BACKGROUND: We compared the efficacies of vildagliptin (50 mg twice daily) relative to pioglitazone (15 mg once daily) as an add-on treatment to metformin for reducing glycosylated hemoglobin (HbA1c) levels in Korean patients with type 2 diabetes. METHODS: The present study was a multicenter, randomized, active-controlled investigation comparing the effects of vildagliptin and pioglitazone in Korean patients receiving a stable dose of metformin but exhibiting inadequate glycemic control. Each patient underwent a 16-week treatment period with either vildagliptin or pioglitazone as an add-on treatment to metformin. RESULTS: The mean changes in HbA1c levels from baseline were -0.94% in the vildagliptin group and -0.6% in the pioglitazone group and the difference between the treatments was below the non-inferiority margin of 0.3%. The mean changes in postprandial plasma glucose (PPG) levels were -60.2 mg/dL in the vildagliptin group and -38.2 mg/dL in the pioglitazone group and these values significantly differed (P=0.040). There were significant decreases in the levels of total, low density lipoprotein, high density lipoprotein (HDL), and non-HDL cholesterol in the vildagliptin group but increases in the pioglitazone group. The mean change in body weight was -0.07 kg in the vildagliptin group and 0.69 kg in the pioglitazone group, which were also significantly different (P=0.002). CONCLUSION: As an add-on to metformin, the efficacy of vildagliptin for the improvement of glycemic control is not inferior to that of pioglitazone in Korean patients with type 2 diabetes. In addition, add-on treatment with vildagliptin had beneficial effects on PPG levels, lipid profiles, and body weight compared to pioglitazone.
Blood Glucose ; Body Weight ; Cholesterol ; Hemoglobin A, Glycosylated ; Humans ; Lipoproteins ; Metformin* ; Thiazolidinediones

A 55-year-old male was admitted to emergency department with a hypoglycemic shock of unknown origin. He was presented with tonic seizure activity after admission. Initial diagnostic procedure could exclude diabetes mellitus, drug side effects, and exogenous insulin application. Detailed evaluation of the patient's history revealed that the patient had experienced repeated hypoglycemic episodes for 2 years. He was diagnosed with hypothyroidism six years ago. Initial laboratory investigations revealed hypoglycemia, hyponatremia, and low plasma cortisol level (0.18 microg/dL). Sellar magnetic resonance imaging showed empty sella. Replacement therapy with hydrocortisone resulted in the improvement of clinical symptoms. Combined pituitary stimulation test with exception of hypoglycemia induced growth hormone and cortisol stimulation test was performed. The response of thyroid stimulating hormone, prolactin, follicle-stimulating hormone, and luteinizing hormone was normal. We report the case of empty sella syndrome associated with hypoglycemic shock due to with multiple anterior pituitary hormone deficiencies.
Coma* ; Diabetes Mellitus ; Emergency Service, Hospital ; Empty Sella Syndrome* ; Follicle Stimulating Hormone ; Growth Hormone ; Humans ; Hydrocortisone ; Hypoglycemia ; Hyponatremia ; Hypothyroidism ; Insulin ; Luteinizing Hormone ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Plasma ; Prolactin ; Seizures ; Shock ; Thyrotropin

OBJECTIVES: We conducted a study to investigate the normal range for TSH and within-individual variations of TSH according to temperature and aging. PATIENTS AND METHODS: We enrolled patients who underwent periodic medical examinations five times over a six year period (2007.8~2013.6). Anthropometric data and thyroid ultrasonography were evaluated, and serum TSH, T3, and T4 were assayed. RESULTS: Subjects were 19-64 years old, 120 were female, and 208 were male. Reference ranges for TSH were 0.53-4.94 mIU/L in the first test, 0.49-5.61 mIU/L in the second test, 0.46-6.06 mIU/L in the third test, 0.48-5.99 mIU/L in the fourth test, and 0.52-6.3 mIU/L in the fifth test. When the TSH level was analyzed according to temperature and sex, mean TSH was higher in months in which the average monthly temperatures were below 10degrees C in Jinju, Gyeongnam and female. The aging and low temperatures are associated with increased serum TSH concentrations in the within-individual. CONCLUSIONS: This study showed that aging is associated with increased serum TSH concentrations in the within-individual and serum TSH concentrations are different in the within-individual according to the temperature.
Aging* ; Female ; Gyeongsangnam-do ; Humans ; Male ; Reference Values ; Thyroid Gland ; Thyrotropin* ; Ultrasonography

The solitary fibrous tumor (SFT) is an uncommon benign tumor, which is usually found in the pleura. Even though SFTs have been reported in various areas including the head and neck these days, laryngeal SFT is very rare, not to mention the bilateral vocal fold. Here, we report a new case of bilateral laryngeal SFT with a review of related literature. A 67-year-old male patient was admitted to our institution because of husky voice he experienced for several months. Endoscopic examination revealed a bilateral vocal folds swelling. The lesion was removed with CO2 laser under direct suspension laryngoscope. The pathological diagnosis was made by various immunohistochemical stainings including vimentin, Bcl-2, CD99 and CD34. During the 24 months follow-up after the surgery, there was no sign of recurrence.
Aged ; Diagnosis ; Edema* ; Follow-Up Studies ; Head ; Humans ; Laryngoscopes ; Larynx ; Lasers, Gas ; Male ; Neck ; Pleura ; Recurrence ; Solitary Fibrous Tumors* ; Vimentin ; Vocal Cords* ; Voice

Infratemporal fossa abscess caused by acute sinusitis, without other predisposing factors, is very rarely reported. We present such a case in a 78-year-old woman who was treated successfully with surgical drainage and antibiotics. She presented with a 10-day history of swelling and pain on the right side of her face. Physical examination revealed swelling on the right mandible area up to the zygomatic arch and the presence of mucopurulent rhinorrhea in the right nasal cavity without abnormal dental findings. Computed tomography revealed a right infratemporal fossa abscess and ipsilateral maxillary sinusitis connected through a defect on the posterior wall of the maxillary sinus. Drainage procedure was performed by navigation-guided endoscopic sinus surgery and intravenous antibiotics were administered. During a four months follow-up period, there was no sign of recurrence. Infratemporal fossa abscess can develop from acute sinusitis without predisposing factors, including dental infection. Surgical drainage along with intravenous antibiotics can lead to successful treatment in such cases.
Abscess* ; Aged ; Anti-Bacterial Agents ; Causality ; Drainage ; Female ; Follow-Up Studies ; Humans ; Mandible ; Maxillary Sinus ; Maxillary Sinusitis ; Nasal Cavity ; Physical Examination ; Recurrence ; Sinusitis* ; Zygoma

The incidence of mastoiditis in pediatric age has consistently increased over the last two decades due to increase of antibiotic-resistant bacteria. Compared to young patients, occurrence of acute otitis media complications such as acute mastoiditis and subperiosteal abscess is relatively low in adults. Various treatments for acute mastoiditis with subperiosteal abscess such as tympanostomy tube insertion, intravenous antibiotics, and postauricular incision and drainage have avoided the morbidity and necessity of mastoid surgery. Recently, many studies have indicated mastoidectomy only in cases of severe complications or failure of disease improvement after antibiotic treatment and myringotomy. In this report, we present two cases of successful treatment of subperiosteal abscess and discuss the management of acute mastoiditis with subperiosteal abscess in both child and adult.
Abscess ; Adult ; Anti-Bacterial Agents ; Bacteria ; Child ; Drainage ; Humans ; Incidence ; Mastoid ; Mastoiditis ; Middle Ear Ventilation ; Otitis Media

Hyperglycemic hyperosmolar state (HHS) is an acute complication mostly occurring in elderly type 2 diabetes mellitus (DM). Thyrotoxicosis causes dramatic increase of glycogen degradation and/or gluconeogenesis and enhances breakdown of triglyc-erides. Thus, in general, it augments glucose intolerance in diabetic patients. A 23-yr-old female patient with Graves' disease and type 2 DM, complying with methimazole and insulin injection, had symptoms of nausea, polyuria and generalized weakness. Her serum glucose and osmolarity were 32.7 mM/L, and 321 mosm/kg, respectively. Thyroid function tests revealed that she had more aggravated hyperthyroid status; 0.01 mU/L TSH and 2.78 pM/L free T3 (reference range, 0.17-4.05, 0.31-0.62, respectively) than when she was discharged two weeks before (0.12 mU/L TSH and 1.41 pM/L free T3). Being diagnosed as HHS and refractory Graves' hyperthyroidism, she was treated successfully with intravenous fluids, insulin and high doses of methimazole (90 mg daily). Here, we described the case of a woman with Graves' disease and type 2 DM developing to HHS.
Thyroid Function Tests ; Methimazole/therapeutic use ; Insulin/therapeutic use ; Hyperthyroidism/*complications/therapy ; Hyperglycemic Hyperosmolar Nonketotic Coma/*etiology ; Humans ; Graves Disease/*complications ; Fluid Therapy ; Female ; Diabetes Mellitus, Type 2/*complications ; Adult

Of two major forms (myo- and chiro-inositol) of inositols, only chiro-inositol enhances the activity of proteins involved in intracellular glucose metabolism. This study aims to determine the urinary myo-/chiro-inositol ratio in type 1 and type 2 diabetes patients and compare its ratio with the normal control group. The 24-hour urinary myo- and chiro-inositols in 71 Korean diabetes patients and 39 control subjects have been quantified using high-performance liquid chromatography, and their ratios have been evaluated as indices of insulin resistance. The level of 24-hour urinary myo-inositol was significantly higher in both type 1 and type 2 diabetes than with the control group, whereas the urinary chiro-inositol in type 1 or type 2 diabetes was lower than that in normal subjects. The myo-/chiro-inositol ratio in diabetes patients was higher than that in the control group. Twenty four-hour urinary myo-/ chiro-inositol ratios were significantly elevated in type 1 and type 2 diabetes patients compared to the control group, suggesting that a high ratio of urinary myo-/chiro- inositol in type 2 diabetes patients might be used for an index of insulin resistance.
Adult ; Aged ; Diabetes Mellitus, Type 1/*urine ; Diabetes Mellitus, Type 2/*urine ; Female ; Humans ; Inositol/*urine ; Insulin Resistance ; Male ; Middle Aged

BACKGROUND: Adult growth hormone (GH) deficiency is related with decreased lean body mass, increased body fat, and poor quality of life. In western countries, adult GH deficiency treatment registriesy provide a database of the effects and safety of GH deficiency treatment. The Korean Adult Growth Hormone Study Group of the Korean Society of Endocrinology register adult GH deficiency since 1996. METHEODS: Subjects were aged over 15 years, had organic hypothalamo-pituitary disease, and GH deficiency as documented by GH stimulation test or serum insulin-like growth factor-I (IGF-I) level. The underlying etiology for GH deficiency, serum IGF-I level, starting and maintenance dose, and adult GH deficiency assessment (AGHDA) score were investigated. RESULTS: From January 1996 to May 2001. 115 patients were enrolled. Mean age was 43.7 13.8 years and 60% were female. Thirteen medical institutions were involved in the registry. The most common underlying diseases were Sheehan's syndrome and pituitary adenomas. GH starting dose was from 0.4 to 1.0 units. Maintenance dose was between 0.5 and 1.2 units. Serum IGF-I levels were increased after GH treatment (0-week, 93.7 69.7 ng/mL; 2-weeks, 184.9 89.0 ng/mL; 6-weeks, 188.4 94.8 ng/mL; 10-weeks, 207.6 111.1 ng/mL; 6 months, 281.9 95.5 ng/mL). AGHDA scores slightly improved from 10.25 6.70 to 8.58 5.47 after 6 months of GH deficiency treatment. CONCLUSION: The GH Treatment Registry will be beneficial in monitoring the effects of GH deficiency treatment on Korean adult GH deficient subjects
Adipose Tissue ; Adult* ; Endocrinology ; Female ; Growth Hormone* ; Humans ; Hypopituitarism ; Insulin-Like Growth Factor I ; Pituitary Neoplasms ; Quality of Life

Primary neuroendocrine carcinoma of the thymus (formerly known as thymic carcinoids) are unusual tumors that account for 5% of all anterior mediastinal neoplasms. Thymic neuroendocrine carcinomas exhibit a much more aggressive behavior than those originating from other foregut locations and are associated with the ectopic ACTH syndrome in 38% of cases. Patients having a thymic neuroendocrine carcinoma usually present with symptoms such as chest tightness, dyspnea, a palpable neck mass and sometimes a weight gain. We report on 2 patients with thymic neuroendocrine carcinoma who showed different clinical manifestations each other. One presented with a typical. Cushingoid appearance and the other had symptoms of fatigue and weight loss which is a common symptom of malignant tumors.
ACTH Syndrome, Ectopic* ; Carcinoma, Neuroendocrine* ; Dyspnea ; Fatigue ; Humans ; Mediastinal Neoplasms ; Neck ; Thorax ; Thymus Gland ; Weight Gain ; Weight Loss