Background: Atherogenic dyslipidemia, which is frequently associated with type 2 diabetes (T2D) and insulin resistance, contributes to the development of vascular complications. Statin therapy is the primary approach to dyslipidemia management in T2D, however, the role of non-statin therapy remains unclear. Ezetimibe reduces cholesterol burden by inhibiting intestinal cholesterol absorption. Fibrates lower triglyceride levels and increase high-density lipoprotein cholesterol (HDL-C) levels via peroxisome proliferator- activated receptor alpha agonism. Therefore, when combined, these drugs effectively lower non-HDL-C levels. Despite this, few clinical trials have specifically targeted non-HDL-C, and the efficacy of triple combination therapies, including statins, ezetimibe, and fibrates, has yet to be determined. Methods: This is a multicenter, prospective, randomized, open-label, active-comparator controlled trial involving 3,958 eligible participants with T2D, cardiovascular risk factors, and elevated non-HDL-C (≥100 mg/dL). Participants, already on moderate-intensity statins, will be randomly assigned to either Ezefeno (ezetimibe/fenofibrate) addition or statin dose-escalation. The primary end point is the development of a composite of major adverse cardiovascular and diabetic microvascular events over 48 months. Conclusion This trial aims to assess whether combining statins, ezetimibe, and fenofibrate is as effective as, or possibly superior to, statin monotherapy intensification in lowering cardiovascular and microvascular disease risk for patients with T2D. This could propose a novel therapeutic approach for managing dyslipidemia in T2D.

Background: Conventional diagnostic approaches for adrenal tumors require multi-step processes, including imaging studies and dynamic hormone tests. Therefore, this study aimed to discriminate adrenal tumors from a single blood sample based on the combination of liquid chromatography-mass spectrometry (LC-MS) and machine learning algorithms in serum profiling of adrenal steroids. Methods: The LC-MS-based steroid profiling was applied to serum samples obtained from patients with nonfunctioning adenoma (NFA, n=73), Cushing’s syndrome (CS, n=30), and primary aldosteronism (PA, n=40) in a prospective multicenter study of adrenal disease. The decision tree (DT), random forest (RF), and extreme gradient boost (XGBoost) were performed to categorize the subtypes of adrenal tumors. Results: The CS group showed higher serum levels of 11-deoxycortisol than the NFA group, and increased levels of tetrahydrocortisone (THE), 20α-dihydrocortisol, and 6β-hydroxycortisol were found in the PA group. However, the CS group showed lower levels of dehydroepiandrosterone (DHEA) and its sulfate derivative (DHEA-S) than both the NFA and PA groups. Patients with PA expressed higher serum 18-hydroxycortisol and DHEA but lower THE than NFA patients. The balanced accuracies of DT, RF, and XGBoost for classifying each type were 78%, 96%, and 97%, respectively. In receiver operating characteristics (ROC) analysis for CS, XGBoost, and RF showed a significantly greater diagnostic power than the DT. However, in ROC analysis for PA, only RF exhibited better diagnostic performance than DT. Conclusion The combination of LC-MS-based steroid profiling with machine learning algorithms could be a promising one-step diagnostic approach for the classification of adrenal tumor subtypes.

An adrenal incidentaloma is an adrenal mass found in an imaging study performed for other reasons unrelated to adrenal disease and often accompanied by obesity, diabetes, or hypertension. The prevalence and incidence of adrenal incidentaloma increase with age and are also expected to rise due to the rapid development of imaging technology and frequent imaging studies. The Korean Endocrine Society is promoting an appropriate practice guideline to meet the rising incidence of adrenal incidentaloma, in cooperation with the Korean Adrenal Gland and Endocrine Hypertension Study Group. In this paper, we discuss important core issues in managing the patients with adrenal incidentaloma. After evaluating core proposition, we propose the most critical 20 recommendations from the initially organized 47 recommendations by Delphi technique.
Adrenal Glands ; Delphi Technique ; Humans ; Hypertension ; Incidence ; Obesity ; Prevalence

An adrenal incidentaloma is an adrenal mass found in an imaging examination performed for reasons unrelated to suspected adrenal disease. The prevalence of adrenal incidentaloma increases with age; there is no gender difference, but it is often accompanied by obesity, diabetes mellitus, or hypertension. The detection of adrenal incidentaloma is expected to rise with the rapid development of imaging technology and increasing frequency of imaging studies. The Korean Endocrine Society is promoting appropriate practice guidelines to meet the rising incidence of adrenal incidentaloma, in cooperation with the Korean Adrenal Gland and Endocrine Hypertension Study Group. In this paper, we discuss important core issues for treating adrenal incidentaloma, along with the most important factors for healthcare providers who treat and manage affected patients. Initially, we identified 47 recommendations using the Delphi technique, after evaluating core propositions. We reduced these to the 20 most critical recommendations.
Adrenal Glands ; Delphi Technique ; Diabetes Mellitus ; Health Personnel ; Humans ; Hypertension ; Incidence ; Obesity ; Prevalence

BACKGROUND: Core needle biopsy is a relatively new technique used to diagnose salivary gland lesions, and its role in comparison with fine needle aspiration cytology needs to be refined. METHODS: We compared the results of 228 ultrasound-guided core needle biopsy and 371 fine needle aspiration procedures performed on major salivary gland tumors with their postoperative histological diagnoses. RESULTS: Core needle biopsy resulted in significantly higher sensitivity and more accurate tumor subtyping, especially for malignant tumors, than fine needle aspiration. No patient developed major complications after core needle biopsy. CONCLUSIONS: We recommend ultrasoundguided core needle biopsy as the primary diagnostic tool for the preoperative evaluation of patients with salivary gland lesions, especially when malignancy is suspected.
Biopsy, Fine-Needle* ; Biopsy, Large-Core Needle* ; Diagnosis ; Humans ; Parotid Gland ; Salivary Gland Neoplasms ; Salivary Glands* ; Submandibular Gland

BACKGROUND/AIMS: Recent epidemiological studies revealed a striking inverse relationship between vitamin D levels, glucose intolerance/insulin resistance (IR), and cardiovascular disease. However, few interventional studies have evaluated the effect of vitamin D supplementation on cardiovascular risk, such as IR and arterial stiffness, in diabetes. We investigated the role of vitamin D supplementation on cardiovascular risk in type 2 diabetes patients, including metabolic parameters, IR, and arterial stiffness. METHODS: We enrolled patients who were taking antidiabetic medications or managed their diabetes using lifestyle changes. We excluded patients who were taking vitamin D or calcium supplements. We randomized participants into the vitamin D group (cholecalciferol 2,000 IU/day + calcium 200 mg/day, n = 40) or the placebo group (calcium 200 mg/day, n = 41). We compared their IR (homeostasis model of assessment [HOMA]-IR) and arterial stiffness (brachial-ankle pulse wave velocity and radial augmentation index) before and after 24 weeks of intervention. RESULTS: The baseline characteristics of the two groups were similar. A total of 62 participants (placebo, 30; vitamin D, 32) completed the study protocol. At the end of the study period, the 25-hydroxyvitamin D [25(OH)D] levels were significantly higher in the vitamin D group than in the placebo group (35.4 +/- 8.5 ng/mL vs. 18.4 +/- 7.3 ng/mL, p < 0.001). There was no difference in HOMA-IR or changes in arterial stiffness (placebo, 21, vitamin D, 24) between the groups. CONCLUSIONS: Our data suggest that high-dose vitamin D supplementation might be effective in terms of elevating 25(OH)D levels. However, we identified no beneficial effects on cardiovascular risk in type 2 diabetes, including IR and arterial stiffness.
Calcium, Dietary/administration & dosage ; Cholecalciferol/*administration & dosage ; Diabetes Mellitus, Type 2/complications/*drug therapy/physiopathology ; Double-Blind Method ; Female ; Humans ; *Insulin Resistance ; Male ; Middle Aged ; Prospective Studies ; Vascular Stiffness/*drug effects ; Vitamin D/analogs & derivatives/blood ; Vitamin D Deficiency/blood/complications/drug therapy

X-linked agammaglobulinemia is a common type of primary immunodeficiency disorder that's caused by mutation of the BTK gene. The absence of B lymphocytes and plasma cells causes recurrent infections. Patients with X-linked agammaglobulinemia also have a high risk for developing hematological malignancies and, to a lesser degree, carcinoma. We report here on a 26-years-old male patient who suffered with X-linked agammaglobulinemia that was caused by BTK gene mutation, and he developed a gastric cancer in the antrum. He was noted to have chronic atrophic gastritis and diffuse intestinal metaplasia on the endoscopic examination that was done 7 years previously. We recommend regular esophagogastroduodenoscopic evaluation for a patient with X-linked agammaglobulinemia in order to make an early diagnosis of stomach carcinoma.
Adenocarcinoma ; Agammaglobulinemia ; B-Lymphocytes ; Early Diagnosis ; Gastritis, Atrophic ; Genetic Diseases, X-Linked ; Hematologic Neoplasms ; Humans ; Male ; Metaplasia ; Plasma Cells ; Stomach ; Stomach Neoplasms

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is frequently associated with type 2 diabetes mellitus, obesity and dyslipidemia. Also, it is recognized to be one of component of the insulin resistance syndrome. But both its pathogenesis and clinical implication associated with cardiovascular disease as an important outcome of insulin resistance have not been well known. We investigated the relationship between NAFLD, metabolic disorders, and brachial-ankle pulse wave velocity (baPWV) as a risk marker of atherosclerosis. METHODS: A total of 213 nonalcoholic subjects (67 males, 146 females) participated in this study. Subjects were divided into NAFLD or normal group based on the existence of fatty liver seen by sonography. RESULTS: The prevalence of hypertension, impaired fasting glucose, hypertriglyceridemia, low HDL-C level and central obesity were higher in NAFLD group than those in normal group. After controlling for age, sex and body mass index, serum ALT, AST, ALP and GGT levels were significantly associated with homeostatis model assessment of insulin resistance (HOMA-IR) (p<0.05). baPWV in NAFLD group was significantly higher than those in normal group in females (p=0.005). After adjusting for age, NAFLD had positive correlation with baPWV (p=0.039). In addition, the positive correlation was stronger in NAFLD with elevated liver enzymes (p=0.011). Individual levels of serum ALT, AST, ALP and GGT were positively correlated with baPWV after adjusting for age, sex, body mass index, HOMA-IR and systolic blood pressure (p<0.05). A multiple regression analysis showed baPWV was significantly associated with age, systolic blood pressure, body mass index and various liver enzymes, respectively. CONCLUSION: baPWV was significantly associated with NAFLD, especially in females. baPWV also had significant positive correlation with various liver enzymes. NAFLD showed more strong correlation with baPWV when it was combined with abnormal liver function. NAFLD, especially combined with abnormal liver function, may be associated with increased risk of cardiovascular disease.
Atherosclerosis ; Blood Pressure ; Body Mass Index ; Cardiovascular Diseases ; Diabetes Mellitus, Type 2 ; Dyslipidemias ; Fasting ; Fatty Liver* ; Female ; Glucose ; Humans ; Hypertension ; Hypertriglyceridemia ; Insulin Resistance ; Liver ; Male ; Metabolic Diseases* ; Obesity ; Obesity, Abdominal ; Prevalence ; Pulse Wave Analysis*

BACKGROUND: As elderly people increasing, prevalence of diabetes will increase but there was paucity of data on the epidemiology of diabetes in Korean elderly population. In this study (Southwest Seoul, SWS study) we investigated the change of prevalence of diabetes mellitus for two points in time (the years 1999 and 2002) and 3-year incidence of diabetes in elderly Korean population of southwest area of Seoul. METHODS: A sampling of 1,652 subjects in 1999 and 1,214 subjects in 2002 who are over 60 years old in southwest area of Seoul were investigated. All subjects underwent a 75 g oral glucose tolerance test (OGTT), biochemical study and anthropometric measurements. Among the 1,652 subjects in 1999, 350 subjects were followed up for 3 years and 294 subjects without diabetes at baseline examination participated in retrospective cohort study. RESULTS: Prevalence of diabetes in 1999 was 20.5% [previous diagnosed people (11.9%), newly diagnosed people (8.6%)] and in 2002 was 22.1% [previous diagnosed people (15.2%), newly diagnosed people (6.9%)]. Prevalence of impaired fasting glucose (IFG) or impaired glucose intolerance (IGT) was 22.8% in 1999 and 27.8% in 2002. In 350 subjects were followed up for 3 years, prevalence of diabetes was 16.0% in 1999 and increased to 23.4% in 2002 (p=0.014). In retrospective cohort study, the annual incidence rate of diabetes was 2.9% (age and sex adjusted rate 2.5%). CONCLUSION: Prevalence of diabetes in elderly Korean population of southwest area of Seoul was 20.5% in 1999 and increased to 22.1% in 2002. Prevalence of IFG or IGT was 22.8% in 1999 and increased to 27.8% in 2002. This report supports that impaired glucose regulations and diabetes mellitus of elderly Korean population will increase in the future as aged Korean population increases.
Aged ; Asian Continental Ancestry Group ; Cohort Studies ; Diabetes Mellitus* ; Epidemiology ; Fasting ; Glucose ; Glucose Intolerance ; Glucose Tolerance Test ; Humans ; Incidence* ; Middle Aged* ; Prevalence* ; Retrospective Studies ; Seoul ; Social Control, Formal

Congenital adrenal hyperplasia refers to a group of autosomal recessive disorders that is defective in the synthesis of cortisol. The enzymes most often affected are 21-hydroxylase and 11beta hydroxylase. The low levels of cortisol stimulate the pituitary gland to release ACTH. Chronic elevation of the ACTH level causes bilateral adrenal hyperplasia and a secondary increase in androgen formation. We examined a 19 year-old woman presented with clitoral hypertrophy and vaginal spotting. The subjects basal level of serum cortisol was low, but the serum levels of ACTH, 17a-hydroxyprogesterone, deoxy-corticosterone were elevated. The urinary excretions of 17-ketosteroids and 17-hydroxycorticosteroids were also increased. The karyotyping study and transrectal ultrasonography showed normal findings. The patient underwent clitoris reduction surgery and received hydrocortisone. To the best of our knowledge, this is the first case of 11beta-Hydroxylase deficiency in Korea.
17-Hydroxycorticosteroids ; 17-Ketosteroids ; Adrenal Hyperplasia, Congenital* ; Adrenocorticotropic Hormone ; Clitoris ; Female ; Humans ; Hydrocortisone ; Hyperplasia ; Hypertrophy ; Karyotyping ; Korea ; Metrorrhagia ; Pituitary Gland ; Steroid 21-Hydroxylase ; Ultrasonography ; Young Adult