Endocrinology and Metabolism

Review Article

Calcium & bone metabolism
Cardiovascular Impact of Calcium and Vitamin D Supplements: A Narrative Review: Fatima Zarzour, Ahmad Didi, Mohammed Almohaya, David Kendler; Endocrinol Metab. 2023;38(1):56-68. Published online February 16, 2023; DOI: https://doi.org/10.3803/EnM.2022.1644

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Calcium and vitamin D play an important role in mineral homeostasis and the maintenance of skeletal health. Calcium and vitamin D supplements have been widely used for fracture prevention in elderly populations. Many trials have studied the effectiveness and cardiovascular safety of calcium and vitamin D supplementation, with disparate results. In this review, we summarize the most important trials and systematic reviews. There is significant heterogeneity in clinical trial design, differences in the nature of trial outcomes (self-reported vs. verified), prior calcium intake, and trial size. Inconsistent results have been reported concerning the effects of calcium and vitamin D supplementation on cardiovascular outcomes. Most current guidelines recommend calcium intake of up to 1,200 mg daily, preferably from the diet, without concern for cardiovascular risk. Recommendations regarding vitamin D supplementation vary widely. There is compelling evidence from well-conducted randomized trials that modest vitamin D supplementation is safe but does not confer cardiovascular benefit or cardiovascular harm.

Citations

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Evaluating adherence, tolerability and safety of oral calcium citrate in elderly osteopenic subjects: a real-life non-interventional, prospective, multicenter study
Mariangela Rondanelli, Salvatore Minisola, Marco Barale, Daniele Barbaro, Francesca Mansueto, Santina Battaglia, Gloria Bonaccorsi, Santina Caliri, Alessandro Cavioni, Luciano Colangelo, Sabrina Corbetta, Federica Coretti, Giorgia Dito, Valentina Gavioli,
Aging Clinical and Experimental Research.2024;[Epub] CrossRef
Association between Daily Dietary Calcium Intake and the Risk of Cardiovascular Disease (CVD) in Postmenopausal Korean Women
Jae Kyung Lee, Thi Minh Chau Tran, Euna Choi, Jinkyung Baek, Hae-Rim Kim, Heeyon Kim, Bo Hyon Yun, Seok Kyo Seo
Nutrients.2024; 16(7): 1043. CrossRef
Calcium deficiency and its implications for cardiovascular disease and cancer: Strategies for resolution via agronomic fortification
Liping Cheng, Jiapan Lian, Yongfeng Ding, Xin Wang, Mehr Ahmed Mujtaba Munir, Shafqat Ullah, Erjiang Wang, Zhenli He, Xiaoe Yang
Food Science & Nutrition.2024;[Epub] CrossRef
Effect of Denosumab on Bone Density in Postmenopausal Osteoporosis: A Comparison with and without Calcium Supplementation in Patients on Standard Diets in Korea
Chaiho Jeong, Jinyoung Kim, Jeongmin Lee, Yejee Lim, Dong-Jun Lim, Ki-Hyun Baek, Jeonghoon Ha
Journal of Clinical Medicine.2023; 12(21): 6904. CrossRef

Original Articles

Diabetes, Obesity and Metabolism Big Data Articles (National Health Insurance Service Database)
Association of High-Density Lipoprotein Cholesterol Phenotypes with the Risk of Cardiovascular Diseases and Mortality: A Cohort Study in Korea: Ga Eun Nam, Youn Huh, Jin-Hyung Jung, Kyungdo Han, Seon Mee Kim, on Behalf of the Taskforce Team of the Obesity Fact Sheet of the Korean Society for the Study of Obesity; Endocrinol Metab. 2022;37(2):261-271. Published online April 25, 2022; DOI: https://doi.org/10.3803/EnM.2021.1259

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Background
We investigated whether low high-density lipoprotein cholesterol (HDL-C) and isolated and non-isolated low HDL-C levels are associated with the risk of cardiovascular diseases and all-cause mortality among Korean adults.
Methods
We included 8,665,841 individuals aged ≥20 years who had undergone a health examination provided by the Korean National Health Insurance Service (NHIS) in 2009 and were followed up until the end of 2018. The hazard ratios (HRs) and 95% confidence intervals (CIs) for study outcomes were calculated using multivariable Cox proportional hazard regression analysis.
Results
During the 8.2 years of mean follow-up, myocardial infarction (MI), stroke, and all-cause mortality occurred in 81,431, 110,996, and 244,309 individuals, respectively. After adjusting for confounding variables (model 3), individuals with low HDL-C and lower HDL quartiles were associated with significantly increased risks of all three outcomes, compared to those with normal HDL-C and highest HDL-C quartile (all P<0.001), respectively. HRs for incident MI (1.28; 95% CI, 1.26 to 1.30), stroke (1.13; 95% CI, 1.11 to 1.15), and all-cause mortality (1.07; 95% CI, 1.05 to 1.08) increased in the non-isolated low HDL-C group compared to the normal HDL-C group. Isolated low HDL-C also showed an increase in the HRs of incident stroke (1.06; 95% CI, 1.04 to 1.08) and all-cause mortality (1.30; 95% CI, 1.28 to 1.32).
Conclusion
Low HDL-C and non-isolated low HDL-C were associated with increased risk of MI, stroke, and all-cause mortality, and isolated low HDL-C was associated with incident stroke and all-cause mortality risk.

Citations

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Association between HDL levels and stroke outcomes in the Arab population
Aizaz Ali, Omar Obaid, Naveed Akhtar, Rahul Rao, Syed Haroon Tora, Ashfaq Shuaib
Scientific Reports.2024;[Epub] CrossRef
Association of adiposity and fitness with triglyceride-to-high-density lipoprotein cholesterol ratio in youth
Danladi Ibrahim Musa, Abel Lamina Toriola, Nurudeen O Abubakar, Sunday Omachi, Victor B Olowoleni, Kolade B Ayodele
Annals of Pediatric Cardiology.2023; 16(3): 194. CrossRef
Association between cholesterol levels and dementia risk according to the presence of diabetes and statin use: a nationwide cohort study
You-Bin Lee, Min Young Kim, Kyungdo Han, Bongsung Kim, Jiyun Park, Gyuri Kim, Kyu Yeon Hur, Jae Hyeon Kim, Sang-Man Jin
Scientific Reports.2022;[Epub] CrossRef

Clinical Study Big Data Articles (National Health Insurance Service Database)
Variabilities in Weight and Waist Circumference and Risk of Myocardial Infarction, Stroke, and Mortality: A Nationwide Cohort Study: Da Hye Kim, Ga Eun Nam, Kyungdo Han, Yang-Hyun Kim, Kye-Yeung Park, Hwan-Sik Hwang, Byoungduck Han, Sung Jung Cho, Seung Jin Jung, Yeo-Joon Yoon, Yong Kyun Roh, Kyung Hwan Cho, Yong Gyu Park; Endocrinol Metab. 2020;35(4):933-942. Published online December 23, 2020; DOI: https://doi.org/10.3803/EnM.2020.871

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Background
Evidence regarding the association between variabilities in obesity measures and health outcomes is limited. We aimed to examine the association between variabilities in obesity measures and cardiovascular outcomes and all-cause mortality.
Methods
We identified 4,244,460 individuals who underwent health examination conducted by the Korean National Health Insurance Service during 2012, with ≥3 anthropometric measurements between 2009 and 2012. Variabilities in body weight (BW) and waist circumference (WC) were assessed using four indices including variability independent of the mean (VIM). We performed multivariable Cox proportional hazards regression analyses.
Results
During follow-up of 4.4 years, 16,095, 18,957, and 30,200 cases of myocardial infarction (MI), stroke, and all-cause mortality were recorded. Compared to individuals with the lowest quartiles, incrementally higher risks of study outcomes and those of stroke and all-cause mortality were observed among individuals in higher quartiles of VIM for BW and VIM for WC, respectively. The multivariable adjusted hazard ratios and 95% confidence intervals comparing the highest versus lowest quartile groups of VIM for BW were 1.17 (1.12 to 1.22) for MI, 1.20 (1.16 to 1.25) for stroke, and 1.66 (1.60 to 1.71) for all-cause mortality; 1.07 (1.03 to 1.12) for stroke and 1.29 (1.25 to 1.33) for all-cause mortality regarding VIM for WC. These associations were similar with respect to the other indices for variability.
Conclusion
This study revealed positive associations between variabilities in BW and WC and cardiovascular outcomes and allcause mortality. Our findings suggest that variabilities in obesity measures are associated with adverse health outcomes in the general population.

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Gender differences in midlife to later-life cumulative burden and variability of obesity measures and risk of all-cause and cause-specific mortality
Karim Kohansal, Siamak Afaghi, Davood Khalili, Danial Molavizadeh, Farzad Hadaegh
International Journal of Obesity.2024; 48(4): 495. CrossRef
Association of body mass index and blood pressure variability with 10-year mortality and renal disease progression in type 2 diabetes
Stephen Fava, Sascha Reiff
Acta Diabetologica.2024; 61(6): 747. CrossRef
Anthropometric indices, a predictive marker for stroke and other metabolic disorders
Clinton David Orupabo, Solomon David Owualah, Iberedem Clinton David
International Journal of Medicine and Medical Research.2024; 10(1): 23. CrossRef
Weight variability and cardiovascular outcomes: a systematic review and meta-analysis
Robert J. Massey, Moneeza K. Siddiqui, Ewan R. Pearson, Adem Y. Dawed
Cardiovascular Diabetology.2023;[Epub] CrossRef
Family history, waist circumference and risk of ischemic stroke: A prospective cohort study among Chinese adults
Lei Liu, Xiaojia Xue, Hua Zhang, Xiaocao Tian, Yunhui Chen, Yu Guo, Pei Pei, Shaojie Wang, Haiping Duan, Ruqin Gao, Zengchang Pang, Zhengming Chen, Liming Li
Nutrition, Metabolism and Cardiovascular Diseases.2023; 33(4): 758. CrossRef
Big Data Research in the Field of Endocrine Diseases Using the Korean National Health Information Database
Sun Wook Cho, Jung Hee Kim, Han Seok Choi, Hwa Young Ahn, Mee Kyoung Kim, Eun Jung Rhee
Endocrinology and Metabolism.2023; 38(1): 10. CrossRef
Weight variability and diabetes complications
Francesco Prattichizzo, Chiara Frigé, Rosalba La Grotta, Antonio Ceriello
Diabetes Research and Clinical Practice.2023; 199: 110646. CrossRef
Research on obesity using the National Health Information Database: recent trends
Eun-Jung Rhee
Cardiovascular Prevention and Pharmacotherapy.2023; 5(2): 35. CrossRef
Weight cycling and risk of clinical adverse events in patients with heart failure with preserved ejection fraction: a post-hoc analysis of TOPCAT
Yi Tan, Hang Guo, Ning Zhang, Keyang Zheng, Guifang Liu
Frontiers in Endocrinology.2023;[Epub] CrossRef
Weight variability, physical functioning and incident disability in older adults
Katie J. McMenamin, Tamara B. Harris, Joshua F. Baker
Journal of Cachexia, Sarcopenia and Muscle.2023; 14(4): 1648. CrossRef
Association between Variability of Metabolic Risk Factors and Cardiometabolic Outcomes
Min Jeong Park, Kyung Mook Choi
Diabetes & Metabolism Journal.2022; 46(1): 49. CrossRef
Effects of exercise initiation and smoking cessation after new-onset type 2 diabetes mellitus on risk of mortality and cardiovascular outcomes
Mee Kyoung Kim, Kyungdo Han, Bongsung Kim, Jinyoung Kim, Hyuk-Sang Kwon
Scientific Reports.2022;[Epub] CrossRef
Lipid cutoffs for increased cardiovascular disease risk in non-diabetic young people
Mee Kyoung Kim, Kyungdo Han, Hun-Sung Kim, Kun-Ho Yoon, Seung-Hwan Lee
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Body Mass Index Is Independently Associated with the Presence of Ischemia in Myocardial Perfusion Imaging
Chrissa Sioka, Paraskevi Zotou, Michail I. Papafaklis, Aris Bechlioulis, Konstantinos Sakellariou, Aidonis Rammos, Evangelia Gkika, Lampros Lakkas, Sotiria Alexiou, Pavlos Kekiopoulos, Katerina K. Naka, Christos Katsouras
Medicina.2022; 58(8): 987. CrossRef
Waist Circumference and Body Mass Index Variability and Incident Diabetic Microvascular Complications: A Post Hoc Analysis of ACCORD Trial
Daniel Nyarko Hukportie, Fu-Rong Li, Rui Zhou, Jia-Zhen Zheng, Xiao-Xiang Wu, Xian-Bo Wu
Diabetes & Metabolism Journal.2022; 46(5): 767. CrossRef
Nonalcoholic fatty liver disease and the risk of insulin-requiring gestational diabetes
Sang Youn You, Kyungdo Han, Seung-Hawn Lee, Mee Kyoung Kim
Diabetology & Metabolic Syndrome.2021;[Epub] CrossRef
Increased Risk of Nonalcoholic Fatty Liver Disease in Individuals with High Weight Variability
Inha Jung, Dae-Jeong Koo, Mi Yeon Lee, Sun Joon Moon, Hyemi Kwon, Se Eun Park, Eun-Jung Rhee, Won-Young Lee
Endocrinology and Metabolism.2021; 36(4): 845. CrossRef

Clinical Study
The Association of Overt and Subclinical Hyperthyroidism with the Risk of Cardiovascular Events and Cardiovascular Mortality: Meta-Analysis and Systematic Review of Cohort Studies: Seo Young Sohn, Eunyoung Lee, Min Kyung Lee, Jae Hyuk Lee; Endocrinol Metab. 2020;35(4):786-800. Published online November 25, 2020; DOI: https://doi.org/10.3803/EnM.2020.728

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Background
Whether hyperthyroidism is an independent risk factor for cardiovascular events remains controversial. We aimed to evaluate the association of overt and subclinical hyperthyroidism with the risk of ischemic heart disease (IHD), stroke, heart failure, and cardiovascular mortality.
Methods
Studies regarding the association between hyperthyroidism and cardiovascular events were searched on PubMed and Embase databases. The cardiovascular disease (CVD) risk was classified as high and low, based on pre-existing diseases, including history of coronary, cerebral, or peripheral artery disease; heart failure; atrial fibrillation; diabetes mellitus; or chronic kidney disease.
Results
Thirty-seven cohort studies were included in this meta-analysis. The pooled hazard ratio for subjects with overt hyperthyroidism compared with the control group was 1.11 (95% confidence interval [CI], 1.03 to 1.19) for IHD, 1.35 (95% CI, 1.03 to 1.75) for stroke, and 1.20 (95% CI, 1.00 to 1.46) for cardiovascular mortality. For subjects with subclinical hyperthyroidism, the pooled hazard ratio was 1.24 (95% CI, 1.07 to 1.45) for IHD, when compared with the control group. Subgroup analysis by CVD risk showed that the risk of stroke in overt hyperthyroidism was increased in the low CVD risk group; however, these association was not observed in the high CVD risk group. Similarly, the risk of IHD in subjects with subclinical hyperthyroidism was significantly increased in the low CVD risk group.
Conclusion
Overt hyperthyroidism is associated with increased risk of IHD, stroke, and cardiovascular mortality, and subclinical hyperthyroidism is associated with increased risk of IHD. These associations were particularly observed in the low risk CVD group without underlying CVD.

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Adequacy of thyroid hormone replacement for people with hypothyroidism in real‐world settings: A systematic review and meta‐analysis of observational studies
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Higher Risk of Incident Hyperthyroidism in Patients With Atrial Fibrillation
Pang-Shuo Huang, Jen-Fang Cheng, Jien-Jiun Chen, Yi-Chih Wang, Juey-Jen Hwang, Cho-Kai Wu, Chia-Ti Tsai
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Clinical Study
Predicting the Development of Myocardial Infarction in Middle-Aged Adults with Type 2 Diabetes: A Risk Model Generated from a Nationwide Population-Based Cohort Study in Korea: Seung-Hwan Lee, Kyungdo Han, Hun-Sung Kim, Jae-Hyoung Cho, Kun-Ho Yoon, Mee Kyoung Kim; Endocrinol Metab. 2020;35(3):636-646. Published online September 22, 2020; DOI: https://doi.org/10.3803/EnM.2020.704

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Background
Most of the widely used prediction models for cardiovascular disease are known to overestimate the risk of this disease in Asians. We aimed to generate a risk model for predicting myocardial infarction (MI) in middle-aged Korean subjects with type 2 diabetes.
Methods
A total of 1,272,992 subjects with type 2 diabetes aged 40 to 64 who received health examinations from 2009 to 2012 were recruited from the Korean National Health Insurance database. Seventy percent of the subjects (n=891,095) were sampled to develop the risk prediction model, and the remaining 30% (n=381,897) were used for internal validation. A Cox proportional hazards regression model and Cox coefficients were used to derive a risk scoring system. Twelve risk variables were selected, and a risk nomogram was created to estimate the 5-year risk of MI.
Results
During 7.1 years of follow-up, 24,809 cases of MI (1.9%) were observed. Age, sex, smoking status, regular exercise, body mass index, chronic kidney disease, duration of diabetes, number of anti-diabetic medications, fasting blood glucose, systolic blood pressure, total cholesterol, and atrial fibrillation were significant risk factors for the development of MI and were incorporated into the risk model. The concordance index for MI prediction was 0.682 (95% confidence interval [CI], 0.678 to 0.686) in the development cohort and 0.669 (95% CI, 0.663 to 0.675) in the validation cohort.
Conclusion
A novel risk engine was generated for predicting the development of MI among middle-aged Korean adults with type 2 diabetes. This model may provide useful information for identifying high-risk patients and improving quality of care.

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A literature review of quality assessment and applicability to HTA of risk prediction models of coronary heart disease in patients with diabetes
Li Jiu, Junfeng Wang, Francisco Javier Somolinos-Simón, Jose Tapia-Galisteo, Gema García-Sáez, Mariaelena Hernando, Xinyu Li, Rick A. Vreman, Aukje K. Mantel-Teeuwisse, Wim G. Goettsch
Diabetes Research and Clinical Practice.2024; 209: 111574. CrossRef
Investigating the impact of extreme weather events and related indicators on cardiometabolic multimorbidity
Di Wu, Yu Shi, ChenChen Wang, Cheng Li, Yaoqin Lu, Chunfang Wang, Weidong Zhu, Tingting Sun, Junjie Han, Yanling Zheng, Liping Zhang
Archives of Public Health.2024;[Epub] CrossRef
Predicting the Risk of Insulin-Requiring Gestational Diabetes before Pregnancy: A Model Generated from a Nationwide Population-Based Cohort Study in Korea
Seung-Hwan Lee, Jin Yu, Kyungdo Han, Seung Woo Lee, Sang Youn You, Hun-Sung Kim, Jae-Hyoung Cho, Kun-Ho Yoon, Mee Kyoung Kim
Endocrinology and Metabolism.2023; 38(1): 129. CrossRef
Factors Affecting High Body Weight Variability
Kyungdo Han, Mee Kyoung Kim
Journal of Obesity & Metabolic Syndrome.2023; 32(2): 163. CrossRef
Coronary Artery Calcium Score as a Sensitive Indicator of Cardiovascular Disease in Patients with Type 2 Diabetes Mellitus: A Long-Term Cohort Study
Dae-Jeong Koo, Mi Yeon Lee, Sun Joon Moon, Hyemi Kwon, Sang Min Lee, Se Eun Park, Cheol-Young Park, Won-Young Lee, Ki Won Oh, Sung Rae Cho, Young-Hoon Jeong, Eun-Jung Rhee
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Assessing the Validity of the Criteria for the Extreme Risk Category of Atherosclerotic Cardiovascular Disease: A Nationwide Population-Based Study
Kyung-Soo Kim, Sangmo Hong, Kyungdo Han, Cheol-Young Park
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Effects of exercise initiation and smoking cessation after new-onset type 2 diabetes mellitus on risk of mortality and cardiovascular outcomes
Mee Kyoung Kim, Kyungdo Han, Bongsung Kim, Jinyoung Kim, Hyuk-Sang Kwon
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Current Trends of Big Data Research Using the Korean National Health Information Database
Mee Kyoung Kim, Kyungdo Han, Seung-Hwan Lee
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Lipid cutoffs for increased cardiovascular disease risk in non-diabetic young people
Mee Kyoung Kim, Kyungdo Han, Hun-Sung Kim, Kun-Ho Yoon, Seung-Hwan Lee
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Low-Density Lipoprotein Cholesterol Level, Statin Use and Myocardial Infarction Risk in Young Adults
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Obesity and Metabolism
Comparison of the Effects of Ezetimibe-Statin Combination Therapy on Major Adverse Cardiovascular Events in Patients with and without Diabetes: A Meta-Analysis: Namki Hong, Yong-ho Lee, Kenichi Tsujita, Jorge A. Gonzalez, Christopher M. Kramer, Tomas Kovarnik, George N. Kouvelos, Hiromichi Suzuki, Kyungdo Han, Chan Joo Lee, Sung Ha Park, Byung-Wan Lee, Bong-Soo Cha, Eun Seok Kang; Endocrinol Metab. 2018;33(2):219-227. Published online May 4, 2018; DOI: https://doi.org/10.3803/EnM.2018.33.2.219

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Background

Ezetimibe-statin combination therapy has been found to reduce low density lipoprotein cholesterol levels and the risk of major adverse cardiovascular events (MACEs) in large trials. We sought to examine the differential effect of ezetimibe on MACEs when added to statins according to the presence of diabetes.

Methods

Randomized clinical trials with a sample size of at least 50 participants and at least 24 weeks of follow-up that compared ezetimibe-statin combination therapy with a statin- or placebo-controlled arm and reported at least one MACE, stratified by diabetes status, were included in the meta-analysis and meta-regression.

Results

A total of seven trials with 28,191 enrolled patients (mean age, 63.6 years; 75.1% men; 7,298 with diabetes [25.9%]; mean follow-up, 5 years) were analysed. MACEs stratified by diabetes were obtained from the published data (two trials) or through direct contact (five trials). No significant heterogeneity was observed among studies (I²=14.7%, P=0.293). Ezetimibe was associated with a greater reduction of MACE risk in subjects with diabetes than in those without diabetes (pooled relative risk, 0.84 vs. 0.93; P_{heterogeneity}=0.012). In the meta-regression analysis, the presence of diabetes was associated with a greater reduction of MACE risk when ezetimibe was added to statins (β=0.87, P=0.038).

Conclusion

Ezetimibe-statin combination therapy was associated with greater cardiovascular benefits in patients with diabetes than in those without diabetes. Our findings suggest that ezetimibe-statin combination therapy might be a useful strategy in patients with diabetes at a residual risk of MACEs.

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Review Article

Calcium and Cardiovascular Disease: Ian R. Reid, Sarah M. Birstow, Mark J. Bolland; Endocrinol Metab. 2017;32(3):339-349. Published online September 18, 2017; DOI: https://doi.org/10.3803/EnM.2017.32.3.339

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Abstract PDF PubReader

Circulating calcium is a risk factor for vascular disease, a conclusion arising from prospective studies involving hundreds of thousands of participants and extending over periods of up to 30 years. These associations may be partially mediated by other cardiovascular risk factors such as circulating lipid levels, blood pressure, and body mass index, but there appears to be a residual independent effect of serum calcium. Polymorphisms of the calcium-sensing receptor associated with small elevations of serum calcium are also associated with cardiovascular disease, suggesting that calcium plays a causative role. Trials of calcium supplements in patients on dialysis and those with less severe renal failure demonstrate increased mortality and/or acceleration of vascular disease, and meta-analyses of trials in those without overt renal disease suggest a similar adverse effect. Interpretation of the latter trials is complicated by a significant interaction between baseline use of calcium supplements and the effect of randomisation to calcium in the largest trial. Restriction of analysis to those who are calcium-naive demonstrates a consistent adverse effect. Observational studies of dietary calcium do not demonstrate a consistent adverse effect on cardiovascular health, though very high or very low intakes may be deleterious. Thus, obtaining calcium from the diet rather than supplements is to be encouraged.

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Case Reports

A Case of Pheochromocytoma Crisis with Acute Myocardial Infarction Induced by Glucocorticoids Administration.: Woo Sun Rou, Sang Kyung Jung, Sung Yun Lee, Yun Jeong Lee, Dong Jun Kim, Young Doo Kim, Hyung Yoon Kim, Sunhee Chang, Jung Hyun Noh; Endocrinol Metab. 2010;25(3):240-244. Published online September 1, 2010; DOI: https://doi.org/10.3803/EnM.2010.25.3.240

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Abstract PDF: The most common symptoms of pheochromocytoma are paroxysmal or sustained hypertension, or symptoms of paroxysmal adrenergic stimulation such as palpitation, headache, and diaphoresis. These patients can on rare occasion reveal or be complicated with cardiovascular symptoms such as arrhythmia, cardiomyopathy, acute coronary syndrome and cardiogenic shock. These cardiac manifestations of pheochromocytoma may delay the diagnosis, which can cause a catastrophic outcome. A pheochromocytoma crisis is provoked by surgery, anesthesia, exercise and, several drugs and it is known to be an endocrine emergency with mortality as high as 85%. Many classes of drugs are well known to precipitate adverse reactions, but the presentation of pheochromocytoma after the administration of steroid has rarely been reported. We report here on a case of pheochromocytoma crisis with acute myocardial infarction after the patient took prednisolone. Furthermore, we discuss the mechanism of glucocorticoid induced crisis and myocardial infarction in pheochromocytoma patients.

A Case of Multiple Endocrine Neoplasia Neoplasia Type IIa Complicated by Acute Myocardial Infarction.: Eung Ho Karl, Mi Duck Lee, Young Uck Kim, Young Goo Shin, Jung Han Yoon, Seong Joon Kang, Choon Hee Chung; J Korean Endocr Soc. 1999;14(1):189-196. Published online January 1, 2001

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Abstract PDF: MEN IIa is the rare disorder consisted of thyroid medullary carcinoma, pheochromocytoma, and hyperparathyroidism. We experienced the case in which 42 year-old male patient with thyroid medullary carcinoma and pheochromocytoma complicated by acute myocardial infarction. During the process of conventional treatment of acute myocardial infarction, paroxysmal hypertension occurred for several times. We sought for the cause of paroxysmal hypertension, and found pheochromocytoma by the radiologic imaging study and the biochemical study and we found the 4X4 cm sized neck mass by palpation. After stabilizing his blood pressure by the use of phenoxybenzamine, we removed the pheochromocytoma in right adrenal gland and the medullary thyroid cancer, by right adrenalectomy and total thyroidectomy respectively. Thereafter, his subjective symptoms and objective signs were improved. We report the case with review of literatures.

A Case of Pheochromocytoma with Acute Myocardial Infarction.: Yoo Bae Ahn, Moo Il Kang, Kwang Woo Lee, Ho Young Son, Sung Koo Kang, Bong Yeon Cha, Baek Jong Seo, Ki Yook Jang, In Jae Yoon, Sang Jun Lee, Sun Sook Park, Yong Seok Oh; J Korean Endocr Soc. 1997;12(4):655-660. Published online January 1, 2001

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Abstract PDF: Pheochromocytoma, the catecholamine-producing tumor of chromaffin tissue, is associated with a curable form of hypertension. Recently we report the case of a 59 year-old male admitted for an acute myocardial infarction and who subsequently developed late recurrent severe ventricular arrhythmia coincident with transient hypertensive episodes. A pheochromocytoma was diagnosed on the basis of the urinary concentration of catecholamines and computerized tomography of the adrenal glands. After stabilization of his cardiac rhythm and blood pressure with alpha adrenergic blockade, the left adrenal gland, which contained the tumor, was subsequently resected. The diagnosis of a pheochromocytoma should be considered when recurrent ventricular arrhythmia are associated with intermittent hypertension after acute myocardial infarction.

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