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Type B insulin resistance syndrome is rare autoimmune disease that is characterized by various abnormalities of glycemic homeostasis, from hyperglycemia caused by extreme insulin resistance to fasting hypoglycemia. It can combine with other autoimmune diseases, most commonly systemic lupus erythematosus. It usually occurs in women and accompanies acanthosis nigricans, hyperandrogenism, and, in many cases, ovary dysfunction. The diagnosis of type B insulin resistance syndrome is based largely on the presence of insulin receptor autoantibodies and hyperglycemia, or hypoglycemia and hyperinsulinemia. In some cases, patients with the type B insulin resistance have been successfully treated with immunosuppressive therapy and plasmapheresis. We experienced type B insulin resistance syndrome in a patient with chronic hepatitis B and used only plasmapheresis for treatment. The immunosuppressive therapy was omitted due to the state of activation of chronic hepatitis B. We present this case with a review of relevant literature.
Acanthosis Nigricans ; Autoantibodies ; Autoimmune Diseases ; Female ; Hepatitis B, Chronic ; Hepatitis, Chronic ; Homeostasis ; Humans ; Hyperandrogenism ; Hyperglycemia ; Hyperinsulinism ; Hypoglycemia ; Insulin ; Insulin Resistance ; Lupus Erythematosus, Systemic ; Ovary ; Plasmapheresis ; Receptor, Insulin

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Diabetic Ketoacidosis Associated with Emphysematous Gastritis: A Case Report.

Young Min CHOI ; Jun Won SEO ; Woo Jin LEE ; Hyeong Jin PARK ; Ji Hye SHIN ; Seung Bum KANG ; Jun LEE ; Jin Hwa KIM ; Sang Yong KIM ; Hak Yeon BAE

Endocrinology and Metabolism.2011;26(4):355-359. doi:10.3803/EnM.2011.26.4.355

Diabetic ketoacidosis is a serious and demanding medical emergency for the field of endocrinology, and the identification and correction of the precipitating factors is equally important. Many patients of diabetic ketoacidosis show gastrointestinal symptoms as an initial presentation, and coincidental gastrointestinal diseases can be neglected or misdiagnosed. Emphysematous gastritis is a rare and lethal disease in which gas bubbles form in the stomach wall. The predisposing factors include ingestion of corrosive substances, alcohol abuse, diabetes, and immunosuppressive therapy. Thus, it may be difficult to detect emphysematous gastritis early, especially when it is developed in conjunction with diabetic ketoacidosis. We report a case of diabetic ketoacidosis associated with emphysematous gastritis in a young male without medical history.
Alcoholism ; Diabetic Ketoacidosis ; Eating ; Emergencies ; Endocrinology ; Gastritis ; Gastrointestinal Diseases ; Humans ; Male ; Precipitating Factors ; Stomach

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A Case of Cushing's Disease in Pregnancy.

Jeong Tae KIM ; Mun Hyuk SUNG ; Woo Ri PARK ; Jeong Ho HAN ; Hye Suk HAN ; Young Kwang SIM ; Tae Gun OH ; Hyun Jeong JEON

Endocrinology and Metabolism.2011;26(4):348-354. doi:10.3803/EnM.2011.26.4.348

Developing Cushing's syndrome during pregnancy is rare because menstruation is irregular and hypercortisolism causes infertility. Developing Cushing's disease during pregnancy is very rare because there is even less ovulation than those with the adrenal adenoma. The clinical manifestations of Cushing's syndrome may easily be missed during pregnancy as the features of weight gain, hypertension, and hyperglycemia overlap with those that occur during a pregnancy. Diagnosing Cushing's syndrome during a pregnancy is complex because the biochemical features are obscured by the natural changes in the hypothalamic-pituitary-adrenal axis that occur during pregnancy. Having Cushing's syndrome during a pregnancy results in increased fetal and maternal complications, so early diagnosis and treatment are critical. We report the clinical and endocrine findings of a pregnant women with Cushing's disease who underwent transsphenoidal surgery after delivery.
Adenoma ; Cushing Syndrome ; Early Diagnosis ; Female ; Humans ; Hyperglycemia ; Hypertension ; Infertility ; Menstruation ; Ovulation ; Pregnancy ; Pregnant Women ; Weight Gain ; Axis, Cervical Vertebra

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Hyperprolactinemia-Associated Breast Uptake of Radioiodine Following 131I Postablation Scan in Differentiated Thyroid Cancer.

Jae Hee AHN ; Sun Young KIM ; Ye Ji KIM ; Suk Young LEE ; Jae Hyoung LEE ; Seung Hun KANG ; Ho Cheol HONG ; Sae Jeong YANG ; Hye Jin YOO ; Ji A SEO ; Sin Gon KIM ; Nan Hee KIM ; Kyung Mook CHOI ; Sei Hyun BAIK ; Dong Seop CHOI ; Hae Yoon CHOI

Endocrinology and Metabolism.2011;26(4):345-347. doi:10.3803/EnM.2011.26.4.345

Scanning with whole-body 131I scintigraphy after surgery has been a valuable diagnostic modality in the surveillance of patients with differentiated thyroid cancer. Radioiodine uptake is rarely observed in non-lactating breast tissue, which mimics thyroid cancer metastasis. We now report a case of a 45-year-old female thyroid cancer patient who underwent radioiodine therapy, and in whom breast uptake of radioiodine was observed on a post-therapy whole body scan. Her serum prolactin level was elevated to 328 ng/mL at the time of the radioiodine uptake, and the hyperprolactinemia was induced by her antipsychotic medications. Six months after she discontinued that medication, her serum prolactin level was normalized to 12.6 ng/mL and breast uptake of iodine was no longer present in a follow-up whole body scan.
Antipsychotic Agents ; Breast ; Female ; Follow-Up Studies ; Humans ; Hyperprolactinemia ; Iodine ; Middle Aged ; Neoplasm Metastasis ; Prolactin ; Thyroid Gland ; Thyroid Neoplasms ; Whole Body Imaging

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Laparoscopically Resected Composite Pheochromocytoma-Ganglioneuroma.

Na Rae KIM ; Taeeun KIM ; Jeong Nam LEE ; Young Sil EOM ; Dong Hae CHUNG ; Sanghui PARK ; Hyun Yee CHO

Endocrinology and Metabolism.2011;26(4):340-344. doi:10.3803/EnM.2011.26.4.340

Composite pheochromocytoma-ganglioneuroma is one of the mixed neuroendocrine-neural tumors composed of pheochromocytoma and other neural crest derivatives. To date, less than 50 cases of composite pheochromocytoma have been reported, and about 70% of the accompanying tumors were ganglioneuromas. Here, we describe six cases of composite pheochromocytoma-ganglioneuromas in five men and one woman, aged 33 to 64. The size of the tumors ranged from 3.0 to 11.0 cm, and four out of the six presented with intermittent onset of hypertension, palpitation, or dizziness. Microscopically, each tumor was composed of large pleomorphic shaped chromaffin cells arranged in the Zellballen patterns characteristic of pheochromocytoma, and they were mixed with clusters of mature ganglion cells and bundles of spindle-shaped Schwann cells characteristic of ganglioneuroma of variable proportions. All were successfully treated laparoscopically, and none were associated with multiple endocrine neoplasm syndrome or neurofibromatosis. Preoperative diagnosis of a composite pheochromocytoma-ganglioneuroma is impossible because of the low incidence rate, and the radiological findings and symptoms are similar to those of typical pheochromocytomas. Although the significance of microscopic detection of the nonpheochromocytoma component from pheochromocytoma has not yet been clarified, microscopic identification of the composite pheochromocytoma-ganglioneuroma is important because cumulative cases are used in an effort to predict the behavior of this composite tumor.
Adrenal Glands ; Aged ; Chromaffin Cells ; Dizziness ; Female ; Ganglion Cysts ; Ganglioneuroma ; Humans ; Hypertension ; Incidence ; Male ; Neural Crest ; Pheochromocytoma ; Schwann Cells

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Ophthalmopathy Induced by Bilateral Carotid Cavernous Fistula in a Patient with Graves' Disease.

Jong Kun HA ; Ji Hye SUK ; A Ra JO ; Chan Woo JUNG ; Bong Jae KIM ; Seong Oh PARK ; Sang Su KIM ; Mi Kyung KIM

Endocrinology and Metabolism.2011;26(4):335-339. doi:10.3803/EnM.2011.26.4.335

Graves' disease (GD) can lead to specific eye afflictions including proptosis, periorbital swelling, conjunctival injection, chemosis, and opthalmoplegia, which then become a condition called Graves' ophthalmopathy or thyroid-associated ophthalmopathy (TAO). A carotid cavernous fistula (CCF) is an abnormal vascular communication between the carotid artery and the cavernous sinus. The clinical signs of CCF are very similar to TAO and should be considered as a differential diagnosis of TAO. We would like to present an interesting case of a bilateral ophthalmopathy induced by CCF in a GD patient. A 54-year-old man with a 6-year history of GD presented with bilateral exophthalmos and conjunctival injection for two months. The orbital CT scan findings were consistent with CCF, and an angiography revealed bilateral CCF. He received a bilateral coil embolization for the CCF and his ophthalmic signs were immediately improved. We recommend orbital imaging to exclude other coexisting diseases in patients who are suspected of TAO, especially when the diagnosis is uncertain or when determining whether medical or surgical intervention is appropriate.
Angiography ; Carotid Arteries ; Cavernous Sinus ; Caves ; Diagnosis, Differential ; Exophthalmos ; Eye ; Fistula ; Graves Disease ; Graves Ophthalmopathy ; Humans ; Middle Aged ; Orbit ; Troleandomycin

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Four Cases of Malignant Pleural Effusion in Patients with Papillary Thyroid Carcinoma.

Min Ji JEON ; Ji Hye YIM ; Eui Young KIM ; Won Gu KIM ; Tae Yong KIM ; Won Bae KIM ; Young Kee SHONG

Endocrinology and Metabolism.2011;26(4):330-334. doi:10.3803/EnM.2011.26.4.330

Papillary thyroid carcinoma could be a rare cause of malignant pleural effusion. The development of malignant pleural effusion in patients with papillary thyroid cancer is an extremely adverse prognostic indicator. Here, we report four cases that showed development of malignant pleural effusion during the clinical course of the papillary thyroid carcinoma and consider the prognosis. In four patients, the median survival time after the development of malignant pleural effusion was only 17 months.
Carcinoma ; Humans ; Pleural Effusion, Malignant ; Prognosis ; Thyroid Gland ; Thyroid Neoplasms

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A Case of Subacute Thyroiditis Associated with Papillary Thyroid Carcinoma and Takayasu's Arteritis.

Dongwon YI ; Seung Hoon BAEK ; Seok Man SON ; Yang Ho KANG

Endocrinology and Metabolism.2011;26(4):324-329. doi:10.3803/EnM.2011.26.4.324

Subacute thyroiditis is a self-limiting inflammation of the thyroid, presenting with painful thyroid swelling, thyrotoxicosis and low radioactive iodine uptake. The characteristic US findings for this disease are focal ill-defined hypoechoic areas in one lobe or diffuse hypoechoic areas in both lobes. Thyroid carcinomas should be included in the differential diagnosis for a lesion with focal hypoechoic areas and have been rarely reported to coexist with subacute thyroiditis. Takayasu's arteritis is an autoimmune disease that affects the aorta and its branches as well as pulmonary arteries. Subacute thyroiditis associated with Takayasu's arteritis is extremely rare, with only three cases being reported. We report here on the first case with the simultaneous diagnosis of subacute thyroiditis, papillary thyroid carcinoma and Takayasu's arteritis.
Aorta ; Autoimmune Diseases ; Carcinoma ; Diagnosis, Differential ; Inflammation ; Iodine ; Pulmonary Artery ; Takayasu Arteritis ; Thyroid Gland ; Thyroid Neoplasms ; Thyroiditis, Subacute ; Thyrotoxicosis

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