Endocrinology and Metabolism

Original Articles

Diabetes, obesity and metabolism
Exendin-4(1-32)K-Capric Acid, a Glucagon-Like Peptide-1 Receptor Agonist, Suppresses Food Intake via Arcuate Pro-Opiomelanocortin Neurons: Sujin Yoo, Eun-Seon Yoo, Jae Il Kim, Jong-Woo Sohn; Endocrinol Metab. 2025;40(3):434-447. Published online April 14, 2025; DOI: https://doi.org/10.3803/EnM.2024.2185

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Background
Glucagon-like peptide-1 (GLP-1) is an incretin known for its anti-obesity effects, and several effective drugs targeting GLP-1 receptors (GLP-1Rs) have recently been developed to treat obesity. Although GLP-1Rs are expressed by various populations of central neurons, it is still unclear which specific populations mediate the anti-obesity effects of GLP-1R agonists.
Methods
In this study, we utilized the previously reported GLP-1R agonist, exendin-4(1-32)K-capric acid (Ex-4c), and conducted whole-cell patch-clamp recordings, immunohistochemistry experiments, and in vivo food intake measurements.
Results
Our findings indicate that the appetite-suppressing effects of Ex-4c depend on pro-opiomelanocortin (POMC) neurons. Fos immunochemistry experiments and whole-cell patch-clamp recordings showed that Ex-4c activated POMC neurons in the arcuate nucleus of the hypothalamus. Additionally, we observed that Ex-4c stimulated GLP-1Rs and activated the protein kinase A (PKA)- dependent signaling pathway, which in turn closed putative adenosine triphosphate-sensitive K⁺ (K_ATP) channels, leading to the depolarization of POMC neurons.
Conclusion
Our results demonstrate that the appetite-suppressing effects of Ex-4c are mediated through the activation of arcuate POMC neurons. Furthermore, the PKA-dependent closure of putative K_ATP conductance is identified as the cellular mechanism responsible for the activation of POMC neurons.

Citations

Citations to this article as recorded by

Hypothalamic regulation of sepsis-associated anorexia: cytokine and hormonal signalling through AgRP/POMC circuits
Wanting Zhu, Claude Libert, Tineke Vanderhaeghen
EMBO Molecular Medicine.2026; 18(5): 1508. CrossRef
Recent developments in GPCR signalling in appetite regulation
Holly R. Brittain, Caroline M. Gorvin
Bioscience Reports.2026;[Epub] CrossRef
Breaking the metabolic–inflammatory vicious cycle in polycystic ovary syndrome: a comparative review of ketogenic and high-fat diets
Wenwen Yang, Nan Pang, Xiaoxia He
Lipids in Health and Disease.2025;[Epub] CrossRef
Glucagon-Like Peptide-1 Receptor Agonists Are Promising for the Treatment of Brain Diseases: an Outlook from the Perspective of Integrative Physiology
N. V. Gulyaeva
Journal of Evolutionary Biochemistry and Physiology.2025; 61(5): 1326. CrossRef

The Localization of Microadenoma with Sella Imaging Study and Inferior Petrosal Sinus Sampling in Cushing's Disease.: Jae Seok Jeon, Sang Jeon Choi, Chan Soo Shin, Kyoung Soo Park, Seong Yeon Kim, Bo Youn Cho, Hong Kyu Lee, Chang Soon Koh, Hee Won Jung, Dae Hee Han, Moon Hee Han, Kee Hyun Chang; J Korean Endocr Soc. 1996;11(4):492-499. Published online November 7, 2019

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Abstract PDF: Background
Inferior petrosal sinus sampling(IPSS) is known to be useful for the differential diagnosis of ACTH-dependent Cushings syndrome and for the preoperative lateralization of pituitary microadenoma. We tried to analyze the relative value of IPSS in localization of microadenoma as compared with sella imaging study including computerized tomogram(CT) or magnet resonance imaging(MRI) in Cushings disease. Methods: We reviewed the clinical records of 21 patients with Cushings disease who underwent IPSS and the radiologic study such as sella CT or sella MRI preoperatively followed by transsphenoidal microsurgery. By pathologic examination including immunohistochemistry and postoperative clinical and biochemical evaluation we confirmed the diagnosis of Cushings disease due to pituitary microadenoma in all 21 cases. Results: Sella CT or sella MRI detected microadenoma in 57.1% of cases( =12/21), while recently available dynamic MRI did so in 7 out of S cases. With IPSS the diagnosis of Cushings disease was possible in 90.5% of cases(= 19/21), but accurate lateralization of microadenoma was achieved in only 63.2% of cases( =12/19). IPSS precisely localized the pituitary microadenoma in 6 out of 9 cases whose lesion were not detected by the radiologic study. Of 7 cases in which IPSS failed to localize microadenoma, the radiologic study detected the lesion in 6 cases. Of 5 cases in which IPSS and the radiologic study showed a discrepancy in location of microadenoma, the radiologic study correctly localizaed the lesion in 4 cases and IPSS did so in one case. Conclusion: IPSS is not more reliable than sella imaging study for preoperative localization of microadenoma in Cushings disease. However it might have a complementary role, especially when sella imaging study failed to visualize the lesion.

A Clinical study on the diagnesis and Treatment of Cushing's Disease - The significance of bilateral inferior petrosal sinus sampling -.: Seong Yeon Kim, Kyung Soo Park, Bo Youn Cho, Hong Kyu Lee, Jae Seok Jeon, Hyeong Kyu Park, Chang Soon Koh, Hun Ki Min, Heu Won Jeong, Dae Hee Han, Moon Hee Han, Kee Hyun Jang; J Korean Endocr Soc. 1994;9(2):115-120. Published online November 6, 2019

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Abstract PDF: Bilateral inferior petrosal sinus sampling(IPSS) is known to be useful for the differential diagnosis of ACTH-dependent Cushing's syndrome and for the preoperative localization of pituitary microadenomas.To evaluate the usefulness of IPSS, we performed the procedure in the 17 cases of ACTH-dependent Cushing's syndrome including 2 cases of macroadenomas, 6 of them with CRH stimulation test. A inferior petrosal sinus-to-peripheral ACTH ratio of 2:1 or greater(3:1 after CRH stimulation) indicates a pituitary source of ACTH hypersecretion, and a ratio of the ACTH level in one inferior petrosal sinus to the ACTH level in the other of 1:4 or greater lateralizes the microadenomas to that half of the pituitary gland.With these criteria, we diagnosed Cushing's disease in 15 of 17 cases of ACTH-dependent Cushing's syndrome, and localized the lesion in 8 of 13 cases of microadenoma.In conclusion, IPSS with CRH stimulation has high diagnostic accuracy in the differential diagnosis of ACTH-dependent Cushing's syndrome, but still has the limitations on the localization of microadenoma.

Clinical Study
Genetic Analysis of CLCN7 in an Old Female Patient with Type II Autosomal Dominant Osteopetrosis: Seon Young Kim, Younghak Lee, Yea Eun Kang, Ji Min Kim, Kyong Hye Joung, Ju Hee Lee, Koon Soon Kim, Hyun Jin Kim, Bon Jeong Ku, Minho Shong, Hyon-Seung Yi; Endocrinol Metab. 2018;33(3):380-386. Published online September 18, 2018; DOI: https://doi.org/10.3803/EnM.2018.33.3.380

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Background

Type II autosomal dominant osteopetrosis (ADO II) is a rare genetically heterogeneous disorder characterized by osteosclerosis and increased bone mass, predominantly involving spine, pelvis, and skull. It is closely related to functional defect of osteoclasts caused by chloride voltage-gated channel 7 (CLCN7) gene mutations. In this study, we aimed to identify the pathogenic mutation in a Korean patient with ADO II using whole exome sequencing.

Methods

We evaluated the clinical, biochemical, and radiographic analysis of a 68-year-old woman with ADO II. We also performed whole exome sequencing to identify pathogenic mutation of a rare genetic disorder of the skeleton. Moreover, a polymorphism phenotyping program, Polymorphism Phenotyping v2 (PolyPhen-2), was used to assess the effect of the identified mutation on protein function.

Results

Whole exome sequencing using peripheral leukocytes revealed a heterozygous c.296A>G missense mutation in the CLCN7 gene. The mutation was also confirmed using Sanger sequencing. The mutation c.296A>G was regarded to have a pathogenic effect by PolyPhen-2 software.

Conclusion

We detect a heterozygous mutation in CLCN7 gene of a patient with ADO II, which is the first report in Korea. Our present findings suggest that symptoms and signs of ADO II patient having a c.296A>G mutation in CLCN7 may appear at a very late age. The present study would also enrich the database of CLCN7 mutations and improve our understanding of ADO II.

Citations

Citations to this article as recorded by

Autosomal dominant osteopetrosis type II resulting from a de novo mutation in the CLCN7 gene: A case report
Xiu-Li Song, Li-Yuan Peng, Dao-Wen Wang, Hong Wang
World Journal of Clinical Cases.2022; 10(20): 6936. CrossRef
Magnetic resonance findings in a Cavalier King Charles spaniel with osteopetrosis, Chiari‐like malformation and syringomyelia
Ricardo Fernandes, C J Jordan, Colin Driver
Veterinary Record Case Reports.2019;[Epub] 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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Consensus on the diagnosis of Cushing’s disease: a collaborative statement from the Korean Endocrine Society and Japan Endocrine Society
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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
Ablation for Aldosterone-Producing versus Cortisol-Producing Adrenal Adenomas: A Comprehensive Review
Byung Kwan Park, Jae Hyeon Kim, Young Lyun Oh, Jung-Han Kim
Journal of Vascular and Interventional Radiology.2026; 37(9): 108894. CrossRef
Clinical Implications of Molecular and Genetic Biomarkers in Cushing’s Disease: A Literature Review
Laura Chinezu, Maximilian Cosma Gliga, Mihnea Bogdan Borz, Camelia Gliga, Ionela Maria Pascanu
Journal of Clinical Medicine.2025; 14(9): 3000. CrossRef
Bilateral Adrenal Ablation for the Treatment of Ectopic ACTH Syndrome With Severe Hypokalemia: A Case Report and a Literature Review
Fang Sun, Yuyu Sun, Hongbo He, Zhigang Zhao, Hexuan Zhang, Nan Jiang, Zhiming Zhu
Clinical Case Reports.2025;[Epub] CrossRef
Cushing’s syndrome due to Carney complex in two siblings
Akhila Panduranga Bhandarkar, Laxminarayana Samaga, Shrikrishna Acharya, Sathvika Bonigi, Lakshmi Nagendra
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Bone mineral density in patients with Cushing’s syndrome
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Diet quality and dietary acid load in relation to cardiovascular disease mortality: Results from Fasa PERSIAN cohort study
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
The British Journal of Radiology.2023;[Epub] CrossRef
Dietary acid load and mortality from all causes, CVD and cancer: results from the Golestan Cohort Study
Ehsan Hejazi, Hadi Emamat, Maryam Sharafkhah, Atoosa Saidpour, Hossein Poustchi, Sadaf Sepanlou, Masoud Sotoudeh, Sanford Dawsey, Paolo Boffetta, Christian C Abnet, Farin Kamangar, Arash Etemadi, Akram Pourshams, Akbar Fazeltabar Malekshah, Paul Berennan,
British Journal of Nutrition.2022; 128(2): 237. CrossRef
Forty Years Together, New Leap Forward! The 40th Anniversary of the Korean Endocrine Society
Jong Chul Won, Ki-Hyun Baek
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
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Metabolic changes in serum steroids for diagnosing and subtyping Cushing’s syndrome
Chang Ho Ahn, Chaelin Lee, Jaeyoon Shim, Sung Hye Kong, Su-jin Kim, Yong Hwy Kim, Kyu Eun Lee, Chan Soo Shin, Jung Hee Kim, Man Ho Choi
The Journal of Steroid Biochemistry and Molecular Biology.2021; 210: 105856. CrossRef
Application of different variants of endoscopic transphenoidal removal of corticotropinomas in order to increase the frequency and duration of remission
A. Ashraf, I. V. Chernov, A. N. Shkarubo, M. A. Kutin, D. V. Fomichev, O. I. Sharipov, Yu. Yu. Trunin, D. N. Andreev, A. A. Abdilatipov, L. I. Astafieva, B. Abdali, A. B. Kurnosov, G. E. Chmutin, Kalinin P. L. Kalinin P. L.
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A. Abdali, L.I. Astafeva, Yu.Yu. Trunin, I.V. Chernov, Yu.G. Sidneva, A.A. Abdilatipov, P.L. Kalinin
Voprosy neirokhirurgii imeni N.N. Burdenko.2021; 85(4): 111. CrossRef
Pituitary microadenomas — current diagnostic and treatment methods
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Original Article

Clinical Characteristics of 16 Patients with Pituitary Tumor Incidentally Detected by 18F-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; Endocrinol Metab. 2010;25(4):321-325. Published online December 1, 2010; DOI: https://doi.org/10.3803/EnM.2010.25.4.321

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Abstract PDF: BACKGROUND
It is uncommon to unexpectedly discover pituitary tumor as a hypermetabolic lesion on an 18F-FDG PET-CT scan for the evaluation of an unrelated disease when the patient does not show neurological or endocrine signs and symptoms. METHODS: We retrospectively analyzed the medical records of 16 patients with pituitary tumor that was detected incidentally on 18FFDG PET-CT at the Korea Cancer Center Hospital from January 2002 to September 2009. We analyzed their clinical features in detail. RESULTS: On 35,505 18F-FDG PET-CT scans, 16 (0.045%) patients were diagnosed with pituitary incidentaloma. They underwent 18FFDG PET-CT for the evaluation of the state of malignancy. All of them had no signs and symptoms related to pituitary tumor. The average age of the patients was 63.3 +/- 12.0 years (49-85 years). Eleven patients were men and 5 were women. The mean diameter of the tumor was 17.9 +/- 5.7 mm. Most of the pituitary incidentalomas were macroadenoma. The result of tumor morphologic evaluation by the Hardy classification was as follows: 6 grade IV, 1 grade III, 3 grade II and 1 grade I. The mean standardized uptake value of the tumor was 10.6 +/- 6.7. Ten patients had endocrine evaluation and they showed a normal hormone level. Among 16 patients, 4 patients received TSA and they were diagnosed with pituitary adenoma. CONCLUSION: This study showed that pituitary incidentaloma discovered on 18F-FDG PET-CT was extremely rare. It was almost all non-functioning macroadenoma and this showed relatively high FDG uptake.

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.

Citations

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 Primary Aldosteronism with Aortic Dissection.: Jung Hyun Seo, Ji Young Kim, Young Sup Kim, Wan Suk Kim, Jin Hyang Shin, Dong Jik Ahn, Yoon Young Cho, Sung Hwan Park, Jae Bok Park, Hyun Dae Yoon, Ji Hyun Lee, Ho Sang Shon; J Korean Endocr Soc. 2004;19(4):452-457. Published online August 1, 2004

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Abstract PDF: Hypertension and atherosclerosis are the most important factors contributing to the development of aortic dissection. Primary aldosteronism is a rare cause of hypertension. The concurrence of aortic dissection is very rare in primary aldosteronism. However, when aortic dissection is found as a life-threatening complication of primary aldosteronism, then the diagnosis of primary aldosteronism is important because the therapeutic intervention can be curative. Only 3 cases of primary aldosteronism with aortic dissection have been reported in the literature. We report here on a case of primary aldosteronism with aortic dissection, which was treated by laparoscopic adrenalectomy. We lowered the blood pressure with antihypertensive drugs and potassium replacement was done to treat the aortic dissection. After stabilization of aortic dissection, we removed his left adrenal mass by laparoscopic adrenalectomy. Postoperatively, the patient's blood pressure has been within normal limits and the serum potassium increased to a normal level without supplementation. The aortic dissection has remained in a stable state

A Case of Raymond-Cestan Syndrome Caused by Inferior Petrosal Sinus Sampling.: Dong Hyeok Cho; J Korean Endocr Soc. 2003;18(1):73-78. Published online February 1, 2003

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Abstract PDF: Inferior petrosal sinus sampling (IPSS) plays an important role in the assessment of patients with ACTH-dependent Cushing's syndrome. IPSS has been described as an innocuous, essentially risk-free procedure. Neurological complications associated with IPSS are rare. Previously reported neurological complications include brain stem infraction, pontine hemorrhage and subarachnoid hemorrhage. A 26-year-old woman was admitted to the hospital because of a moon face and a buffalo hump. A MRI showed a suspicious, but uncertain, area on the left side of the sella turcica. IPSS was performed as an appropriate means of providing more information about the side of the ACTH source. Immediately after the procedure, the woman experienced double vision, caused by a complete sixth nerve palsy of the left eye, together with a contralateral hemiparesis. From a clinical point of view, abducens nerve palsy and contralateral hemiparesis corresponded to Raymond-Cestan syndrome. I report a case of Raymond-Cestan syndrome, following petrosal sinus sampling in a female patient with ACTH-dependent Cushing's syndrome. To the best of our knowledge, this complication associated with petrosal sinus sampling has only been described in one previous case report. Although IPSS may provide essential information in the investigation of Cushing's syndrome, the possibility of very occasional but devastating complications should be remembered.

Original Article

Clinical Applications of 18-FDG PET in Recurred Differentiated Thyroid Cancer with Negative 131I Whole Body Scintigraphy: A Comparative Analysis with 99mTc-MIBI Scintigraphy.: Jong Chul Won, Sung Jin Lee, Tae Yun Lee, Il Seong Nam-Goong, Sy Yeol Lee, Ha Young Kim, Jung Hee Han, Jin Sook Ryu, Dae Hyuk Moon, Il Min Ahn; J Korean Endocr Soc. 2001;16(4-5):481-493. Published online October 1, 2001

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Abstract PDF: BACKGROUND
In patients with differentiated thyroid cancer treated by surgery and radioactive iodine ablation, serum thyroglobulin(Tg) and 131I whole body scan(WBS) are recognized as being the best cooperative indicators for detection of recurrence or metastasis. However, in some cases, 131I WBS shows no specific lesions despite elevated serum Tg. Therefore, 18-Fluorine-fluorodeoxyglucose (FDG) positron emission tomography(PET) has emerged as a useful method for the detection of 131I WBS negative thyroid cancers. The aims of the present study are to evaluate the clinical usefulness of this technique in detection and to compare the results with 99mTc-MIBI scintigraphy(MIBI) in cases of final results being confirmed by histologic diagnosis and other imaging methods. METHODS: We conducted a retrospective analysis amon 131I WBS negative recurred papillary thyroid carcinoma patients(male: female ratio=9:22, median age=42 yr). FDG PET was performed in 28 patients and MIBI 28 patients, 25 of whom were common to both groups. All patients had histologically proven recurrence/metastasis and negative 131I WBS results but persistently elevated serum Tg levels. In each case overall clinical evaluations were performed including histology, cytology, thyroglobulin level, other imaging methods, posttherapy 131I WBS and subsequent clinical course, to allow comparison with the results of FDG PET. RESULTS: In 19 cases of patients with negative 131I WBS, proven recurrence/metastasis lesions were detected in FDG PET. Compared with MIBI, FDG PET was found to be superior in 8 cases(including 2 patients with distant metastases). No FDG-negative/MIBI-positive tumor was observed. One FDG PET negative and MIBI negative case was proven 3 months later to be metastatic cervical lymph nodes, Sensitivities were 94.7% in the FDG PET group and 52.6% in MIBI. Diagnostic accuracy of FDG PET was superior to that of MIBI(93% vs. 62%, respectively, p=0.003). CONCLUSION: Our results confirmed the clinical usefulness of FDG PET for detection of 131I negative differentiated thyroid cancers and suggested the value of FDG PET as an initial diagnostic step, rather than MIBI, in these cases.

Case Report

A Case of Ectopic ACTH Syndrome Caused by Thymic Carcinoid Tumor and Localized by PET.: Jong Chul Won, Sung Kwan Hong, Hyun Ju Lee, Sang Ook Kim, Yun Hee Jeong, Dae Hyuk Moon, Dong Kwan Kim, Kyung Yub Kong, Jae Sung Lee, Ki Soo Kim; J Korean Endocr Soc. 1999;14(4):771-778. Published online January 1, 2001

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Abstract PDF: Ectopic ACTH syndrome is frequently caused by lung cancer and uncommonly by other tumors such as thymic carcinoid. For its treatment, early diagnosis and complete resection is irresponsible, but some cases are remained unlocalized in spite of all diagnostic modalities. Here we report a case of ectopic ACTH syndrome which was localized by PET but could not be localized by conventional technique. A tumor at thymic area was ACTH secreting thymic carcinoid which was operated but couldnt resect completly. Glucocorticoid hypersecretion was persisted with chemotherapy, radiotherapy, and ketoconazole treatment. Patient died of sepsis after 12 months of diagnosis.

Original Articles

FDG-PET as a Predictor of Recurrence with 131I Scan Negative Differentiated Thyroid Cancer: An Evaluation Compared with Pathologic Findings.: Eunju Lee, Sung Jin Lee, Cheol Ryoung Lee, Ha Young Kim, Hun Ho Song, Young So, Jin Sook Ryu, Dae Hyuk Moon, Suk Joon Hong, June Kkey Chung, Il Min Ahn; J Korean Endocr Soc. 1999;14(3):520-530. Published online January 1, 2001

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Abstract PDF: BACKGROUND
FDG-PET has been suggested to have a supplementary role in localizing recurred sites of differentiated thyroid carcinoma. This study was performed to show whether FDG-PET is feasible as an alternative diagnostic modality for patients with I-131 scan negative thyroid carcinoma by verification of post-surgical pathology findings. METHODS: Eighteen patients of papillary thyroid carcinoma (M:F=4:14, age 41+/-16 year) who had total thyroidectomy and I-131 ablation therapy were included. All patients showed negative I-131 scan on therapeutic dose but they were suspected as disease recurrence because of elevated serum Tg or anti-Tg Ab during follow-up periods. FDG-PET was performed, and then cervical lymph node dissection on either side or both sides of the neck was done according to FDG-PET results. RESULTS: A total of 77 cervical lymph node groups were dissected in 18 patients; internal jugular chain 49, spinal accessory 9, jugulodigastric 5, anterior jugular 4, paratracheal 3, supraclavicular 2, and others 5. Forty eight lymph node groups revealed metastatic papillary carcinoma on pathology and their largest diameter ranged from 0.4 to 7.0cm (1.2+/-0.7cm). All patients had at least one malignant lymph node group. FDG-PET detected 37 among 48 malignant lymph nodes (sensitivity 77%), and their count ratio ranged 1.7-31.1 (6.1+/-6.3). Among the 30 malignant lymph nodes less than 1cm, FDG-PET detected 20 lymph nodes. Of the 29 lymph node groups without malignant cells, FDG-PET was also negative in 24 groups (specificity S3%). Positive predictive value of FDG-PET on I-131 scan negative differentiated thyroid carcinoma was 88%; negative predictive value was 69%. CONCLUSION: FDG-PET has been confirmed as a valuable diagnostic modality to detect cervical lymph nodes of differentiated thyroid carcinoma who are suspicious for recurrence but with negative I-131 scan, by pathologic findings.

Diagnosis of Cushing's Disease by Inferior Petrosal Sinus Sampling (IPSS): Evidence of False Negative Results.: Seon Hwa Lee, Hyeon Jeong Jeon, Sun Hee Park, Sun Wook Kim, Do Joon Park, Kyong Soo Park, Seong Yeon Kim, Bo Youn Cho, Hong Kyu Lee; J Korean Endocr Soc. 1999;14(3):483-492. Published online January 1, 2001

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Abstract PDF: BACKGROUND
While inferior petrosal sinus sampling (IPSS) correctly diagnoses pituitary dependent Cushings syndrome if a significant ratio of plasma ACTH between the IPS and the peripheral blood is demonstrated, little has been said about the significance of a negative ratio in Cushings disease (e.g. false negative result). We evaluated the results of IPSS with Cushings disease, and compared them with imaging findings through transsphenoidal surgery. METHODS: 29 patients with Cushings disease underwent transsphenoidal examination of the pituitary gland from 1989 to 1998 at Seoul National University Hospital were evaluated. We compared the results of IPSS and imaging findings with sellar CT or dynamic MRI. The ratio of the ACTH concentrations at the IPS and in the peripheral blood (IPS:P ratio) and the ratio of the ACTH concentrations between the IPSs (interpetrosal ratio) were calculated before and after CRH infusion. RESULTS: With IPSS the diagnosis of Cushings disease was possible in 90% (26/29), and 3 cases in whom IPSS did not show significant IPS:P ACTH ratio were confirmed to be Cushings disease through hemihypophysectomy of lesion suspected by sellar dynamic MRI and achieved remission after operation (e.g. false negative result of diagnosis for Cushings disease by IPSS). However, accurate localization of microadenoma was achieved in only 59% (17/29). Imaging study detected microadenoma in 76% (22/29) and correctly localized in 66% (19/29). Both IPSS and imaging study precisely localized the pituitary microadenoma in 10 (34.5%) cases of 29 cases and a discrepancy between two studies existed in 7 (24.1%) cases in which the imaging study correctly localized microadenoma in 6 cases and IPSS in 1 case. CONCLUSION: Only when a significant IPS:P ACTH ratio is present can Cushings disease be established by IPSS. The absence of a significant IPS:P ACTH ratio does not necessarily imply ectopic secretion of ACfH, nor does it exclude Cushings disease. The results of lateralization by IPSS do not remove the need for transsphenoidal examination of the sella turcica because false negative result can be. IPSS and radiologic study should be complementary used in diagnosis of Cushings disease and localization of microadenoma, as IPSS can be used when sellar imaging study failed to visualize the lesion and hemihypophysectomy of suspected lesion by imaging study can be considered when IPSS did not show significant ratio of ACTH.

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