Gwi Hong Jeong, Se In Hong, Dong Hyeok Cho, Dong Jin Chung, Min Young Chung; J Korean Endocr Soc. 2007;22(4):292-298. Published online August 1, 2007; DOI: https://doi.org/10.3803/jkes.2007.22.4.292

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Abstract PDF

Most patients with hypercalcemia are asymptomatic or they have non-specific symptoms at diagnosis. Yet hypercalcemic crisis is a potentially fatal complication of hyperparathyroidism. Cystic parathyroid adenoma is a rare cause of primary hyperparathyroidism and hypercalcemic crisis. A 52-year-old woman was transferred to our hospital due to her relapsed drowsy mental state and renal insufficiency that occurred in course of her management for intracranial hemorrhage with manitol. The total serum calcium was 16.2 mg/dL and the intact parathyroid hormone was 546 pg/mL. Neck computed tomography showed a 3.1 x 1.8 cm sized cystic mass on the right thyroid lower pole. 99mTc-labelled sestamibi scintigraphy showed no significant uptake. In addition to prompt saline infusion and loop diuretics, the patient was given pamidronate to lower the serum calcium, and she was improved to an alert mental state with normal renal function. Surgical excision of the parathyroid cyst was performed. A histological examination confirmed a cystic parathyroid adenoma. The levels of plasma PTH and serum calcium were normalized after resection.

Citations

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Can Biochemical Markers and Ultrasonographical Diameters Be Used to Predict Histopathological Diagnosis in Patients with Primary Hyperparathyroidism?
Ahmet Dirikoc, Husniye Baser, Burcak Polat, Cevdet Aydin, Aylin Kilic Yazgan, Mehmet Kilic, Didem Ozdemir, Bekir Cakir
Indian Journal of Surgery.2024; 86(S1): 136. CrossRef
Preoperative Predictive Factors for Parathyroid Carcinoma in Patients with Primary Hyperparathyroidism
Jae Hyun Bae, Hyung Jin Choi, Yenna Lee, Min Kyong Moon, Young Joo Park, Chan Soo Shin, Do Jun Park, Hak Chul Jang, Seong Yeon Kim, Sang Wan Kim
Journal of Korean Medical Science.2012; 27(8): 890. CrossRef

A Case of Cushing's Disease due to Pituitary Microadenoma Combined with Primary Empty Sella Syndrome.: Yun Jung Lee, Sangyoul Rhee, Suk Chon, Seungjoon Oh, Jeong Taek Woo, Sung Woon Kim, Jin Woo Kim, Young Seol Kim, Byung Wook Lee, Jung Won Jeon; J Korean Endocr Soc. 2006;21(6):567-571. Published online December 1, 2006; DOI: https://doi.org/10.3803/jkes.2006.21.6.567

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Abstract PDF: An empty sella is defined as a sella which, regardless of its size, is completely or partly filled with cerebrospinal fluid. The endocrine function of primary empty sella syndrome is usually normal, but sometimes this syndrome is associated with complete or partial pituitary insufficiency and rarely hypersecretion of pituitary hormone. Primary empty sella syndrome combined with Cushing's disease has rarely been reported. A 45-years-old woman presented with cushingoid feature. Her urinary cortisol and 17-hydroxycorticosteroid excretion were increased. The results of endocrine function testing were suggestive of Cushing's disease. Sella MRI showed of partially empty sella and pituitary microadenoma. The pituitary microadenoma was removed by the trans-sphenoidal approach. We report here on this case together with a review of the literature.

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

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

A Case of Iodine-induced Thyrotoxicosis with Acromegaly.: Kwang Hyun Kim, Kyu Hong Kim, Ho Yoel Ryu, Su Min Nam, Mi Young Lee, Jang Hyun Koh, Jang Yeol Sin, Choon Hee Chung; J Korean Endocr Soc. 2006;21(1):63-67. Published online February 1, 2006; DOI: https://doi.org/10.3803/jkes.2006.21.1.63

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Abstract PDF: Hyperthyroidism is seen in 3.5-26% of subjects with acromegaly. Hyperthyroidism can be developed by thyroid stimulating hormone (TSH) dependent mechanism in TSH-secreting adenomas with acromegaly or by TSH independent mechanism through the stimulation of thyroid cells by growth hormone (GH). So, confirming the cause of hyperthyroidism is important to treat that. We report a case of a 56-year-old man who had acromegaly with iodine-induced thyrotoxicosis. He took the sea tangle for 4 years because he had constipation. His face and hands indicated acromegaly. Thyroid function test showed that T3 and free T4 were increased and TSH was decreased. Ultrasonography of neck showed diffuse enlargement of thyroid gland and thyroid scan showed decreased uptake of thyroid gland. So we could confirm iodine-induced thyrotoxicosis due to excessive iodine intake. Serum GH and insulin-like growth factor (IGF)-1 were markedly increased and brain MRI showed heterogenous 1 cm sized pituitary mass in right side. Acromegaly was confirmed by brain MRI, pituitary stimulation test and increased level of GH, IGF-1. He stopped iodine intake. After 6 months, T3, free T4 and TSH were normalized and he is waiting for the surgical removal of pituitary adenoma.

A Case of Adrenocortical Adenoma Causing Subclinical Cushing's Syndrome Mistaken for Liddle's Syndrome.: Kyu Hong Kim, Kwang Hyun Kim, Ho Yoel Ryu, Soo Min Nam, Mi Young Lee, Jang Hyun Koh, Jang Yel Shin, Soon Hee Jung, Choon Hee Chung; J Korean Endocr Soc. 2006;21(1):58-62. Published online February 1, 2006; DOI: https://doi.org/10.3803/jkes.2006.21.1.58

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Abstract PDF

Subclinical Cushing's syndrome is defined as an autonomous cortisol hyperproduction without specific clinical signs of cortisol excess, but detectable biochemically as derangements of the hypothalamic-pituitary-adrenal axis function. We report a case of a 33-year-old woman with subclinical Cushing's syndrome caused by left adrenocortical adenoma, mistaken for Liddle's syndrome. The patient complained of fatigue. Laboratory findings showed metabolic alkalosis, hypokalemia, high TTKG (transtubular K concentration gradient), low plasma renin activity, and low serum aldosterone level, that findings implied as Liddle's syndrome. So we performed further study. Hormonal and radiologic studies revealed subclinical Cushing's syndrome with a left adrenal mass. The adrenal mass was resected and pathologically diagnosed as adrenocortical adenoma. After the resection of the left adrenal mass, patient's hormonal levels showed normal range.

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Missed Ipsilateral Adrenal Adenoma With Recurrent Hypercortisolism After Prior Left Adrenalectomy
Jihoon Kim, Hae Kyung Kim, Choon Hee Chung
Journal of Korean Medical Science.2022;[Epub] CrossRef

A Case of Acromegaly Caused by Double Pituitary Adenomas.: Hai Jin Kim, Chul Sik Kim, Jong Suk Park, Jina Park, Jee Hyun Kong, Ji Sun Nam, Chul Woo Ahn, Bong Soo Cha, Sung Kil Lim, Kyung Rae Kim, Hyun Chul Lee, Soon Won Hong; J Korean Endocr Soc. 2006;21(1):53-57. Published online February 1, 2006; DOI: https://doi.org/10.3803/jkes.2006.21.1.53

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Abstract PDF: Acromegaly is a clinical syndrome, which is caused by an excess of growth hormone (GH), most commonly secreted from a pituitary solitary adenoma. However, our patient had bilateral GH-secreting pituitary tumors, the incidence of which has been reported in only 1.3 to 1.69% of all acromegalic patients. A 59-year-old female, with no family history of pituitary adenomas, demonstrated an increased level of serum insulin-like growth factor-1 (IGF-1), and GH not suppressed after 75 g oral glucose loading. On a preoperative MRI, only one pituitary tumor, measuring 1.1 x 0.7 cm, could be observed using sellar MRI. After surgical resection of the tumor, her headache and myalgia were sustained, and the IGF-1 level was still in a high titer. Therefore, a follow-up sellar MRI was taken, and a 0.6 x 0.7 cm sized newly growing pituitary tumor was found on the other side. With a retrospective review of radiological examinations, the patient was found to have bilateral tumors. The 0.3 cm sized tumor on the left was too small to be detected on the preoperative MRI. As the patient preferred medical treatment after surgery, she was treated with sandostatin analogues. Acromegaly with bilateral GH-secreting pituitary tumors, is a very rare disease, with no previous case having been reported in Korea. Herein, we report the case with a review of the literature.

A Case Of Transient Hyporeninemic Hypoaldosteronism After Unilateral Adrenalrectomy for Aldosterone-Producing Adenoma.: Jungho Suh, Gwanpyo Koh, Keun Yong Park, Jongwook Hong, Suk Chon, Seungjoon Oh, Jeong taek Woo, Sung Woon Kim, Jin Woo Kim, Young Seol Kim; J Korean Endocr Soc. 2005;20(5):502-506. Published online October 1, 2005; DOI: https://doi.org/10.3803/jkes.2005.20.5.502

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Abstract PDF

Primary aldosteronism is due to either a unilateral adrenal adenoma or bilateral hyperplasia of the adrenal cortex in most cases. A unilateral adrenalectomy in hypertensive and hypokalemic patients, with a well-documented adrenal adenoma, is usually followed by the correction of hypokalemia in all subjects, with the cure of hypertension in 60 to 87% of patients. Here, a unique case, in which a unilateral adrenalectomy for the removal of an adrenal adenoma was followed by severe hyperkalemia, low levels of plasma renin activity and serum aldosterone, suggestive of chronic suppression of the renin-aldosterone axis, is reported. In a follow-up Lasix stimulation test on the 70th day after surgery, the suppression of the renin-aldosterone axis was resolved, indicating the suppression was transient. Patients undergoing a unilateral adrenalectomy for an aldosterone-producing adenoma should be closely followed up to avoid severe hyperkalemia.

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Citations to this article as recorded by

A Case of Persistent Hyperkalemia After Unilateral Adrenalectomy for Aldosterone-Producing Adenoma
Min Jae Yang, Seung Jin Han, Min Seok Lee, Eun Kyung Kim, Hae Jin Kim, Dae Jung Kim, Yoon Sok Chung, Tae Hee Lee, Jang Hee Kim, Kwan Woo Lee
Journal of Korean Endocrine Society.2009; 24(3): 201. CrossRef

The Change of Thyroid Hormone by Short-term Antithyroid Drug Treatment for Preoperative Euthyroidism in TSH-secreting Pituitary Adenoma.: Min Hee Lee, Ji Hyun Park; J Korean Endocr Soc. 2005;20(3):261-267. Published online June 1, 2005; DOI: https://doi.org/10.3803/jkes.2005.20.3.261

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Abstract PDF: Preoperative euthyroidism is needed to minimize the risk of intraoperative and postoperative complications, such as thyroid storm by surgery. Antithyroid drugs or steroid hormones are commonly used in primary hyperthyroidism for euthyroidism. However, there is no definite consensus for the preoperative management of a TSH secreting pituitary adenoma for the restoration of euthyroidism. Antithyroid drugs are not used for long-term the management of a TSH secreting pituitary adenoma, as they may cause rapid growth and greater invasiveness of the tumor due to a feedback mechanism, but they can be used for short-term management before neurosurgery. We experienced one case of a TSH secreting pituitary adenoma, which showed rapid free thyroid hormone increase due to the short term administration of antithyroid drugs for only 10 days. A somatostatin analogue, octreotide at a dose of 0.1mg, twice a day, was then tried. About 4 weeks later, her serum TSH and free T4 had normalized, with a concomitant clinical improvement. She subsequently underwent an uncomplicated trans-sphenoidal resection of the pituitary adenoma. Antithyroid drugs can induce a rapid thyroid hormone increase, but can only be used for a short-term period, so they should be administered with caution or their use reconsidered

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