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.
Abducens Nerve Diseases ; Adrenocorticotropic Hormone ; Adult ; Brain Stem ; Buffaloes ; Cushing Syndrome ; Diplopia ; Female ; Hemorrhage ; Humans ; Magnetic Resonance Imaging ; Paresis ; Petrosal Sinus Sampling* ; Sella Turcica ; Subarachnoid Hemorrhage

No abstract available.
Carotid Intima-Media Thickness ; Diabetic Nephropathies ; Humans

Obesity is becoming increasingly prevalent worldwide. It is linked to health problems including cardiovascular disease, diabetes, cancer, musculoskeletal problems and even psychiatric problems. Intermittent fasting is an interventional strategy wherein individuals are subjected to varying periods of fasting. Intermittent fasting has recently attracted attention because experimental studies have highlighted its potential for correcting metabolic abnormalities. Preliminary findings indicate that intermittent fasting may be associated with increased lifespan, decreased mortality from cancers and cardiovascular diseases, improved insulin sensitivity, and reduced oxidative stress and inflammation. However, some of the data still remain controversial. No human studies have examined the effects of intermittent fasting in diabetics. Studies examining intermittent fasting in diabetic patients have encountered problems with compliance, malnutrition, and hypoglycemia rather than seeing benefits of weight loss. Regular meals (at least three meals each day) and a balanced diet are crucial in the management of blood sugar levels in diabetic patients.
Blood Glucose ; Caloric Restriction ; Cardiovascular Diseases ; Compliance ; Diabetes Mellitus ; Diet ; Fasting* ; Humans ; Hypoglycemia ; Inflammation ; Insulin Resistance ; Malnutrition ; Meals ; Mortality ; Obesity ; Oxidative Stress ; Weight Loss

The antinuclear antbody (ANA) test have been used to screen the patients with systemic lupus erythematosus (SLE) and other autoimmune diseases. We had retrospectively reviewed the 263 records of pediatric patients with doing ANA tests who admitted at Department of Pediatrics, Kyung Hee University Hospital, from January 1988 to May 1993. The following results were obtained. 1) The positive rate of ANA test in patients with connective tissue diseases is 16 out of 40(40%).In patients with SLE, the positive rate of ANA test is 9 out of 11 (82%). 2) The positive predictivity for SLE is 9 out 36 (25%). 3) The positive predictivity for connective tissue disease and possible immune disease is 28 out of 36 (78%). 4) The false positive rate is 8 0ut of 36 (22%), Thus, the pediatric patients with positive ANA test should be applicable for diagnosis with prudence. 5) The positive anti-dsDNA in patients with the positive ANA is shown in 4 cases and these patients are all SLE. In conclusion, the patients who had repeated positive ANA should be tested Anti-dsDNA antibody, and further clinical and diagnostic evaluation of other ANA associated diseases.
Autoimmune Diseases ; Connective Tissue Diseases ; Diagnosis ; Humans ; Immune System Diseases ; Lupus Erythematosus, Systemic ; Pediatrics ; Retrospective Studies

No abstract available.

Alcohol influences glucose metabolism in both diabetic and non-diabetic individuals. Moderate alcohol consumption significantly decreases fasting glucose levels, but does not affect postprandial glucose levels. However, acute alcohol intake without food may provoke hypoglycemia. Moderate alcohol consumption may inhibit gluconeogenesis and enhance insulin sensitivity, but excessive alcohol intake (three or more drinks per day) may contribute to hyperglycemia. Daily alcohol intake in diabetics should be limited to a moderate amount (one drink per day or less for women and two drinks per day or less for men). Moderate alcohol intake may have cardiovascular benefits for patients with diabetes, but the trade-off between the cardiovascular benefits versus the potential risk of lower adherence associated with self-care behaviors should be considered.
Alcohol Drinking ; Blood Glucose ; Diabetes Mellitus ; Fasting ; Female ; Gluconeogenesis ; Glucose ; Humans ; Hyperglycemia ; Hypoglycemia ; Insulin Resistance ; Self Care

Sodium glucose cotransporter-2 inhibitors (SGLT2i) block SGLT2 in the renal proximal tubule and increase the excretion of glucose into the urine, thereby decreasing serum glucose concentrations. These glucose-lowering effects are independent of insulin action. SGLT2i has been demonstrated to reduce cardiovascular complications and hospitalization for heart failure. SGLT2i has also shown remarkable inhibition effects on the progression of renal complications, decreasing serum creatinine, reducing albuminuria, and decreasing death from renal disease. These cardiorenal protective effects appear to be independent of glycemic control efficacy, and in view of these results, SGLT2i is recommended in type 2 diabetes patients at high risk of cardiovascular or renal disease. This review aims to provide an update on the mechanisms, efficacy, cardiorenal protective effects, and adverse effects of SGLT2i.

No abstract available.
Myofibroblasts* ; Thyroid Gland*

BACKGROUND: The initial insulin dose is often determined by clinical experience or with a formula using the body weight. However, it may be difficult to determine the initial insulin dose because various factors such as insulin sensitivity and the glycemic status can influence the insulin requirement. The purpose of this study was to assess the factors that influence the initial insulin requirement in insulin naive patients with type 2 diabetes mellitus. METHODS: A total 128 patients who were admitted for glycemic control were investigated. The patients were managed with long-acting insulin glargine and rapid-acting insulin lispro. RESULTS: The basal insulin requirement was positively correlated with waist circumference, body mass index (BMI), the HbA1C, AST, ALT, fasting plasma glucose and 2-hour postprandial glucose levels and the homeostasis model assessment of insulin resistance (HOMA-IR), but it was negatively correlated with age and the stimulated C-peptide level. The daily insulin requirement was positively correlated with waist circumference, BMI, the HbA1C, AST, ALT, triglyceride, fasting plasma glucose and 2-hour postprandial glucose level and HOMA-IR, but it was negatively correlated with age. On the multiple linear regression analysis, the basal insulin requirement was independently associated with BMI (beta = 0.507, p < 0.001), the 2-hour postprandial glucose level (beta = 0.307, p < 0.001), the ALT level (beta = 0.214, P = 0.015) and the meal-stimulated C-peptide level (beta = -0.209, P = 0.010). The daily insulin requirement was independently associated with BMI (beta = 0.508, p < 0.001) and the 2-hour postprandial glucose level (beta = 0.404, p < 0.001). CONCLUSION: Our results show that the BMI and 2-hour postprandial glucose level are useful predictors of the initial insulin requirement in insulin naive type 2 diabetic patients. It may be prudent to consider the other various factors that influence the insulin requirement together when insulin therapy is required.
Body Mass Index ; Body Weight ; C-Peptide ; Diabetes Mellitus ; Diabetes Mellitus, Type 2 ; Fasting ; Glucose ; Homeostasis ; Humans ; Insulin ; Insulin Lispro ; Insulin Resistance ; Insulin, Long-Acting ; Insulin, Short-Acting ; Linear Models ; Plasma ; Waist Circumference ; Insulin Glargine

It is becoming increasingly evident that adults with Turner's syndrome are susceptible to endocrine autoimmunity. An increased prevalence of thyroid autoantibodies and hypothyroidism in patients with Turner's syndrome has been reported, but the involvement of Graves' disease in these patients is relatively rare. We describe a case of Graves' disease associated with Turner's syndrome. A 28-year-old woman was referred for diffuse anterior neck swelling and palpitation. She had been diagnosed with Turner's syndrome with monosomy 45,X before the age of 9 years and she took estrogen together with progesterone. The physical examination revealed a firm, non-tender goiter. The T3 level was 632 ng/dL, the free T4 level was 5.68 ng/dL, the TSH level was 0.02 microIU/mL, the % of TSH-binding inhibiting immunoglobulin was 24% and the anti-thyroid autoantibodies were positive. The radioactive iodine uptake was increased. Therefore, she was diagnosed as having Graves' disease.
Adult ; Autoantibodies ; Autoimmunity ; Estrogens ; Female ; Goiter ; Graves Disease ; Humans ; Hypothyroidism ; Immunoglobulins ; Iodine ; Monosomy ; Neck ; Physical Examination ; Prevalence ; Progesterone ; Thyroid Gland ; Turner Syndrome