Growth hormone (GH) deficiency is caused by congenital or acquired causes and occurs in childhood or adulthood. GH replacement therapy brings benefits to body composition, exercise capacity, skeletal health, cardiovascular outcomes, and quality of life. Before initiating GH replacement, GH deficiency should be confirmed through proper stimulation tests, and in cases with proven genetic causes or structural lesions, repeated GH stimulation testing is not necessary. The dosing regimen of GH replacement therapy should be individualized, with the goal of minimizing side effects and maximizing clinical improvements. The Korean Endocrine Society and the Korean Society of Pediatric Endocrinology have developed a position statement on the diagnosis and treatment of GH deficiency. This position statement is based on a systematic review of evidence and expert opinions.

Acromegaly is a chronic disorder caused by excessive growth hormone (GH) secretion. In most cases, the excess GH originates from GH-producing pituitary adenomas. Surgery is the preferred first-line treatment for patients with acromegaly, but medical management is considered when the disease persists after surgery or in cases where patients refuse surgery or are poor candidates for surgery. Somatostatin analogues are commonly used to treat acromegaly. The Korean Endocrine Society and the Korean Neuroendocrine Study Group have developed a position statement for the use of somatostatin analogues in the medical treatment of acromegaly. This position statement is based on evidence from the current literature and expert opinions. In the case of discrepancies among expert opinions, the experts voted to determine the recommended approach.

Acromegaly is a chronic disorder caused by excessive growth hormone (GH) secretion. In most cases, the excess GH originates from GH-producing pituitary adenomas. Surgery is the preferred first-line treatment for patients with acromegaly, but medical management is considered when the disease persists after surgery or in cases where patients refuse surgery or are poor candidates for surgery. Somatostatin analogues are commonly used to treat acromegaly. The Korean Endocrine Society and the Korean Neuroendocrine Study Group have developed a position statement for the use of somatostatin analogues in the medical treatment of acromegaly. This position statement is based on evidence from the current literature and expert opinions. In the case of discrepancies among expert opinions, the experts voted to determine the recommended approach.
Acromegaly ; Expert Testimony ; Growth Hormone ; Humans ; Octreotide ; Pituitary Neoplasms ; Somatostatin

The Korean Endocrine Society (KES) published clinical practice guidelines for the treatment of acromegaly in 2011. Since then, the number of acromegaly cases, publications on studies addressing medical treatment of acromegaly, and demands for improvements in insurance coverage have been dramatically increasing. In 2017, the KES Committee of Health Insurance decided to publish a position statement regarding the use of somatostatin analogues in acromegaly. Accordingly, consensus opinions for the position statement were collected after intensive review of the relevant literature and discussions among experts affiliated with the KES, and the Korean Neuroendocrine Study Group. This position statement includes the characteristics, indications, dose, interval (including extended dose interval in case of lanreotide autogel), switching and preoperative use of somatostatin analogues in medical treatment of acromegaly. The recommended approach is based on the expert opinions in case of insufficient clinical evidence, and where discrepancies among the expert opinions were found, the experts voted to determine the recommended approach.
Acromegaly ; Consensus ; Expert Testimony ; Insurance Coverage ; Insurance, Health ; Octreotide ; Somatostatin

Subcutaneous tissue calcification in rheumatic diseases usually occurs in connective tissue diseases, such as systemic lupus erythematosus, scleroderma, and dermatomyositis. Domestic cases of calcification in rheumatoid arthritis have not been reported. The mechanism of subcutaneous tissue calcification may differ depending on the cause and it can develop on all parts of the body. Calcification occurring in rheumatic diseases is a major mechanism of tissue damage caused by chronic inflammation. No standard therapy for calcification has been established; however, many studies have reported on medical and surgical treatment. We report on subcutaneous tissue calcification in a rheumatoid arthritis patient tissue calcification on both sides of the buttocks, the upper limbs, and the lower limbs.
Arthritis, Rheumatoid* ; Buttocks ; Calcinosis ; Connective Tissue Diseases ; Dermatomyositis ; Humans ; Inflammation ; Lower Extremity ; Lupus Erythematosus, Systemic ; Rheumatic Diseases ; Subcutaneous Tissue* ; Upper Extremity

PURPOSE: A retrospective study was conducted to examine the current trend in incidence rates of hip fractures among patients aged 50 years and older in Korea. MATERIALS AND METHODS: A retrospective study was conducted using data on the population, collected by Statistics Korea within the different gender and age groups in total population of Korea from 2007 to 2012. The International Classification of Diseases-10 classification method from the Health Insurance Review and Assessment Service was used to investigate the number of patients with hip fractures, and determine the crude incidence rate (CR) and the age-adjusted incidence rate (AR) for comparison. RESULTS: The CR of hip fractures for patients aged 50 years and older was 178 per 100,000 for men and 350 per 100,000 for women in 2007. In 2012, the CR was 194 per 100,000 for men, and 418 per 100,000 for women. The AR was 197 per 100,000 for men and 281 per 100,000 for women in 2007. In 2012, the AR was 206 per 100,000 for men, and 310 per 100,000 for women. During the observation period, the AR and the CR of hip fractures showed a statistically significant increase. However, the increasing trend has been slowing since its peak in 2010. Comparison of the AR of men and women, showed statistical significance only for women. CONCLUSION: In Korea, the incidence of hip fractures increased significantly from 2007 to 2012. The AR showed statistical significance only for women and the increasing trend is slowing down from 2010.
Classification ; Epidemiologic Studies* ; Female ; Hip Fractures* ; Hip* ; Humans ; Incidence* ; Insurance, Health ; Korea* ; Male ; Methods ; National Health Programs* ; Retrospective Studies

In upper gastrointestinal endoscopy, intravenous anesthesia is commonly used due to its safety and improvement in patient's satisfaction and comfort. The aim of this approach is to improve the condition for endoscopy. Although the risks of sedation are reported to be very low with sufficient monitoring, we still have few risks that cannot be overlooked including aspiration pneumonia. There have been two reported cases of aspiration pneumonia after endoscopic submucosal dissection. However, to our knowledge, there has been no reports about aspiration pneumonia developing after endoscopy for a young healthy female. So, we report a first case of unexpected aspiration pneumonia after endoscopy.
Anesthesia, Intravenous ; Endoscopy ; Endoscopy, Gastrointestinal* ; Female ; Humans ; Pneumonia, Aspiration*

We report a case of anal squamous cell carcinoma extended to the rectal mucosa that was clinically mistaken for rectal adenocarcinoma and literature reviwed. Sigmoidoscopic finding showed spherical shaped elevated lesion with central ulceration, interpreted as rectal adenocarcinoma in the distal portion of rectum. Anal squamous cell carcinoma is very rare among gastrointestinal cancer. Pathological study of the biopsy specimen demonstrated squamous cell carcinoma and normal rectal glands. Sigmoidoscopic finding of the presented case showed the ulcerarive lesion contineuosly extended from anal verge upward to the rectum. We postulate that the presented case is primarilly originated from the anal squamous cell carcinoma extended proximally to the rectum. Immunohistochemical stain(p-63) of the biopsy specimens showed squamous cell carcinoma. This patient has been completely recovered after treartment of chemoradiation and trans-anal excision. We present a case of anal squamous cell carcinoma invading rectal mucosa clinically mistaken for rectal adenocarcinoma and literature reviewed.
Adenocarcinoma* ; Anus Neoplasms ; Biopsy ; Carcinoma, Squamous Cell* ; Gastrointestinal Neoplasms ; Humans ; Mucous Membrane ; Rectum ; Salt Gland ; Ulcer

BACKGROUND/AIMS: Hood cap-assisted chromocolonoscopy using indigocarmine is expected to improve the detection rate of colorectal polyps, especially adenomatous polyps. Therefore, aim of the present study was to evaluate the usefulness of hood cap-assisted chromocolonoscopy in routine colonoscopic examinations. METHODS: From January, 2013 through March, 2013, a total of 86 patients were enrolled (M:F=33:53, mean age=60 years). For each patient, hood cap-assisted colonoscopic examination was performed, followed by hood cap-assisted chromocolonoscopy using 0.2% indigocarmine from the cecum to the hepatic flexure. Total numbers and characteristics of polyps were compared before and after indigo carmine dye spraying. RESULTS: Prior to dye spraying, 48 polyps were found in 37 patients, and after dye spraying, 53 additional polyps were found in 34 patients. Of these undetected polyps, 45 (85%) were small sized polyps (< or =0.5 cm). Histologically, 19 (36%) were adenomatous polyps, and of these, 15 (28%) were tubular adenomas and 4 (8%) were serrated adenomas. As for the polyp detection rate, there was no difference between the expert and the non-expert groups. CONCLUSION: Hood cap-assisted chromocolonoscopic examination using indigocarmine was helpful in detecting cecum and ascending colon polyps, especially small sized polyps (<0.5 cm) and neoplastic polyps.
Adenoma ; Adenomatous Polyps ; Cecum ; Colon, Ascending ; Colonoscopy ; Humans ; Indigo Carmine ; Polyps*

Adrenal oncocytomas are very rare. Because most of them are benign and nonfunctioning, they are detected incidentally. Here, we report a case of nonfunctioning benign adrenocortical oncocytoma located in the left adrenal gland in a 54-year-old man who presented with no symptoms. The tumor was 4.5 x 3 x 3 cm in size and was predominantly composed of oncocytes, which exhibited abundant eosinophilic granular cytoplasm and were arranged with a nested or diffuse architecture without capsular or vascular invasion. Nuclear atypia and mitotic figures were not observed. A discussion of this case and a review of recent updates in the literature are presented. In patients with adrenocortical oncocytomas, treatment is similar to that for adrenocortical neoplasia. However, due to the risk of over-diagnosis of malignancy, and the better clinical outcomes associated with adrenocortical oncocytoma, more attention should be paid to the diagnosis of adrenocortical oncocytoma.
Adenoma, Oxyphilic ; Adrenal Glands ; Adrenocortical Adenoma ; Cytoplasm ; Eosinophils ; Humans ; Oxyphil Cells