Adrenal hormones are essential for the timely differentiation and maturation of fetal organs and the regulation of intrauterine homeostasis. These hormones play complex roles during fetal life, and they are believed to provide the cellular communication that coordinates maternal-fetal interactions. Cortisol serves to modulate functional adaptations for extrauterine life in the perinatal period. Serum cortisol levels of preterm infants are similar to basal levels reported for healthy full-term neonates. However, a rise of cortisol production is absent during illness. Compared with a fetus of a similar gestational age, premature maturation of the hypothalamic-pituitary-adrenal (HPA) axis is suggested in preterm infants; however, the inappropriate cortisol value observed in severe illness is due to immaturity of 11beta-hydroxylase activity and an immature response of the brain to stress. Cardiovascular instability associated with adrenal insufficiency is more frequent than formerly reported, and replacing glucocorticoids in the treatment of refractory hypotension is effective without an increase in short term adverse consequences. However, the diagnostic criteria and optimal management have not yet been determined. Thus, further understanding of perinatal adrenal function will provide insight into the improved management of preterm infants.
Adrenal Insufficiency ; Axis, Cervical Vertebra ; Brain ; Fetus ; Gestational Age ; Glucocorticoids ; Homeostasis ; Humans ; Hydrocortisone ; Hypotension ; Infant, Newborn ; Infant, Premature*

Severe iodine deficiency causes hypothyroidism that results in impaired somatic growth and motor development in children. Mild and moderate iodine deficiencies cause multifocal autonomous growth of thyroid, which results in thyrotoxicosis. On the other hand, iodine excess is associated with the development of hypothyroidism and thyroid autoimmunity. In areas of iodine deficiency, a sudden increase in iodine intake is associated with transient hyperthyroidism. Recent studies demonstrated that long-term thyroid function of subjects who experienced both iodine deficiency and iodine excess during childhood tended to be abnormal despite optimization of their current iodine intake. Iodine status in the Korean Peninsula is very unique because people in the Republic of Korea have been shown to have predominantly excessive iodine levels, whereas the Democratic People's Republic of Korea is known to be an iodine-deficient area. Further research is warranted to verify the optimal ranges of iodine intake and to clarify the effects of iodine intake on thyroid disorders in the Korean Peninsula.
Autoimmunity ; Child ; Democratic People's Republic of Korea ; Hand ; Humans ; Hyperthyroidism ; Hypothyroidism ; Iodine* ; Republic of Korea ; Thyroid Gland* ; Thyrotoxicosis

PURPOSE:Obesity is a common complication in children who were surgically treated for craniopharyngioma. We analysed body composition, metabolic parameters and evaluated for correlation between adiponectin and metabolic parameters in children who were surgically treated for craniopharyngioma. METHODS:Sixteen patients with craniopharyngioma (9 males, 7 females) were included in this study (patient group). The data of patient group were compared to those of children who visited the clinic for normal short stature with appropriate gestational age (14 males, 4 females) (control group). Height SDS, weight SDS, BMI were calculated. Total body fat, abdominal fat distribution were measured by bioelectrical impedance analysis. Plasma levels of total cholesterol, HDL-cholesterol, triglycerides, adiponectin, and insulin were measured after overnight fasting. The degree of insulin resistance was calculated by HOMA-IR. RESULTS:Four of 16 patients were obese. and three were overweight. Patient group had higher total body fat percentage (27.5+/-6.8 vs 17.6+/-6.8, P=0.01), triglycerides (207.9+/-241.6 vs 76.7+/-30.8, P=0.001), lower HDL-cholesterol (37.5+/-14.6 vs 61.4+/-15.4, P=0.000) and adiponectin levels (7.1+/-4.2 vs 10.7+/-4.3, P=0.012). Adiponectin levels were correlated negatively with total body fat percentage (r=-0.631, P= 0.009), abdominal fat distribution (r=-0.547, P=0.03), triglycerides (r=-0.518, P=0.04), insulin (r=-0.525, P=0.037) and correlated positively with HDL-cholesterol (r=0.572, P=0.021). CONCLUSION: These results suggest that children who were surgically treated for craniopharyngioma, had tendency to develop obesity, dyslipidemia and Insulin resistance. Therefore, patients who were surgically treated, should be closely monitored to minimize the effect of metabolic syndrome on their health and well being.
Abdominal Fat ; Adiponectin ; Adipose Tissue ; Body Composition ; Child* ; Cholesterol ; Craniopharyngioma* ; Dyslipidemias ; Electric Impedance ; Fasting ; Gestational Age ; Humans ; Insulin ; Insulin Resistance ; Male ; Obesity ; Overweight ; Plasma ; Triglycerides

Adrenal and thyroid hormones are essential for the regulation of intrauterine homeostasis, and for the timely differentiation and maturation of fetal organs. These hormones play complex roles during fetal life, and are believed to underlie the cellular communication that coordinates maternal-fetal interactions. They serve to modulate the functional adaptation for extrauterine life during the perinatal period. The pathophysiology of systemic vasopressor-resistant hypotension is associated with low levels of circulating cortisol, a result of immaturity of hypothalamic-pituitary-adrenal axis in preterm infants under stress. Over the past few decades, studies in preterm infants have shown abnormal clinical findings that suggest adrenal or thyroid dysfunction, yet the criteria used to diagnose adrenal insufficiency in preterm infants continue to be arbitrary. In addition, although hypothyroidism is frequently observed in extremely low gestational age infants, the benefits of thyroid hormone replacement therapy remain controversial. Screening methods for congenital hypothyroidism or congenital adrenal hyperplasia in the preterm neonate are inconclusive. Thus, further understanding of fetal and perinatal adrenal and thyroid function will provide an insight into the management of adrenal and thyroid function in the preterm infant.
Adrenal Glands ; Adrenal Hyperplasia, Congenital ; Adrenal Insufficiency ; Axis, Cervical Vertebra ; Congenital Hypothyroidism ; Fetus* ; Gestational Age ; Homeostasis ; Hormone Replacement Therapy ; Humans ; Hydrocortisone ; Hypotension ; Hypothyroidism ; Infant ; Infant, Newborn ; Infant, Premature* ; Mass Screening ; Thyroid Gland* ; Thyroid Hormones

Preterm infants can suffer various thyroid dysfunctions associated with developmental immaturity of the hypothalamic-pituitary-thyroid axis, postnatal illness, medications, or iodine supply. The incidence of thyroid dysfunction among preterm infants is higher than that among term infants and has been increasing with improvement in the survival of preterm infants. Hypothyroxinemia is frequently observed during the first week of life in extreme preterm neonates, and the incidence of delayed thyrotropin elevation is high at the age of 2–6 weeks. Although the necessity of routine rescreening remains controversial, recent guidelines on screening for congenital hypothyroidism have recommended rescreening of all preterm neonates. Thyroid hormone replacement is recommended for persistent thyrotropin elevation with or without hypothyroxinemia. Hypothyroxinemia without thyrotropin elevation does not require treatment, and some potential risks of levothyroxine supplementation have been reported. Although most thyroid dysfunctions are transient, careful follow-up after discontinuation of levothyroxine is considered so as to avoid missing persistent hypothyroidism.
Congenital Hypothyroidism ; Follow-Up Studies ; Humans ; Hypothyroidism ; Incidence ; Infant ; Infant, Newborn ; Infant, Premature ; Iodine ; Mass Screening ; Thyroid Gland ; Thyrotropin ; Thyroxine

PURPOSE: To assess the association between decreased visual acuity (VA) and diagnosis of depressive disorder by a physician or experience of depressive mood using self-report questionnaires. METHODS: We conducted a cross-sectional analysis using nationally representative data from the Korean National Health and Nutrition Examination Survey (KNHANES, 2008-2012). A total of 28,919 adults who had sociodemographic and health behavioral risk factors available were included. An association between decreased VA and depression was identified using multivariate logistic regression analysis after adjusting for possible confounders. Depression was defined as a depressive disorder with a diagnosis by a physician or depressive mood lasting more than 2 weeks using self-report questionnaires. RESULTS: The prevalence of depressive disorder and depressive mood in Koreans was 1,160 (4.0%) and 4,063 (14.1%), respectively. In univariable logistic regression, there was significant association between VA and depressive disorder or depressive mood. However, in multivariable logistic regression analysis, this study found no statistically significant association between VA status and the prevalence of depressive disorder or depressive mood in Koreans. CONCLUSIONS: No association between decreased VA and a depressive disorder/depressive mood in Korean adults after adjusting for possible confounders was found. Therefore, further longitudinal cohort studies examining the causal relationship between decreased VA and depression in Korean adults are necessary.
Adult ; Cohort Studies ; Cross-Sectional Studies ; Depression ; Depressive Disorder* ; Diagnosis ; Health Behavior ; Humans ; Logistic Models ; Nutrition Surveys ; Prevalence ; Risk Factors ; Vision, Low ; Visual Acuity*

BACKGROUND: In our hospital, an abrupt increase in the resistant rate of A. baumannii to imipenem was observed. We evaluated the imipenem minimal inhibitory concentration (MIC) of an automated system that our laboratory is using, by comparing with those of other methods. METHODS: During the period from February 2002 to February 2003, the imipenem MICs of the agar dilution method, Etest(R), and the disk diffusion method, were compared for imipenem-resistant A. baumannii tested by an automated system in 46 samples at Chung-Ang University Phil-Dong Hospital. We tested for susceptibility to imipenem with the Vitek system by using the GNI card, the disk diffusion method by using the imipenem disk (BBL(TM)), and the agar dilution method. PCR testing of the isolates for carbapenemase genes (IMP-1 and VIM-2) detected in other hospitals was done using published primers and conditions. RESULTS: By the agar dilution method, 23 (50.0%) isolates were susceptible to imipenem, 14 (30.4%) isolates were intermediate, and 9 (19.6%) isolates were resistant. However, by the Etest, 8 (17.4%) were susceptible to imipenem, and 28 (60.9%) isolates were resistant. By the disk diffusion method, the susceptible isolates were 14 (30.4%) and the resistant isolates were 17 (37.0%). Quantitative agreement between the agar dilution method and the disk diffusion test gave an inverse linear correlation coefficient (r=-0.564). The results of the 13 isolates, whose results of the MIC were below 2 or above 16 in the agar dilution method, corresponded with the Etest and the disk diffusion test. The IMP-1 gene was detected in one isolate. CONCLUSIONS: It is recommended that when a gram-negative bacilli isolate including A. baumannii is characterized as resistant to imipenem by the Vitek system, an additional simple test, such as the disk diffusion assay, might be used.
Acinetobacter baumannii* ; Agar ; Diffusion ; Imipenem* ; Polymerase Chain Reaction

Glucose is essential for energy metabolism in human, especially in brain, and is a source of energy storage in the form of glycogen, fat and protein. During fetal life, the predominant source of energy is also glucose, which crosses the placenta by facilitated diffusion. There is very little endogenous glucose production under normal circumstances during fetal life. During labor, the fetus is exposed to physiological challenges that require metabolic adaptation. A healthy infant successfully manages the postnatal transition by mobilizing and using alternative. After birth, there is a rapid surge in catecholamine and glucagon levels, and a steady decrease in insulin, as blood glucose levels decline. These hormonal changes induce enzyme activities that lead to glycogenolysis and gluconeogenesis. During the first 24-48 hours of life, plasma glucose concentrations of neonates are typically lower than later in life. Distinguishing between transitional neonatal glucose regulation in normal neonates and hypoglycemia that persists or occurs for the first time beyond the first 72 hours of life is important for prompt diagnosis and treatment to avoid serious consequences.
Blood Glucose ; Brain ; Diagnosis ; Energy Metabolism ; Facilitated Diffusion ; Fetus ; Glucagon ; Gluconeogenesis ; Glucose* ; Glycogen ; Glycogenolysis ; Homeostasis* ; Humans ; Hypoglycemia ; Infant ; Infant, Newborn ; Insulin ; Parturition ; Placenta

The cyto-histologic correlation and cytologic accuracy are reported in thirty cases of consecutive aspirated cells and their biopsied tissues of patients with clinical and neuroradiologic evidences of central nervous system tumors and other lesions investigated at the Pathology and Neurosurgery Department, Korea University Hospital, from Apr. 1987 to Apr. 1988. The series comprised of 17 benign and 12 malignant histopathologically verified brain neoplasms and 1 infectious lesion. In 78% of the cases, the cytologic diagnosis was concordant with the histologic diagnosis provided adequate sample was obtained. In 17 benign tumors, the diagnostic rate was 87% ; the diagnostic accuracy for 12 malignant CNS tumors was 63% cytologically. In almost all cases, differentiation of non-neoplastic lesion from neoplastic one and that of benign tumors from malignant ones were possible. Most discordance stemmed from failure to distinguish different types of malignant tumors. In meningioma, neurilemmoma, pituitary adenoma, and medulloblastoma, cytologic diagnostic accuracy was high, but germinoma, malignant ependymoma, and hemangioblastoma were difficult to diagnose by cytology alone.

PURPOSE: Although chronic autoimmune thyroiditis(AIT) is known to progress into overt hypothyroidism in adults, the outcomes of this disorder in pediatric patients are different from those in adults, so it is hard to predict its course. We reviewed clinical characteristics of chronic AIT in children. METHODS: The medical records of 94 children, who were diagnosed as AIT, were analyzed, retrospectively. Of 58 patients, who had been followed up for more than three years, we investigated family history, age at diagnosis, initial thyroid function, initial level of thyroid peroxisome antibody and thyroglobulin antibody, and changes of thyroid function. RESULTS: Ninety four patients were all females and mean age at diagnosis was 11.2+/-2.3 years. Twenty five patients had family histories of thyroid disease. None of them had an other autoimmune endocrine disease. At diagnosis, 51 patients were hypothyroid, and 43 patients were euthyroid. Of 58 patients, who had been followed up for more than three years, 35 patients were hypothyroid and 23 patients were euthyroid at diagnosis. At last follow-up, 22 patients were hypothyroid, 33 patients were euthyroid, and three patients were hyperthyroid. The patients of hypothyroidism at last follow-up revealed significantly higher TSH levels at initial diagnosis, although initial TSH levels fell into a normal range, compared with patients of euthyroidism at last follow up. CONCLUSION: The clinical course of AIT in children was variable. Particularly we should monitor thyroid function closely in patients who revealed higher TSH levels at the initial diagnosis, even if these are within normal limits, because they are prone to develop hypothyroidism during follow up.
Adult ; Child* ; Diagnosis ; Endocrine System Diseases ; Female ; Follow-Up Studies ; Humans ; Hypothyroidism ; Medical Records ; Peroxisomes ; Reference Values ; Retrospective Studies ; Thyroglobulin ; Thyroid Diseases ; Thyroid Gland ; Thyroiditis, Autoimmune*