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Polyglandular autoimmune syndrome is defined as multiple endocrine gland insufficiencies accompanied by autoimmune diseases of the endocrine and nonendocrine system. After Schmidt introduced a case of nontuberculosis adrenal gland dysfunction with thyroiditis in 1926, Neufeld defined polyglandular autoimmune syndrome by I, II, and III subtypes in 1980 by their presentation of occurrence age, heredity methods, relationship with human leukocyte antigen, and accompanying diseases. We report a case of a 32-year-old female with polyglandular autoimmune syndrome III accompanied by type 1 diabetes mellitus that was treated with insulin (36 units per day) for 11 years. She had insulin deficiency and Hashimoto thyroiditis as an autoimmune disorder. In addition, she had several features similar to Albright's hereditary osteodystrophy including short stature, truncal obesity, round face, short neck, low intelligence (full IQ 84), and decreased memory. Although Albright's hereditary osteodystrophy is morphological evidence of pseudohypoparathyroidism or pseudopseudohypoparathyroidism, she had primary hypoparathyroidism on laboratory results. Here, we report a case of polyglandular autoimmune syndrome III with type 1 diabetes mellitus, autoimmune thyroiditis, and primary hypoparathyroidism, accompanied by clinical features similar to Albright's hereditary osteodystrophy.
Adrenal Glands ; Adult ; Autoimmune Diseases ; Diabetes Mellitus, Type 1 ; Endocrine Glands ; Female ; Fibrous Dysplasia, Polyostotic ; Hashimoto Disease ; Heredity ; Humans ; Hypoparathyroidism ; Insulin ; Intelligence ; Leukocytes ; Memory ; Neck ; Obesity ; Pseudohypoparathyroidism ; Pseudopseudohypoparathyroidism ; Thyroid Gland ; Thyroiditis ; Thyroiditis, Autoimmune

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Delayed Surgery for Parathyroid Adenoma Misdiagnosed as a Thyroid Nodule and Treated with Radiofrequency Ablation.

Ho Su KIM ; Bong Hoi CHOI ; Jung Rang PARK ; Jong Ryeal HAHM ; Jung Hwa JUNG ; Soo Kyoung KIM ; Sungsu KIM ; Kyong Young KIM ; Soon Il CHUNG ; Tae Sik JUNG

Endocrinology and Metabolism.2013;28(3):231-235. doi:10.3803/EnM.2013.28.3.231

Primary hyperparathyroidism occurs as a result of isolated parathyroid adenoma in 80% to 85% of all cases. A 99mtechnetium (99mTc) sestamibi scan or neck ultrasonography is used to localize the neoplasm prior to surgical intervention. A 53-year-old female was referred for the exclusion of metabolic bone disease. She presented with low back pain that had persisted for the past 6 months and elevated serum alkaline phosphatase (1,253 IU/L). Four years previously, she had been diagnosed at a local hospital with a 2.3-cm thyroid nodule, which was determined to be pathologically benign. Radiofrequency ablation was performed at the same hospital because the nodule was still growing during the follow-up period 2 years before the visit to our hospital, and the procedure was unsuccessful in reducing the size of the nodule. The results of the laboratory tests in our hospital were as follows: serum calcium, 14.6 mg/dL; phosphorus, 3.5 mg/dL; and intact parathyroid hormone (iPTH), 1,911 pg/mL. Neck ultrasonography and 99mTc sestamibi scan detected a 5-cm parathyroid neoplasm in the left lower lobe of the patient's thyroid; left parathyroidectomy was performed. This case indicated that thyroid ultrasonographers and pathologists need to be experienced enough to differentiate a parathyroid neoplasm from a thyroid nodule; 99mTc sestamibi scan, serum calcium, and iPTH levels can help to establish the diagnosis of parathyroid neoplasm.
Alkaline Phosphatase ; Bone Diseases, Metabolic ; Calcium ; Female ; Follow-Up Studies ; Humans ; Hyperparathyroidism, Primary ; Low Back Pain ; Middle Aged ; Neck ; Parathyroid Hormone ; Parathyroid Neoplasms ; Parathyroidectomy ; Phosphorus ; Technetium Tc 99m Sestamibi ; Thyroid Gland ; Thyroid Nodule

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Graves' Disease that Developed Shortly after Surgery for Thyroid Cancer.

Hea Min YU ; Soon Hyun PARK ; Jae Min LEE ; Kang Seo PARK

Endocrinology and Metabolism.2013;28(3):226-230. doi:10.3803/EnM.2013.28.3.226

Graves' disease is an autoimmune disorder that may present with various clinical manifestations of hyperthyroidism. Patients with Graves' disease have a greater number of thyroid nodules and a higher incidence of thyroid cancer compared with patients with normal thyroid activity. However, cases in which patients are diagnosed with recurrence of Graves' disease shortly after partial thyroidectomy for thyroid cancer are very rare. Here we report a case of hyperthyroid Graves' disease that occurred after partial thyroidectomy for papillary thyroid cancer. In this case, the patient developed hyperthyroidism 9 months after right hemithyroidectomy, and antithyroglobulin autoantibody and thyroid stimulating hormone receptor stimulating autoantibody were positive. Therefore, we diagnosed Graves' disease on the basis of the laboratory test results and thyroid ultrasonography findings. The patient was treated with and maintained on antithyroid drugs. The mechanism of the recurrence of Graves' disease in this patient is still unclear. The mechanism may have been the improper response of the immune system after partial thyroidectomy. To precisely determine the mechanisms in Graves' disease after partial thyroidectomy, further studies based on a greater number of cases are needed.
Antithyroid Agents ; Autoantibodies ; Carcinoma ; Graves Disease ; Humans ; Hyperthyroidism ; Immune System ; Incidence ; Receptors, Thyrotropin ; Recurrence ; Thyroid Gland ; Thyroid Neoplasms ; Thyroid Nodule ; Thyroidectomy

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Thyroid Dysfunction Associated with Administration of the Long-Acting Gonadotropin-Releasing Hormone Agonist.

Eun Jin HAN ; Ha Do SONG ; Ji Hoon YANG ; So Young PARK ; Sung Hoon KIM ; Hyun Koo YOON ; Chang Hoon YIM

Endocrinology and Metabolism.2013;28(3):221-225. doi:10.3803/EnM.2013.28.3.221

Gonadotropin-releasing hormone (GnRH) agonist has been used in the treatment of a wide variety of sex-hormone-related diseases, as the administration of GnRH agonist can alter the secretion of gonadotropin and sex hormones. Recently, we found that the long-acting GnRH agonist aggravated hyperthyroidism and induced painless thyroiditis. This is the first report to demonstrate the association of thyroid dysfunction with GnRH agonist injection in Korea. Here, we report three cases and emphasize the clinical importance of this aggravating factor in autoimmune thyroid disease.
Gonadal Steroid Hormones ; Gonadotropin-Releasing Hormone ; Gonadotropins ; Graves Disease ; Hyperthyroidism ; Korea ; Thyroid Diseases ; Thyroid Gland ; Thyroiditis

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Herpes Virus Entry Mediator Signaling in the Brain Is Imperative in Acute Inflammation-Induced Anorexia and Body Weight Loss.

Kwang Kon KIM ; Sung Ho JIN ; Byung Ju LEE

Endocrinology and Metabolism.2013;28(3):214-220. doi:10.3803/EnM.2013.28.3.214

BACKGROUND: Reduced appetite and body weight loss are typical symptoms of inflammatory diseases. A number of inflammatory stimuli are responsible for the imbalance in energy homeostasis, leading to metabolic disorders. The herpes virus entry mediator (HVEM) protein plays an important role in the development of various inflammatory diseases, such as intestinal inflammation and diet-induced obesity. However, the role of HVEM in the brain is largely unknown. This study aims to investigate whether HVEM signaling in the brain is involved in inflammation-induced anorexia and body weight loss. METHODS: Food intake and body weight were measured at 24 hours after intraperitoneal injection of lipopolysaccharide (LPS) or intracerebroventricular injection of recombinant mouse LIGHT (also called tumor necrosis factor receptor superfamily 14, TNFSF14), an HVEM ligand, into 8- to 10-week-old male C57BL/6 mice and mice lacking HVEM expression (HVEM-/-). We also assessed LPS-induced change in hypothalamic expression of HVEM using immunohistochemistry. RESULTS: Administration of LPS significantly reduced food intake and body weight, and moreover, increased expression of HVEM in the hypothalamic arcuate nucleus. However, LPS induced only minor decreases in food intake and body weight in HVEM-/- mice. Administration of LIGHT into the brain was very effective at decreasing food intake and body weight in wild-type mice, but was less effective in HVEM-/- mice. CONCLUSION: Activation of brain HVEM signaling is responsible for inflammation-induced anorexia and body weight loss.
Animals ; Anorexia ; Appetite ; Arcuate Nucleus ; Body Weight ; Brain ; Eating ; Homeostasis ; Humans ; Inflammation ; Injections, Intraperitoneal ; Light ; Male ; Mice ; Obesity ; Receptors, Tumor Necrosis Factor ; Virus Internalization ; Viruses

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Variation in Serum Creatinine Level Is Correlated to Risk of Type 2 Diabetes.

Jun Sung MOON ; Ji Eun LEE ; Ji Sung YOON

Endocrinology and Metabolism.2013;28(3):207-213. doi:10.3803/EnM.2013.28.3.207

BACKGROUND: Skeletal muscle is well established as a major target organ of insulin action, and is associated with the pathogenesis of type 2 diabetes. Therefore, we attempted to determine whether a variation in serum creatinine is related to the development of type 2 diabetes and other risk factors for diabetes. METHODS: A total of 2,676 nondiabetic subjects with stable and normal renal function (estimated glomerular filtration rate >60 mL/min/1.73 m2) were followed up for approximately 4.5 years. New onset diabetes was defined as fasting plasma glucose (FPG) > or =7.0 mmol/L, glycated hemoglobin (HbA1c) > or =6.5%, or subjects taking antidiabetic agents. Variation of serum creatinine (DeltaCre) was defined as a difference between follow-up and baseline creatinine. In subgroup analysis, body composition was examined by bioelectric impedance analysis method. RESULTS: A total of 106 subjects were diagnosed with new-onset diabetes during the follow-up period. Baseline serum creatinine was not different between the new-onset diabetes and no diabetes groups. Negative DeltaCre (DeltaCre <0) showed an association with increased risk of type 2 diabetes after adjusting for age, sex, body mass index, systolic blood pressure, FPG, HbA1c, triglyceride, high density lipoprotein cholesterol, and gamma-glutamyl transpeptidase (odds ratio, 1.885; 95% confidence interval, 1.127 to 3.153). Serum creatinine level demonstrated positive correlation with muscle mass and negative correlation with percentage of body fat in body composition analysis. CONCLUSION: Serum creatinine reflected body muscle mass and the decrease of serum creatinine might be regarded as a risk factor for type 2 diabetes.
Adipose Tissue ; Blood Pressure ; Body Composition ; Body Mass Index ; Cholesterol ; Cholesterol, HDL ; Creatinine ; Diabetes Mellitus ; Electric Impedance ; Fasting ; Follow-Up Studies ; gamma-Glutamyltransferase ; Glomerular Filtration Rate ; Glucose ; Hemoglobins ; Hypoglycemic Agents ; Insulin ; Lipoproteins ; Muscle, Skeletal ; Muscles ; Plasma ; Risk Factors

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The Impact of Different Anthropometric Measures on Sustained Normotension, White Coat Hypertension, Masked Hypertension, and Sustained Hypertension in Patients with Type 2 Diabetes.

Baris AFSAR

Endocrinology and Metabolism.2013;28(3):199-206. doi:10.3803/EnM.2013.28.3.199

BACKGROUND: Many studies have aimed to determine whether body mass index (BMI), waist circumference (WC), or waist to hip ratio (WHR) best predicts hypertension in diabetic patients, with conflicting results. However, no study has examined the specific relationship between these anthropometric parameters with sustained normotension (SNT), white coat hypertension (WCHT), masked hypertension (MHT), and sustained hypertension (SHT) based on office and ambulatory blood pressure (BP) measurements in these patients. METHODS: Patients with newly diagnosed type 2 diabetes underwent the following procedures: history taking, measurements of anthropometric parameters, office and ambulatory BP measurements, physical examination, laboratory analysis, and random and 24-hour urine analysis. RESULTS: In total, there were 65 dippers and 37 nondipper patients. None of the anthropometric parameters were different between the dippers and the nondippers. There were 25 patients with SNT, 32 with WCHT, seven with MHT, and 38 with SHT. A comparison of anthropometric parameters between these four groups of patients showed that WC (P=0.016) and WHR (P=0.015) were different among all groups. According to regression analysis, only BMI was independently related with MHT (odds ratio [OR], 1.373, P=0.022), whereas only WC has been associated with SHT (OR, 1.321, P=0.041). CONCLUSION: Among anthropometric parameters, only WC and WHR were different in SNT, WCHT, MHT, and SHT in newly diagnosed patients with type 2 diabetes.
Blood Pressure ; Body Mass Index ; Humans ; Hypertension ; Masked Hypertension ; Masks ; Physical Examination ; Waist Circumference ; Waist-Hip Ratio ; White Coat Hypertension

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The Expression of Tumor-Associated Macrophages in Papillary Thyroid Carcinoma.

Seunghwan KIM ; Sun Wook CHO ; Hye Sook MIN ; Kang Min KIM ; Gye Jeong YEOM ; Eun Young KIM ; Kyu Eun LEE ; Yeo Gyu YUN ; Do Joon PARK ; Young Joo PARK

Endocrinology and Metabolism.2013;28(3):192-198. doi:10.3803/EnM.2013.28.3.192

BACKGROUND: Tumor-associated macrophages (TAMs) play a tumorigenic role related to advanced staging and poor prognosis in many human cancers including thyroid cancers. Yet, a functional role of TAMs in papillary thyroid carcinoma (PTC) has not been established. The aim of this study was to investigate TAM expression in human PTC with lymph node (LN) metastasis. METHODS: Thirty-six patients who underwent surgery after being diagnosed with PTC with LN metastasis were included. Primary tumor tissues were immunohistochemically stained with an anti-CD68 antibody and clinical characteristics according to TAM density were evaluated. RESULTS: The TAM densities (CD68+ cells) varied from 5% to 70%, in all tumor areas, while few cells were stained in adjacent normal tissues. TAMs were identified as CD68+ cells with thin, elongated cytoplasmic extensions that formed a canopy structure over tumor cells. Comparing clinicopathologic characteristics between tumors with low (<25%) and high (25% to 70%) TAM densities, primary tumors were larger in the high density group than in the low density group (2.0+/-0.1 vs. 1.5+/-0.1; P=0.009). CONCLUSION: TAMs were identified in primary PTC tumors with LN metastasis and higher TAM densities were related to larger tumor sizes, suggesting a tumorigenic role of TAMs in human PTCs.
Carcinoma ; Cytoplasm ; Factor IX ; Humans ; Lymph Nodes ; Macrophages ; Neoplasm Metastasis ; Prognosis ; Thyroid Gland ; Thyroid Neoplasms

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