Pub Date : 2009-03-01DOI: 10.3803/JKES.2009.24.1.25
Won Gu Kim, Hyunji Choi, Eui Young Kim, Tae Yong Kim, W. Kim, Seong Chul Kim, Y. Shong
Background: Peroxisome proliferator-activated receptor delta (PPAR-δ) is a ligand-activated nuclear transcription factor that is associated with many diseases, such as diabetes, obesity, metabolic syndrome, and cancer. However, the function of PPAR-δ is controversial in carcinogenesis since its ligands may inhibit or promote the growth of cancer cells. The purpose of this study was to determine the effect of GW501516, the specific agonist of PPAR-δ, in the growth and invasiveness of thyroid cancer cell lines by modulation of the target genes, ANGPTL-4 and MCP-1. Methods: Three kinds of human cancer cell lines, FRO (thyroid anaplastic carcinoma), NPA (melanoma), and ARO (colon cancer) were treated with GW501516 in serum-free media. Cell viability was assayed using a colorimetric cell counting kit-8 assay. The changes in the level of expression of PPAR-δ and its target genes, angiopoietin-like protein-4 (ANGPTL-4) and monocyte chemotactic protein-1 (MCP-1), were determined by RT-PCR analysis and invasiveness was assessed by a cell invasion assay kit. Results: GW501516 inhibited the cell growth of cancer cell lines in a dose-dependent manner and modulated the stimulation of ANGPTL-4, as well as inhibition of MCP-1. These effects were more prominent in NPA and ARO, but less effective in the thyroid cancer cell l ine, which had higher PPAR-δ and lower ANGPTL-4 mRNA levels. The inhibitory effects of GW501516 on cancer invasiveness had a similar pattern. Conclusion: The activation of PPAR-δ by GW501516 reduced the cell growth and invasiveness of the thyroid cancer cell line. This effect of GW501516 was associated with a stimulatory effect of ANGPTL4 and an inhibitory effect of MCP-1 in cancer cell lines. GW501516 was less effective in the thyroid cancer cell line, which had a low basal ANGPTL-4 mRNA level. The findings of our study serve as an impetus for further studies to elucidate the precise role of ANGPTL-4 and PPAR-δ in carcinogenesis. (J Korean Endocr
{"title":"Effects of Peroxisome Proliferator-Activated Receptor (PPAR) Delta on the Growth and Invasion of a Thyroid Cancer Cell Line","authors":"Won Gu Kim, Hyunji Choi, Eui Young Kim, Tae Yong Kim, W. Kim, Seong Chul Kim, Y. Shong","doi":"10.3803/JKES.2009.24.1.25","DOIUrl":"https://doi.org/10.3803/JKES.2009.24.1.25","url":null,"abstract":"Background: Peroxisome proliferator-activated receptor delta (PPAR-δ) is a ligand-activated nuclear transcription factor that is associated with many diseases, such as diabetes, obesity, metabolic syndrome, and cancer. However, the function of PPAR-δ is controversial in carcinogenesis since its ligands may inhibit or promote the growth of cancer cells. The purpose of this study was to determine the effect of GW501516, the specific agonist of PPAR-δ, in the growth and invasiveness of thyroid cancer cell lines by modulation of the target genes, ANGPTL-4 and MCP-1. Methods: Three kinds of human cancer cell lines, FRO (thyroid anaplastic carcinoma), NPA (melanoma), and ARO (colon cancer) were treated with GW501516 in serum-free media. Cell viability was assayed using a colorimetric cell counting kit-8 assay. The changes in the level of expression of PPAR-δ and its target genes, angiopoietin-like protein-4 (ANGPTL-4) and monocyte chemotactic protein-1 (MCP-1), were determined by RT-PCR analysis and invasiveness was assessed by a cell invasion assay kit. Results: GW501516 inhibited the cell growth of cancer cell lines in a dose-dependent manner and modulated the stimulation of ANGPTL-4, as well as inhibition of MCP-1. These effects were more prominent in NPA and ARO, but less effective in the thyroid cancer cell l ine, which had higher PPAR-δ and lower ANGPTL-4 mRNA levels. The inhibitory effects of GW501516 on cancer invasiveness had a similar pattern. Conclusion: The activation of PPAR-δ by GW501516 reduced the cell growth and invasiveness of the thyroid cancer cell line. This effect of GW501516 was associated with a stimulatory effect of ANGPTL4 and an inhibitory effect of MCP-1 in cancer cell lines. GW501516 was less effective in the thyroid cancer cell line, which had a low basal ANGPTL-4 mRNA level. The findings of our study serve as an impetus for further studies to elucidate the precise role of ANGPTL-4 and PPAR-δ in carcinogenesis. (J Korean Endocr","PeriodicalId":119859,"journal":{"name":"Journal of Korean Endocrine Society","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2009-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115941463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2008-12-01DOI: 10.3803/JKES.2008.23.6.438
H. Kim, Hong-Joon Shin, Ho-Cheol Kang
Painful Hashimoto’s thyroiditis (HT) is a subtype of HT characterized by thyroid pain with overt elevation in inflammatory markers and thyroid autoantibodies. The differential diagnosis of painful HT with subacute granulomatous thyroiditis is often difficult because initial clinical findings are very similar. Findings that favor the diagnosis of painful HT include preceding history of chroni c goiter or autoimmune thyroid diseases, a high titer of thyroid autoantibodies, and repeated painful attacks even with chronic glucocorticoid therapy. Surgery is often needed to relieve the thyroid pain. We report a case of painful HT who received only temporary relief from steroid therapy and required total thyroidectomy for relapsing thyroid pain. The clinical response s to steroid and surgical therapy are described, with a literature review emphasizing the differential diagnosis with subacute granulomatous thyroiditis. To our knowledge, this is the first case report of painful HT treated with total thyroidectomy in the Korean literature.
{"title":"A Case of Painful Hashimoto's Thyroiditis Successfully Treated with Total Thyroidectomy","authors":"H. Kim, Hong-Joon Shin, Ho-Cheol Kang","doi":"10.3803/JKES.2008.23.6.438","DOIUrl":"https://doi.org/10.3803/JKES.2008.23.6.438","url":null,"abstract":"Painful Hashimoto’s thyroiditis (HT) is a subtype of HT characterized by thyroid pain with overt elevation in inflammatory markers and thyroid autoantibodies. The differential diagnosis of painful HT with subacute granulomatous thyroiditis is often difficult because initial clinical findings are very similar. Findings that favor the diagnosis of painful HT include preceding history of chroni c goiter or autoimmune thyroid diseases, a high titer of thyroid autoantibodies, and repeated painful attacks even with chronic glucocorticoid therapy. Surgery is often needed to relieve the thyroid pain. We report a case of painful HT who received only temporary relief from steroid therapy and required total thyroidectomy for relapsing thyroid pain. The clinical response s to steroid and surgical therapy are described, with a literature review emphasizing the differential diagnosis with subacute granulomatous thyroiditis. To our knowledge, this is the first case report of painful HT treated with total thyroidectomy in the Korean literature.","PeriodicalId":119859,"journal":{"name":"Journal of Korean Endocrine Society","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116303785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2008-12-01DOI: 10.3803/JKES.2008.23.6.413
Won Jun Kim, J. Kim, D. Park, C. Lee, Yongsoo Park, Dong Kim, W. Choi, Tae Wha Kim, Y. Ahn
Background: The purpose of this study was to assess the prevalence of thyroid nodules in healthy adults without a history of thyroid disease and the results of fine needle aspiration cytology (FNAC). Methods: We retrospectively studied 4,832 adults (2,427 women, 2,405 men) over the age of 20 who had visited our health care center from January, 2005, to March, 2008. Subjects with previous thyroid disease were excluded. All were screened by thyroid ultrasonography and FNAC was performed on large or potentially malignant nodules. Results: Thyroid nodules were present in 686 women (28.3%) and 396 men ( 16.5%), with a female predominance (odds ratio = 1.47, 95% CI = 1.35~1.60). The prevalence of a thyroid nodule was significantly correlated with age in both women and men (P < 0.001). Multinodularity also increased according to age in both groups. Ninety patients were tested with conventional FNAC and 195 underwent ultrasonography-guided FNAC. The rate of inadequate cytology by ultrasonographic guidance was lower than by freehand methods, and the total rate of malignant cytology per patient was 17.9%. Ultrasonographic characteristics that significantly correlated with histologically-confirmed papillary carcinoma included a solid component, hypoechogenecity, irregular margin, and the presence of microcalcification or macrocalcification. Conclusion: The prevalence of thyroid nodules detected by ultrasonography was 28.3% in healthy women and 16.5% in healthy men population. The prevalence and multinodularity was significantly correlated with age in both groups. It’s useful to examine thyroid by ultrasonography because of detecting more nodules, providing guidance of FNAC, achieving more adequate sampling and not missing small malignant nodules. (J Korean
背景:本研究的目的是评估无甲状腺病史的健康成人甲状腺结节的患病率和细针穿刺细胞学检查(FNAC)的结果。方法:我们回顾性研究了2005年1月至2008年3月期间到我们医疗中心就诊的20岁以上的4,832名成年人(2,427名女性，2,405名男性)。排除既往有甲状腺疾病的受试者。所有患者均经甲状腺超声检查，对大结节或潜在恶性结节行FNAC检查。结果:女性686例(28.3%)，男性396例(16.5%)，女性占优势(优势比= 1.47,95% CI = 1.35~1.60)。男性和女性甲状腺结节的患病率均与年龄显著相关(P < 0.001)。在两组中，多轴性也随着年龄的增长而增加。90例患者行常规FNAC, 195例行超声引导下FNAC。超声引导下的细胞学检查不充分率低于徒手检查，每例患者的恶性细胞学检查率为17.9%。与组织学证实的乳头状癌显著相关的超声特征包括实性成分、低回声、边缘不规则以及微钙化或大钙化的存在。结论:超声检查甲状腺结节检出率在健康女性中为28.3%，在健康男性中为16.5%。两组患者的患病率和多结节性均与年龄显著相关。超声检查甲状腺的优点是能检出更多的结节，为FNAC提供指导，采样更充分，不会遗漏小的恶性结节。(J韩国
{"title":"Prevalence of Thyroid Nodules Detected by Ultrasonography in Adults for Health Check-Ups and Analysis of Fine Needle Aspiration Cytology","authors":"Won Jun Kim, J. Kim, D. Park, C. Lee, Yongsoo Park, Dong Kim, W. Choi, Tae Wha Kim, Y. Ahn","doi":"10.3803/JKES.2008.23.6.413","DOIUrl":"https://doi.org/10.3803/JKES.2008.23.6.413","url":null,"abstract":"Background: The purpose of this study was to assess the prevalence of thyroid nodules in healthy adults without a history of thyroid disease and the results of fine needle aspiration cytology (FNAC). Methods: We retrospectively studied 4,832 adults (2,427 women, 2,405 men) over the age of 20 who had visited our health care center from January, 2005, to March, 2008. Subjects with previous thyroid disease were excluded. All were screened by thyroid ultrasonography and FNAC was performed on large or potentially malignant nodules. Results: Thyroid nodules were present in 686 women (28.3%) and 396 men ( 16.5%), with a female predominance (odds ratio = 1.47, 95% CI = 1.35~1.60). The prevalence of a thyroid nodule was significantly correlated with age in both women and men (P < 0.001). Multinodularity also increased according to age in both groups. Ninety patients were tested with conventional FNAC and 195 underwent ultrasonography-guided FNAC. The rate of inadequate cytology by ultrasonographic guidance was lower than by freehand methods, and the total rate of malignant cytology per patient was 17.9%. Ultrasonographic characteristics that significantly correlated with histologically-confirmed papillary carcinoma included a solid component, hypoechogenecity, irregular margin, and the presence of microcalcification or macrocalcification. Conclusion: The prevalence of thyroid nodules detected by ultrasonography was 28.3% in healthy women and 16.5% in healthy men population. The prevalence and multinodularity was significantly correlated with age in both groups. It’s useful to examine thyroid by ultrasonography because of detecting more nodules, providing guidance of FNAC, achieving more adequate sampling and not missing small malignant nodules. (J Korean","PeriodicalId":119859,"journal":{"name":"Journal of Korean Endocrine Society","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124123588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2008-12-01DOI: 10.3803/JKES.2008.23.6.444
H. Jeong, Ji-young Kang, Hyun Kim, Kyu-Ho Lee, Dal-Sic Lee, G. Choi, Tae Geun Oh, Hyen Jeong Jeon
MELAS (mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes) syndrome is characterized by stroke-like episodes before the age of 40, encephalopathy, seizures, dementia and lactic acidosis, and is caused by mutations in mitochondrial DNA. Diabetes mellitus and cardiac involvement are also frequently seen in MELAS syndrome. It is a classic mitochondrial disorder that shows a slow, chronic, progressive course, and presents with multiple organ involvement including the central nervous system, skeletal muscle, eye, cardiac muscle and gastrointestinal system. Here, we report a case of 33 year-old woman with insulin-deficient diabetes mellitus and sensorineural hearing loss experiencing repeated stroke-like episodes. MELAS syndrome with an A3243G point mutation was confirmed by mitochondrial DNA sequencing analysis. (J Korean Endocr Soc 23:444~449, 2008) ꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏ
{"title":"A Case of MELAS Syndrome Manifested by Insulin-deficient Diabetes Mellitus","authors":"H. Jeong, Ji-young Kang, Hyun Kim, Kyu-Ho Lee, Dal-Sic Lee, G. Choi, Tae Geun Oh, Hyen Jeong Jeon","doi":"10.3803/JKES.2008.23.6.444","DOIUrl":"https://doi.org/10.3803/JKES.2008.23.6.444","url":null,"abstract":"MELAS (mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes) syndrome is characterized by stroke-like episodes before the age of 40, encephalopathy, seizures, dementia and lactic acidosis, and is caused by mutations in mitochondrial DNA. Diabetes mellitus and cardiac involvement are also frequently seen in MELAS syndrome. It is a classic mitochondrial disorder that shows a slow, chronic, progressive course, and presents with multiple organ involvement including the central nervous system, skeletal muscle, eye, cardiac muscle and gastrointestinal system. Here, we report a case of 33 year-old woman with insulin-deficient diabetes mellitus and sensorineural hearing loss experiencing repeated stroke-like episodes. MELAS syndrome with an A3243G point mutation was confirmed by mitochondrial DNA sequencing analysis. (J Korean Endocr Soc 23:444~449, 2008) ꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏ","PeriodicalId":119859,"journal":{"name":"Journal of Korean Endocrine Society","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116098291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2008-12-01DOI: 10.3803/JKES.2008.23.6.395
J. Yoon, M. Kang, H. Y. Ahn, J. An, S. W. Kim, C. Shin, K. Park, H. Jang, B. Cho, Hong-Kyu Lee, S. Kim
Background: This study was performed to evaluate the frequency and clinical characteristics of patients with active acromegaly and who show discordance of the growth hormone (GH) level and the insulin-like growth factor-I (IGF-I) level. Methods: We reviewed the medical records of the patients who were diagnosed with acromegaly between 01/01/1995 and 6/30/2007 at Seoul National University Hospital. We selected only the patients whose basal GH and IGF-I levels were available. We investigated the pre- and post-operative clinical characteristics, as well as the blood concentrations of GH and IGF-I. The concordance rate between the two hormones was examined. The patients were considered to have active disease on the basis of their IGF-I levels above the normal range, after adjustment for age and gender, and their mean basal GH value was ≥ 2.5 μg/L. The hormone levels and the clinical parameters were compared between the hormone concordant and discordant groups. Results: We reviewed the preoperative records of 103 acromegalic patients, and these patients met the above-mentioned criteria. 53 postoperative patients who were not cured by operation were monitored without them receiving radiation or medical therapy. Both the basal GH and IGF-I levels were above normal in 103 patients preoperatively, and the discordant rate was 0% (0/103 cases). Postoperatively, the discordant rate between the two hormones was increased to 30.2% (16/53 cases). Age, gender, body mass index and tumor size were insignificantly different between the concordant and discordant groups. However, postoperative residual tumors were less frequently observed in the discordant group (P = 0.006). Conclusion: For the patients with acromegaly, unlike the 0% discordance preoperatively, 30.2% of patients showed a discrepancy between their GH and IGF-I levels postoperatively. The patients who had hormonal discrepancy were less likely to have residual tumors after operation. Considering the frequency of this hormonal discrepancy, both hormone levels should be measured to evaluate the disease activity after treatment. Further, oral glucose tolerance testing should be performed and especially for the patients with an increased GH level, but who have a normal IGF-I concentration. (J Korean Endocr Soc 23:395~403, 2008)
背景:本研究旨在评估生长激素(GH)和胰岛素样生长因子- i (IGF-I)水平不一致的活动性肢端肥大症患者的频率和临床特征。方法:回顾1995年1月1日至2007年6月30日在首尔国立大学医院诊断为肢端肥大症的患者的病历。我们只选择了基础生长激素和igf - 1水平可用的患者。我们调查了术前和术后的临床特征，以及GH和IGF-I的血药浓度。检测两种激素的一致性。经年龄、性别调整后，若IGF-I水平高于正常范围，且平均GH基础值≥2.5 μg/L，则视为活动性疾病。比较激素和谐组和激素不和谐组的激素水平和临床参数。结果:我们回顾了103例肢端肥大症患者的术前记录，均符合上述标准。术后未治愈的53例患者在未接受放疗或药物治疗的情况下进行监测。103例患者术前基础GH和IGF-I水平均高于正常值，不正常率为0%(0/103例)。术后两种激素不一致率提高至30.2%(16/53)。年龄、性别、体重指数和肿瘤大小在和谐组和不和谐组之间无显著差异。而不协调组术后残留肿瘤发生率较低(P = 0.006)。结论:肢端肥大症患者的GH和IGF-I水平与术前的0%不一致不同，30.2%的患者术后出现了差异。激素差异的患者术后残留肿瘤的可能性较小。考虑到这种激素差异的频率，应测量两种激素水平，以评估治疗后的疾病活动性。此外，应进行口服葡萄糖耐量试验，特别是对于生长激素水平升高但igf - 1浓度正常的患者。(韩国医师社23:395~403,2008)
{"title":"Discrepancy between the Growth Hormone and Insulin-like Growth Factor-I Concentrations in Patients with Acromegaly.","authors":"J. Yoon, M. Kang, H. Y. Ahn, J. An, S. W. Kim, C. Shin, K. Park, H. Jang, B. Cho, Hong-Kyu Lee, S. Kim","doi":"10.3803/JKES.2008.23.6.395","DOIUrl":"https://doi.org/10.3803/JKES.2008.23.6.395","url":null,"abstract":"Background: This study was performed to evaluate the frequency and clinical characteristics of patients with active acromegaly and who show discordance of the growth hormone (GH) level and the insulin-like growth factor-I (IGF-I) level. Methods: We reviewed the medical records of the patients who were diagnosed with acromegaly between 01/01/1995 and 6/30/2007 at Seoul National University Hospital. We selected only the patients whose basal GH and IGF-I levels were available. We investigated the pre- and post-operative clinical characteristics, as well as the blood concentrations of GH and IGF-I. The concordance rate between the two hormones was examined. The patients were considered to have active disease on the basis of their IGF-I levels above the normal range, after adjustment for age and gender, and their mean basal GH value was ≥ 2.5 μg/L. The hormone levels and the clinical parameters were compared between the hormone concordant and discordant groups. Results: We reviewed the preoperative records of 103 acromegalic patients, and these patients met the above-mentioned criteria. 53 postoperative patients who were not cured by operation were monitored without them receiving radiation or medical therapy. Both the basal GH and IGF-I levels were above normal in 103 patients preoperatively, and the discordant rate was 0% (0/103 cases). Postoperatively, the discordant rate between the two hormones was increased to 30.2% (16/53 cases). Age, gender, body mass index and tumor size were insignificantly different between the concordant and discordant groups. However, postoperative residual tumors were less frequently observed in the discordant group (P = 0.006). Conclusion: For the patients with acromegaly, unlike the 0% discordance preoperatively, 30.2% of patients showed a discrepancy between their GH and IGF-I levels postoperatively. The patients who had hormonal discrepancy were less likely to have residual tumors after operation. Considering the frequency of this hormonal discrepancy, both hormone levels should be measured to evaluate the disease activity after treatment. Further, oral glucose tolerance testing should be performed and especially for the patients with an increased GH level, but who have a normal IGF-I concentration. (J Korean Endocr Soc 23:395~403, 2008)","PeriodicalId":119859,"journal":{"name":"Journal of Korean Endocrine Society","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133551757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2008-12-01DOI: 10.3803/JKES.2008.23.6.430
Hee-Kwan Won, Myoung Jun Lee, J. Park, In Girl Song, Go Eun Lee, Ji-Hyun Jeong, Jee-Young Cheon, H. Sul, Dong Mi Lim, Keun-Young Park
The diffuse sclerosing variant of papillary thyroid carcinoma (DSPTC) is a rare histological subtype characterized by diffuse involvement of one or both thyroid lobes, widespread lymphatic permeation, prominent fibrosis, squamous metaplasia, abundant psammoma body and lymphatic infiltration. This subtype usually occurs in young female, and exhibits a higher frequency of cervical and distant metastasis. DSPTC clinically resembles Hashimoto’s thyroiditis, and often delays the correct diagnosis. We experienced two patients with DSPTC: the one patient presented with a neck mass lasting for a month, and in the other patient, a thyroid lesion was incidentally found during a medical examination. (J Korean Endocr Soc 23:430~437, 2008)
{"title":"Two Cases of the Diffuse Sclerosing Variant of Papillary Thyroid Carcinoma","authors":"Hee-Kwan Won, Myoung Jun Lee, J. Park, In Girl Song, Go Eun Lee, Ji-Hyun Jeong, Jee-Young Cheon, H. Sul, Dong Mi Lim, Keun-Young Park","doi":"10.3803/JKES.2008.23.6.430","DOIUrl":"https://doi.org/10.3803/JKES.2008.23.6.430","url":null,"abstract":"The diffuse sclerosing variant of papillary thyroid carcinoma (DSPTC) is a rare histological subtype characterized by diffuse involvement of one or both thyroid lobes, widespread lymphatic permeation, prominent fibrosis, squamous metaplasia, abundant psammoma body and lymphatic infiltration. This subtype usually occurs in young female, and exhibits a higher frequency of cervical and distant metastasis. DSPTC clinically resembles Hashimoto’s thyroiditis, and often delays the correct diagnosis. We experienced two patients with DSPTC: the one patient presented with a neck mass lasting for a month, and in the other patient, a thyroid lesion was incidentally found during a medical examination. (J Korean Endocr Soc 23:430~437, 2008)","PeriodicalId":119859,"journal":{"name":"Journal of Korean Endocrine Society","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115686651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2008-12-01DOI: 10.3803/JKES.2008.23.6.425
Seo-hee Lee, S. Kim, Hae Ri Lee, J. Kang, O. Ryu, C. Kim, B. Lee, Seong-Jin Lee, E. Hong, H. Kim, D. Kim, J. Yu, S. Ihm, M. Choi, H. Yoo
Hyperthyroidism combined with rhabdomyolysis is extremely rare. There are only 6 reported cases of hyperthyroidism accompanied with rhabdomyolysis in the medical literature. Rhabdomyolysis is a syndrome involving the breakdown of skeletal muscle, and this causes myoglobin and intracellular protein to leak into the circulation. The causes of rhabdomyolysis include trauma, electrolyte abnormality, infection, drug, toxin and hypothyroidism. We report here on a patient who presented with thyrotoxic periodic paralysis and rhabdomyolysis with hypokalemia. He complained of lower leg paralysis along with muscle tenderness, and the laboratory findings showed elevated creatine kinase (CK) levels. After treatment by hydration, potassium replacement and drug medication, including propylthiouracil and beta-blocker, his CK levels were normalized and his symptoms were much improved. For patient with thyrotoxic periodic paralysis and muscle tenderness, the possibility of rhabdomyolysis should be clarified by examining the CK levels. (J Korean Endocr Soc
{"title":"A Case of Thyrotoxic Periodic Paralysis with Rhabdomyolysis","authors":"Seo-hee Lee, S. Kim, Hae Ri Lee, J. Kang, O. Ryu, C. Kim, B. Lee, Seong-Jin Lee, E. Hong, H. Kim, D. Kim, J. Yu, S. Ihm, M. Choi, H. Yoo","doi":"10.3803/JKES.2008.23.6.425","DOIUrl":"https://doi.org/10.3803/JKES.2008.23.6.425","url":null,"abstract":"Hyperthyroidism combined with rhabdomyolysis is extremely rare. There are only 6 reported cases of hyperthyroidism accompanied with rhabdomyolysis in the medical literature. Rhabdomyolysis is a syndrome involving the breakdown of skeletal muscle, and this causes myoglobin and intracellular protein to leak into the circulation. The causes of rhabdomyolysis include trauma, electrolyte abnormality, infection, drug, toxin and hypothyroidism. We report here on a patient who presented with thyrotoxic periodic paralysis and rhabdomyolysis with hypokalemia. He complained of lower leg paralysis along with muscle tenderness, and the laboratory findings showed elevated creatine kinase (CK) levels. After treatment by hydration, potassium replacement and drug medication, including propylthiouracil and beta-blocker, his CK levels were normalized and his symptoms were much improved. For patient with thyrotoxic periodic paralysis and muscle tenderness, the possibility of rhabdomyolysis should be clarified by examining the CK levels. (J Korean Endocr Soc","PeriodicalId":119859,"journal":{"name":"Journal of Korean Endocrine Society","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127548053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2008-12-01DOI: 10.3803/JKES.2008.23.6.404
J. Kwon, Y. An, Y. Kang, S. Son, In‐Ju Kim, Y. K. Kim
Aims: Alanine aminotransferase (ALT) is associated with insulin resistance, and is independent of the general metabolic measures. Gamma-glutamyltransferase (GGT) is regarded as a predictor of diabetes mellitus. We analyzed which of ALT or GGT is better tool to preestimate the development of metabolic syndrome. Method: A total of 1203 Koreans who visited the Institute of Health in Pusan National University Hospital from January 2005 to August 2006 were enrolled in this cross-sectional study. Their median age was 51 years old, and the prevalence of metabolic syndrome was 16.4% (n = 197). We excluded the subjects with diabetes mellitus, hypertension and viral hepatitis or those subjects with a level of alanine aminotransferase (ALT) or gamma-glutamyltransferase (r-GGT) > 80 IU/L. Results: For all the patients in the metabolic syndrome group, the median homeostatic assessment of insulin resistance (HOMA-IR), the waist circumference, the fasting blood glucose level, the systolic and diastolic blood pressure were all associated with the ALT level (P < 0.05). For the nonmetabolic syndrome group, all the metabolic risk factors were associated with the ALT level (P < 0.05). On logistic regression analysis, after correction for age, alcohol intake, HOMA-IR and body mass index, the logALT maintained a highly predictive value for metabolic syndrome, and this was better than the logGGT [odds ratio (OR) of logALT: 18.489, odds ratio of logGGT: 2.024] (P < 0.001). The risk of developing metabolic syndrome was significantly higher in the above 50 percentile and the above 75 percentile of ALT than in the lowest quartile. [for men – OR: 3.6; 95% confidence interval (CI), 2.2-5.9; OR: 6.9; 95% CI: 4.3-10.9] [for women – OR: 2.7; 95% CI: 1.5-4.7; OR: 6.5; 95% CI: 3.8-11] (P < 0.001). The cut-off value of ALT by the ROC curve was 24 IU/L for men (sensitivity: 64.3%, specificity: 66%, negative predictive value: 99.5%) and 20 IU/L for women (sensitivity: 78.9%, specificity: 61.4%, negative predictive value: 84.9%). Conclusions: Even although patients can have an ALT level that’s included within the upper normal level, we may consider the probability that these patients will have metabolic syndrome. Furthermore, in our analysis, the ALT level is a better predictor of metabolic syndrome than the GGT level. (J Korean Endocr
{"title":"Alanine Aminotransferase as a Predictor of Metabolic Syndrome in Koreans","authors":"J. Kwon, Y. An, Y. Kang, S. Son, In‐Ju Kim, Y. K. Kim","doi":"10.3803/JKES.2008.23.6.404","DOIUrl":"https://doi.org/10.3803/JKES.2008.23.6.404","url":null,"abstract":"Aims: Alanine aminotransferase (ALT) is associated with insulin resistance, and is independent of the general metabolic measures. Gamma-glutamyltransferase (GGT) is regarded as a predictor of diabetes mellitus. We analyzed which of ALT or GGT is better tool to preestimate the development of metabolic syndrome. Method: A total of 1203 Koreans who visited the Institute of Health in Pusan National University Hospital from January 2005 to August 2006 were enrolled in this cross-sectional study. Their median age was 51 years old, and the prevalence of metabolic syndrome was 16.4% (n = 197). We excluded the subjects with diabetes mellitus, hypertension and viral hepatitis or those subjects with a level of alanine aminotransferase (ALT) or gamma-glutamyltransferase (r-GGT) > 80 IU/L. Results: For all the patients in the metabolic syndrome group, the median homeostatic assessment of insulin resistance (HOMA-IR), the waist circumference, the fasting blood glucose level, the systolic and diastolic blood pressure were all associated with the ALT level (P < 0.05). For the nonmetabolic syndrome group, all the metabolic risk factors were associated with the ALT level (P < 0.05). On logistic regression analysis, after correction for age, alcohol intake, HOMA-IR and body mass index, the logALT maintained a highly predictive value for metabolic syndrome, and this was better than the logGGT [odds ratio (OR) of logALT: 18.489, odds ratio of logGGT: 2.024] (P < 0.001). The risk of developing metabolic syndrome was significantly higher in the above 50 percentile and the above 75 percentile of ALT than in the lowest quartile. [for men – OR: 3.6; 95% confidence interval (CI), 2.2-5.9; OR: 6.9; 95% CI: 4.3-10.9] [for women – OR: 2.7; 95% CI: 1.5-4.7; OR: 6.5; 95% CI: 3.8-11] (P < 0.001). The cut-off value of ALT by the ROC curve was 24 IU/L for men (sensitivity: 64.3%, specificity: 66%, negative predictive value: 99.5%) and 20 IU/L for women (sensitivity: 78.9%, specificity: 61.4%, negative predictive value: 84.9%). Conclusions: Even although patients can have an ALT level that’s included within the upper normal level, we may consider the probability that these patients will have metabolic syndrome. Furthermore, in our analysis, the ALT level is a better predictor of metabolic syndrome than the GGT level. (J Korean Endocr","PeriodicalId":119859,"journal":{"name":"Journal of Korean Endocrine Society","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125981135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2008-12-01DOI: 10.3803/JKES.2008.23.6.379
S. Rhee, Young Seol Kim
역학에 있어 임상역학(clinical epidemiology)은 매우 중 요한 개념이다. 임상역학은 임상의학의 다양한 문제점에 대 해 역학적 기법을 이용하여 해결하려는 과학으로 1938년 질 병이 발생되기 쉬운 상황에 대해 연구하는 과학이라는 의미 에서 처음 도입된 후, 의학의 발전에 따라 1970년대에 역학 적 기법을 이용하여 진료, 검사, 치료의 유효성과 효율성을 평가하는 학문으로 정의, 발전되었다. 최근의 거의 모든 의학 분야에서 이러한 임상역학적 접근 이 주목 받고 있는 것은 1991년 Guyatt가 근거중심의학 (EBM)이라는 용어를 제창한 이후부터이다. 근거중심의학에 서는 임상 진료가 의사의 개인적 경험이나 기호에 의해서가 아닌 일정한 진료지침에 의거하여 이루어져야 한다. 이를 위 해 각각의 환자에 대한 의사 개인의 경험적 치료가 아닌, 명 확한 최종 목적에 따라 계획된 진료를 시행하고 이를 통해 얻어진 데이터에 근거한 표준화된 진료지침이 필요하게 되 었다. 그러므로 각각의 진료 지침들은 기본적으로 여러 역학 연구들에 근거하여 작성되어야 하게 되었다. 이러한 역학 연구 들이 바로 근거중심의학(evidence based medicine, EBM)을 이루는 기본 요소이다. 역학 연구는 본태적으로 불확실성을 가지고 있는 임상의 학의 약점을 극복하기 위한 필수적인 검증 단계이다. 예를 들어, 고혈압은 연령 증가에 따라 필수적으로(essential) 발생 하는 현상이므로 고혈압을 치료하면 장기 손상이 일어난다고 생각했던 시절이 있었다. 하지만, 역학연구를 통하여 고혈압 치료가 뇌졸중이나 심혈관 질환과 같은 치명적인 중증 질환 을 예방할 수 있다는 것이 근거로 증명되었기 때문에 혈압 강하 치료는 일상 진료에 필수적인 의료 행위가 되었다. 이렇듯 EBM의 기조는 전 세계적으로 폭넓게 확산되고 있어 향후 임상의 여러 분야에서 보다 엄격한 EBM이 적용 될 것으로 전망되고 있다. 그리고 이는 의학의 여러 영역에 있어 다양한 임상 역학 연구들이 폭넓게 시행될 것임을 의 미한다. 실제 이러한 추세에 따라 내분비-대사내과의 여러 분야에서 전 세계적으로 광범위한 EBM 연구가 이루어지고 있다. 하지만 이러한 연구들은 주로 당뇨병, 고지혈증, 골다 공증 분야에 한정된 편이며, 전통적인 내분비 질환들의 진단 과 치료에 대한 연구는 아직 부족한 실정이다. 특히, 우리나라에서는 한국인의 고유한 특성에 대한 역학 연구가 많지 않은 실정으로 대부분 외국의 연구 결과를 이 용한 진료를 시행하고 있다. 한국인의 유전적, 생활환경이 구미인과 많은 차이가 있으므로 한국인을 위한 진정한 EBM 의 실현을 위해 우리나라만의 독자적인 근거 구축이 필요하 다고 생각된다. 이에 저자들은 우리나라 내분비분야에서의 EBM의 활성을 기대하며 그간의 문헌에 보고된 연구 성과 들을 정리하고 현시점에서의 가치관이 어떠한가를 제시하고 자 한다.
临床力学是一个非常重要的概念。临床流行病学对临床医学的多种问题并利用力学方法来解决会1938年到科学对易病发生情况研究的科学”的意义中首次引入的,然后按医学的发展在20世纪70年代利用动态的技法诊疗、检查、治疗的有效性和效率评价的学问,定义为发展了。这种临床力学方法在最近几乎所有医学领域都受到关注，是在1991年Guyatt提倡“根据中心医学(EBM)”之后。在以根据为中心的医学中，临床诊疗不应根据医生的个人经验或嗜好，而应根据一定的诊疗指南进行。为此，需要的不是医生个人对每个患者进行经验性治疗，而是根据明确的最终目的进行计划的诊疗，并根据由此获得的数据制定标准化的诊疗方针。因此，每一个治疗指南基本上都需要根据各种流行病学研究来制定。这些力学研究是形成根据中心医学(evidence based medicine，简称EBM)的基本要素。力学研究是克服临床医学本来就具有不确定性的弱点的必需的验证阶段。例如，有一段时间认为，高血压是随着年龄的增长而必然发生的现象，因此治疗高血压会导致器官损伤。但是，流行病学研究证明，高血压治疗可以预防脑中风、心血管疾病等致命的重症疾病，因此降压治疗成为日常治疗所必需的医疗行为。EBM的基调正在全世界范围内广泛扩散，预计今后在临床的各个领域将适用更加严格的EBM。这意味着在医学的多个领域将广泛进行多种临床力学研究。实际上，随着这一趋势，在内分泌-代谢内科的各个领域，全世界范围内正在进行广泛的EBM研究。但这些研究主要局限在糖尿病、高脂血症、骨质疏松症领域，对传统内分泌疾病的诊断和治疗研究尚不足。特别是，在我国，对韩国人固有特性的力学研究并不多，因此大部分都是利用外国的研究结果进行诊疗。韩国人的遗传、生活环境与欧美人有很大的差异，因此我认为为了实现韩国人的真正的EBM，有必要构筑韩国独有的根据。对此，作者们期待EBM在我国内分泌领域的活性化，整理期间文献中报告的研究成果，并提出目前的价值观。
{"title":"Evidence Based Medicine in Endocrinology","authors":"S. Rhee, Young Seol Kim","doi":"10.3803/JKES.2008.23.6.379","DOIUrl":"https://doi.org/10.3803/JKES.2008.23.6.379","url":null,"abstract":"역학에 있어 임상역학(clinical epidemiology)은 매우 중 요한 개념이다. 임상역학은 임상의학의 다양한 문제점에 대 해 역학적 기법을 이용하여 해결하려는 과학으로 1938년 질 병이 발생되기 쉬운 상황에 대해 연구하는 과학이라는 의미 에서 처음 도입된 후, 의학의 발전에 따라 1970년대에 역학 적 기법을 이용하여 진료, 검사, 치료의 유효성과 효율성을 평가하는 학문으로 정의, 발전되었다. 최근의 거의 모든 의학 분야에서 이러한 임상역학적 접근 이 주목 받고 있는 것은 1991년 Guyatt가 근거중심의학 (EBM)이라는 용어를 제창한 이후부터이다. 근거중심의학에 서는 임상 진료가 의사의 개인적 경험이나 기호에 의해서가 아닌 일정한 진료지침에 의거하여 이루어져야 한다. 이를 위 해 각각의 환자에 대한 의사 개인의 경험적 치료가 아닌, 명 확한 최종 목적에 따라 계획된 진료를 시행하고 이를 통해 얻어진 데이터에 근거한 표준화된 진료지침이 필요하게 되 었다. 그러므로 각각의 진료 지침들은 기본적으로 여러 역학 연구들에 근거하여 작성되어야 하게 되었다. 이러한 역학 연구 들이 바로 근거중심의학(evidence based medicine, EBM)을 이루는 기본 요소이다. 역학 연구는 본태적으로 불확실성을 가지고 있는 임상의 학의 약점을 극복하기 위한 필수적인 검증 단계이다. 예를 들어, 고혈압은 연령 증가에 따라 필수적으로(essential) 발생 하는 현상이므로 고혈압을 치료하면 장기 손상이 일어난다고 생각했던 시절이 있었다. 하지만, 역학연구를 통하여 고혈압 치료가 뇌졸중이나 심혈관 질환과 같은 치명적인 중증 질환 을 예방할 수 있다는 것이 근거로 증명되었기 때문에 혈압 강하 치료는 일상 진료에 필수적인 의료 행위가 되었다. 이렇듯 EBM의 기조는 전 세계적으로 폭넓게 확산되고 있어 향후 임상의 여러 분야에서 보다 엄격한 EBM이 적용 될 것으로 전망되고 있다. 그리고 이는 의학의 여러 영역에 있어 다양한 임상 역학 연구들이 폭넓게 시행될 것임을 의 미한다. 실제 이러한 추세에 따라 내분비-대사내과의 여러 분야에서 전 세계적으로 광범위한 EBM 연구가 이루어지고 있다. 하지만 이러한 연구들은 주로 당뇨병, 고지혈증, 골다 공증 분야에 한정된 편이며, 전통적인 내분비 질환들의 진단 과 치료에 대한 연구는 아직 부족한 실정이다. 특히, 우리나라에서는 한국인의 고유한 특성에 대한 역학 연구가 많지 않은 실정으로 대부분 외국의 연구 결과를 이 용한 진료를 시행하고 있다. 한국인의 유전적, 생활환경이 구미인과 많은 차이가 있으므로 한국인을 위한 진정한 EBM 의 실현을 위해 우리나라만의 독자적인 근거 구축이 필요하 다고 생각된다. 이에 저자들은 우리나라 내분비분야에서의 EBM의 활성을 기대하며 그간의 문헌에 보고된 연구 성과 들을 정리하고 현시점에서의 가치관이 어떠한가를 제시하고 자 한다.","PeriodicalId":119859,"journal":{"name":"Journal of Korean Endocrine Society","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128147309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2008-12-01DOI: 10.3803/JKES.2008.23.6.450
S. Hwang, Mikwang Kwon, S. Chon
Paragangliomas are extra-adrenal pheochromocytomas that arise from specialized neural crest cells. They are distributed anywhere from the upper neck to the pelvic floor, a nd they are classified on the basis of their anatomic origin. Functioning paragangliomas can cause the same clinical manifestations as pheochromocytoma, such as hypertension, diabetes mellitus, hyperadrenergic spells and so on. We experienced a retroperitoneal paraganglioma that was found in 66 year-old male who suffered from intractable constipation, and his constipation was caused by paralytic ileus and uncontrolled hyperglycemia. After he was diagnosed, removal of the paraganglioma was done and his clinical symptoms and sustained hyperglycemia were successfully
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