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Characterization of Incidentally Detected Adrenal Pheochromocytoma.

Ye An KIM ; Yul HWANGBO ; Min Joo KIM ; Hyung Jin CHOI ; Je Hyun SEO ; Yenna LEE ; Soo Heun KWAK ; Eu Jeong KU ; Tae Jung OH ; Eun ROH ; Jae Hyun BAE ; Jung Hee KIM ; Kyoung Soo PARK ; Seong Yeon KIM

Endocrinology and Metabolism.2012;27(2):132-137. doi:10.3803/EnM.2012.27.2.132

BACKGROUND: In approach to an adrenal incidentaloma, early exclusion of pheochromocytoma is clinically important, due to the risk of catecholamine crisis. The aims of this study are to investigate the characteristics of incidentally detected pheochromocytomas, compared with that of the other adrenal incidentalomas, and to compare these characteristics with those of symptomatic pheochromocytomas. METHODS: In this retrospective study, we reviewed the medical records of 198 patients with adrenal incidentaloma from 2001 to 2010. We analyzed the clinical, laboratory and radiological data of pheochromocytomas, in comparison with those of the other adrenal incidentalomas. We also compared the characteristics of these incidentally detected pheochromocytomas with the medical records of 28 pathologically proven pheochromocytomas, diagnosed based on typical symptoms. RESULTS: Among the 198 patients with adrenal incidentaloma, nineteen patients were diagnosed with pheochromocytoma. Pheochromocytomas showed larger size and higher Hounsfield unit at precontrast computed tomography (CT) than did non-pheochromocytomas. All pheochromocytomas were larger than 2.0 cm, and the Hounsfield units were 19 or higher in precontrast CT. When both criteria of size > 2.0 cm and Hounsfield unit > 19 were met, the sensitivity and specificity for the diagnosis of pheochromocytoma were 100% and 79.3%, respectively. Compared with patients with pheochromocytoma, diagnosed based on typical symptoms, patients with incidentally detected pheochromocytoma were older, presented less often with hypertension, and showed lower levels of 24-hour urine metanephrine. CONCLUSION: Adrenal incidentaloma with < 2.0 cm in size or < or = 19 Hounsfield units in precontrast CT imaging was less likely to be a pheochromocytoma. Patients with incidentally discovered pheochromocytoma showed lower catecholamine metabolites, compared with those patients with symptomatic pheochromocytoma.
Adrenal Gland Neoplasms ; Adrenocortical Adenoma ; Humans ; Hypertension ; Medical Records ; Pheochromocytoma ; Retrospective Studies ; Sensitivity and Specificity

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The Association between Low Serum Bilirubin and Carotid Atherosclerosis in Subjects with Type 2 Diabetes.

Byoung Hyun PARK ; Hye Jung NHO ; Chung Gu CHO

Endocrinology and Metabolism.2012;27(2):126-131. doi:10.3803/EnM.2012.27.2.126

BACKGROUND: Bilirubin prevents oxidative modification of low density lipoprotein, and may protect vessels from atherosclerosis. Several studies showed an inverse relationship between serum bilirubin and coronary artery disease. However, there are some needs to clarify the relationship between serum bilirubin and carotid atherosclerosis in type 2 diabetes, especially. METHODS: A total of 346 type 2 diabetic patients, between 35 and 95 years of age (146 men and 200 women), were studied. Subjects with normal serum total bilirubin were divided into two groups, according to their serum total bilirubin levels (group I, total bilirubin > or = 1.0 mg/dL [n = 59]; group II, total bilirubin < or = 0.5 mg/dL [n = 76]). Carotid intima-media thickness (IMT) and plaque scores were measured by ultrasonography. Carotid atherosclerosis was defined by the presence of plaque or more than 1 mm of common carotid IMT. RESULTS: Carotid IMT was positively correlated with age, duration of diabetes and hypertension, high sensitive C-reactive protein (hs-CRP) and fibrinogen, but, it was negatively correlated with bilirubin, gamma glutaryltransferase, albumin, hemoglobin, cystatin C and estimated-glomerular filtration rate (GFR) in all subjects. After controlling for sex, age and levels of hemoglobin, direct bilirubin only was negatively correlated with carotid IMT (r = -0.151, P = 0.034). Low serum total bilirubin group had a lot of female, long duration of diabetes and hypertension, higher hs-CRP, platelet counts, serum creatinine, HbA1c and homeostasis model assessment-insulin resistance, lower albumin, hemoglobin, estimated-GFR and quantitative insulin sensitivity check index. Carotid IMT and plaque scores were significantly greater in low serum bilirubin group (0.785 +/- 0.210 mm vs. 0.678 +/- 0.146 mm, P < 0.01; 1.95 +/- 2.56 vs. 1.03 +/- 1.40, P < 0.05, respectively) than in the high serum bilirubin group. Multivariate logistic regression analysis showed that age, serum albumin and total bilirubin were independent associated factors for carotid atherosclerosis in type 2 diabetic women. CONCLUSION: Total bilirubin is inversely correlated with carotid atherosclerosis in type 2 diabetic patients, and it is an independent associated factor for carotid atherosclerosis in women.
Atherosclerosis ; Bilirubin ; C-Reactive Protein ; Carotid Arteries ; Carotid Artery Diseases ; Carotid Intima-Media Thickness ; Coronary Artery Disease ; Creatinine ; Cystatin C ; Diabetes Mellitus, Type 2 ; Female ; Fibrinogen ; Filtration ; Hemoglobins ; Homeostasis ; Humans ; Hypertension ; Insulin Resistance ; Lipoproteins ; Logistic Models ; Male ; Platelet Count ; Serum Albumin

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Differential Diagnostic Value of Total T3/Free T4 Ratio in Graves' Disease and Painless Thyroiditis Presenting Thyrotoxicosis.

Sang Min LEE ; Soo Kyoung KIM ; Jong Ryeal HAHM ; Jung Hwa JUNG ; Ho Su KIM ; Sungsu KIM ; Soon Il CHUNG ; Bong Hoi CHOI ; Tae Sik JUNG

Endocrinology and Metabolism.2012;27(2):121-125. doi:10.3803/EnM.2012.27.2.121

BACKGROUND: It is important to differentiate Graves' disease from that of painless thyroiditis in patients with thyrotoxicosis. In this study, we evaluated the usefulness of total T3 to free T4 ratio in making a differential diagnosis between Graves' disease and painless thyroiditis. METHODS: We reviewed medical records of thyrotoxic patients, who had been diagnosed with Graves' disease or painless thyroiditis, from October 2009 to July 2011. We assessed clinical characteristics, serum levels of total T3, free T4, thyroid stimulating hormone, thyrotropin-binding inhibitory immunoglobulin, and findings of 99mTechnetium thyroid scan. We analyzed the total T3/free T4 ratios between Graves' disease and painless thyroiditis patients. RESULTS: A total of 76 untreated thyrotoxic patients "49 Graves' disease and 27 painless thyroiditis" were examined. The total T3, free T4 levels and the total T3/free T4 ratios were significantly higher in patients with Graves' disease than in those with painless thyroiditis (P < 0.001). In the total T3/free T4 ratio > 73, the possibility of Graves' disease was significantly higher than in painless thyroiditis (sensitivity, 75.5%; specificity, 70.3%). The sensitivity and specificity of the total T3/free T4 ratio in patients with free T4 < 3.6 ng/dL have been increased (sensitivity, 100%; specificity, 71.4%). CONCLUSION: The total T3/free T4 ratios was useful for making a differential diagnosis between Graves' disease and painless thyroiditis.
Diagnosis, Differential ; Graves Disease ; Humans ; Immunoglobulins ; Immunoglobulins, Thyroid-Stimulating ; Medical Records ; Sensitivity and Specificity ; Thyroid Gland ; Thyroiditis ; Thyrotoxicosis ; Thyrotropin

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A Case of Asymptomatic Giant Cystic Pheochromocytoma.

Sang Hoon LEE ; Seungkoo LEE ; Sang Wook KIM ; Eun Hee CHO

Endocrinology and Metabolism.2012;27(2):119-120. doi:10.3803/EnM.2012.27.2.119

No abstract available.
Pheochromocytoma

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Characterization of Incidentally Detected Adrenal Pheochromocytoma.

Soon Jib YOO ; Woohyeon KIM

Endocrinology and Metabolism.2012;27(2):116-118. doi:10.3803/EnM.2012.27.2.116

No abstract available.
Pheochromocytoma

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AMP-activated protein kinase Activating Agent and Its Implication.

Hyoung Chul CHOI

Endocrinology and Metabolism.2012;27(2):109-115. doi:10.3803/EnM.2012.27.2.109

AMP-activated protein kinase (AMPK) is an important cellular fuel sensor. Activation of AMPK requires phosphorylation at threonine (Thr)-172, which resides in the activation loop of the alpha1 and alpha2 subunits. Several AMPK upstream kinases are capable of phosphorylating AMPK at Thr-172, including LKB1 and CaMKKbeta. AMPK has been implicated in the regulation of physiological signals, such as inhibition of cholesterol, fatty acid, protein synthesis, and enhancement of glucose uptake and blood flow. AMPK activation also exhibits several salutary effects on vascular function and improves vascular abnormalities. AMPK is activated by numerous drugs and xenobiotics. Some of these are in clinical use for the treatment of type 2 diabetes (e.g., metformin and thiazolidinediones), hypertension (e.g., nifedipine and losartan), and impaired blood flow (e.g., aspirin, statins, and cilostazol). Plant-derived xenobiotics or nutraceuticals that were claimed to have health benefits in diabetes or cancer have been reported to activate AMPK. These include resveratrol from red wine, epigallocatechin gallate from green tea, capsaicin from peppers, berberine, which is a yellow dye of the genus berberis, genistein from soy bean, and ginsenoside from ginseng panax. AMPK is also modulated by numerous hormones and cytokines that regulate energy balance at the whole body level, including leptin, adiponectin, ghrelin, and even thyroid hormones. This work shows that the precise mechanisms of AMPK kinase and AMPK interaction.
Adiponectin ; AMP-Activated Protein Kinases ; Aspirin ; Berberine ; Berberis ; Calcium-Calmodulin-Dependent Protein Kinase Kinase ; Capsaicin ; Catechin ; Cholesterol ; Cytokines ; Dietary Supplements ; Genistein ; Ghrelin ; Glucose ; Hypertension ; Insurance Benefits ; Leptin ; Metformin ; Nifedipine ; Panax ; Phosphorylation ; Phosphotransferases ; Protein Kinases ; Soybeans ; Stilbenes ; Tea ; Threonine ; Thyroid Hormones ; Wine ; Xenobiotics

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A Case of Malignant Pheochromocytoma Presenting as Inverted Takotsubo-Like Cardiomyopathy.

Jung Eun JANG ; Hyuk Hee KWON ; Min Jung LEE ; Chang Hee JUNG ; Sung Jin BAE ; Hong Kyu KIM ; Woo Je LEE

Endocrinology and Metabolism.2012;27(1):98-104. doi:10.3803/EnM.2012.27.1.98

Takotsubo cardiomyopathy or stress induced cardiomyopathy is characterized by acute transient left ventricular apical ballooning without significant coronary artery disease. The pathophysiology of Takotsubo cardiomyopathy remains unclear, but it has been suggested that the stress related neurohumoral factors, especially catecholamines, play an important role. Recently, several reports have described an inverted Takotsubo cardiomyopathy, which is characterized by the dysfunction of the basal and mid-ventricular segments sparing the apex of the heart. In this report, we present a case of a 50-year-old female with a transient left ventricular dysfunction in an inverted Takotsubo pattern, that later was diagnosed as a malignant pheochromocytoma.
Cardiomyopathies ; Catecholamines ; Coronary Artery Disease ; Female ; Heart ; Humans ; Middle Aged ; Pheochromocytoma ; Takotsubo Cardiomyopathy ; Ventricular Dysfunction, Left

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A Case of an Adrenocortical Carcinoma with Pulmonary Embolism as the Initial Manifestation.

Hyo Jin LEE ; Ji Young KWAK ; Young Jip KIM ; Tae Ho KIM ; Jan Dee LEE ; Hyun Woo LEE ; Hae Jin KIM ; Dae Jung KIM ; Yoon Sok CHUNG ; Kwan Woo LEE ; Seung Jin HAN

Endocrinology and Metabolism.2012;27(1):93-97. doi:10.3803/EnM.2012.27.1.93

The annual incidence of a first episode of deep vein thrombosis or pulmonary embolism (PE) in the general population is 120 per 100,000. Cancer is associated with an approximately 4- to 7-fold higher risk of thrombosis. Adrenocortical carcinoma (ACC) is a rare type of malignancy, accounting for 0.02% of all cancers reported annually. Approximately 40% of ACCs are nonsecretory. Most patients with nonsecreting tumors have clinical manifestations related to tumor growth (e.g., abdominal or flank pain). Often the adrenal mass is detected by chance via radiographic imaging. As a result, most ACC patients are diagnosed at an advanced stage and have a poor prognosis. Herein, we report a case of a 54-year-old woman who was admitted to our emergency department complaining of dyspnea. She was diagnosed with ACC accompanied by thrombi in the pulmonary artery and inferior vena cava. We performed a left adrenalectomy and administered adjuvant radiotherapy. The patient is currently receiving warfarin and adjuvant mitotane therapy. She was incidentally diagnosed with ACC, with PE as the initial manifestation.
Accounting ; Adrenalectomy ; Adrenocortical Carcinoma ; Dyspnea ; Emergencies ; Female ; Humans ; Incidence ; Middle Aged ; Mitotane ; Prognosis ; Pulmonary Artery ; Pulmonary Embolism ; Radiotherapy, Adjuvant ; Thrombosis ; Vena Cava, Inferior ; Venous Thrombosis ; Warfarin

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Ketoacidosis with Hypertriglyceridemia-Induced Pancreatitis in a Patient with Gestational Diabetes: A Case Report.

Hyun Hee CHUNG ; Sang Hyun PARK ; Ji Sung YOON ; Kyu Chang WON ; Hyoung Woo LEE

Endocrinology and Metabolism.2012;27(1):89-92. doi:10.3803/EnM.2012.27.1.89

Hypertriglyceridemia-induced acute pancreatitis in pregnancy is not a common complication. Moreover, ketoacidosis in gestational diabetes occurs rarely. Here we report a case of ketoacidosis with hypertriglyceridemia-induced pancreatitis in a patient with gestational diabetes that was successfully treated with insulin and supportive care. In this case, a 36-year-old woman (at 32 weeks' gestation) was diagnosed with gestational diabetes 4 weeks prior, but did not have well controlled blood sugar. She complained of severe epigastric pain concomitant with nausea and vomiting. Radiology and laboratory tests found hypertriglyceridemia (1,996 mg/dL), acute pancreatitis, and ketoacidosis with absence of fetal deceleration on a non-stress test. The patient's condition improved with insulin therapy and fluid replacement. To our knowledge, this is the first report of a case of ketoacidosis with hypertriglyceridemia-induced pancreatitis in a patient with gestational diabetes.
Adult ; Blood Glucose ; Deceleration ; Diabetes, Gestational ; Female ; Humans ; Hypertriglyceridemia ; Insulin ; Ketosis ; Nausea ; Pancreatitis ; Pregnancy ; Vomiting

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Primary Hyperaparathyroidism due to Cystic Parathyroid Adenoma not Detected on 99mTc-Sestamibi Scan.

Ah Reum KHANG ; Eun Ki KIM ; Eun Young NAM ; Sun Ju BYEON ; Jung Hee KIM ; Jung Hun OHN ; Eun Shil HONG ; Hyung Jin CHOI ; Kyeong Cheon JUNG ; Myung Whun SUNG ; Chan Soo SHIN ; Kyong Soo PARK ; Seong Yeon KIM

Endocrinology and Metabolism.2012;27(1):83-88. doi:10.3803/EnM.2012.27.1.83

Parathyroid cysts, which can be divided into functional and non-functional cysts, are rare causes of primary hyperparathyroidism. A technetium-99m-methoxyisobutylisonitrile (99mTc-sestamibi) parathyroid scan is a sensitive diagnostic tool for the localization, although it sometimes shows a false-negative result. Here we report a case of presumed cystic parathyroid adenoma based on clinical findings and analysis of cystic fluid with negative findings in a parathyroid scan. A 44-year-old male patient visited the hospital due to leg pain and compressive symptoms (dysphagia, hoarseness) that had started 4-5 months before. His serum calcium level was 14.4 mg/dL and his intact parathyroid hormone (iPTH) had increased to 478.1 pg/mL. On neck computed tomography, a cystic nodule measuring 6.2 cm was detected in the inferior part of the right thyroid gland. Sestamibi uptake for this nodule was not detected on 2-h delayed imaging, and fluorodeoxyglucose positron emission tomography showed only subtle uptake. Fine-needle aspiration was performed and intracystic iPTH had increased to 61,600 pg/mL. Focused parathyroidectomy guided by intraoperative iPTH monitoring led to successful enucleation of the right inferior parathyroid gland. A parathyroid adenoma was confirmed, and his laboratory results had normalized. This study shows that cystic parathyroid adenoma can sometimes be difficult to detect on a 99mTc-sestamibi parathyroid scan.
Adult ; Biopsy, Fine-Needle ; Calcium ; Humans ; Hyperparathyroidism ; Hyperparathyroidism, Primary ; Leg ; Male ; Neck ; Parathyroid Glands ; Parathyroid Hormone ; Parathyroid Neoplasms ; Parathyroidectomy ; Positron-Emission Tomography ; Technetium Tc 99m Sestamibi ; Thyroid Gland

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