Characteristics of Acromegaly in Korea with a Literature Review

Acromegaly is a slowly progressive disease caused by excessive growth hormone (GH), which is related to a GH secreting pituitary tumor in most cases. Herein, we describe the epidemiology, clinical characteristics, and treatment of acromegaly in Korea with a literature review. The average annual incidence of acromegaly in Korea was 3.9 cases per million people, which was within the range of previous Western studies. The primary treatment for acromegaly was also transsphenoidal adenomectomy, which accounted for 90.4% of patients whose primary therapeutic options were known. The overall surgical remission rates were 89%, 87%, 64%, 70%, and 50% for modified Hardy classification I, II, IIIA, IIIB, and IV, respectively. An updated and larger study regarding the treatment outcome of medical/radiotherapy in Korean acromegalic patients is needed.ope

Secondary Pituitary Hyperplasia Induced by Hashimoto’s Thyroiditis Related Hypothyroidism: A Case Report

ope

성장호르몬 분비 뇌하수체 종양의 수술적 완치 후 발견된 지연형 자가면역 당뇨병 1예

Acromegaly is generally caused by a benign growth hormone (GH)-secreting pituitary adenoma. It is characterized by a wide range of complications; cardiovascular, respiratory, bone and joint, and metabolic complications. Among them, impaired glucose tolerance and diabetes mellitus, due to GH-induced insulin resistance, has been reported in approximately 16-46% and 19-56%. They are usually improved following the treatment of acromegaly, surgical or medical therapy. We report a first case of 36-year-old man who was paradoxically diagnosed with GAD antibody positive latent autoimmune diabetes in adults (LADA) after the surgical cure of acromegaly.ope

A Case of Insulin Autoimmune Syndrome in a Patient with Partial Hypopituitarism

Insulin autoimmune syndrome is one of the rare causes of hypoglycemia, and characterized by hyperinsulinemic hypoglycemia associated with high titer of antibodies to endogenous insulin. We report a case of insulin autoimmune syndrome in a 57-year-old woman, presenting with mental changes due to hypoglycemia. She had no history of diabetes or insulin administration. The serum C-peptide level was 4.69 ng/mL and the insulin concentration was 229.55 μU/mL, when fasting plasma glucose level was 32 mg/dL. The insulin-to-glucose ratio was 7.17, while there was no radiologic evidence of insulinoma. The insulin antibody level was over 100 μU/mL, resulting in the diagnosis of insulin autoimmune syndrome. Hormonal studies revealed partial hypopituitarism and a lack of glucagon-response to hypoglycemia. Hypoglycemia disappeared with replacement of prednisolone with levothyroxine therapy. Under secretion of growth hormone and of adrenocorticotropic hormone due to hypopituitarism were associated with insufficient counterregulation to hypoglycemia. One should keep in mind that insulin autoimmune syndrome or hypopituitarism is one cause of hypoglycemia in patients with no history of diabetes, and corticosteroid can be an effective treatment for both diseases.ope

A 47,X,+t(X;X)(p22.3;p22.3)del(X)(p11.23q11.2),Y Klinefelter Variant with Morbid Obesity

Klinefelter syndrome is the most common type of genetic cause of hypogonadism. This syndrome is characterized by the presence of 1 or more extra X chromosomes. Phenotype manifestations of this syndrome are small testes, fibrosis of the seminiferous tubules, inability to produce sperm, gynecomastia, tall stature, decrease of serum testosterone and increases of luteinizing hormone and follicle stimulating hormone. Most patients with Klinefelter syndrome are tall, with slender body compositions, and reports of obesity are rare. We report the case of a 35-yr-old man with hypogonadism and morbid obesity and diabetes mellitus. He had gynecomastia, small testes and penis, very sparse body hair and his body mass index was 44.85. He did not report experiencing broken voice and was able to have erections. We conducted a chromosome study. His genotype was 47,X,+t(X;X)(p22.3;p22.3)del(X)(p11.23q11.2). In this case, the patient was diagnosed as Klinefelter syndrome. He showed rare phenotypes like morbid obesity and average height and the phenotype may be caused by the karyotype and the excess number of X chromosome. Further studies of the relationship between chromosomes and phenotype are warranted.ope

Recurrent Coccidioidomycosis Manifesting as Osteomyelitis in Korea

Coccidioidomycosis is a fungal infection that results from inhaling the airborne arthroconidia of the Coccidioides species. It is an endemic disease in the southwest part of North America and rarely diagnosed in Korea. As tourism to endemic areas and the number of immunocompromised patients have been increasing, the incidence of this infection has increased in non-endemic areas. Treatment is usually successful with antifungal agents; however, recurrence is common. It is difficult to decide when to discontinue the antifungal treatment especially in non-endemic areas where doctors are not familiar with the disease. We report a case of recurrent coccidioidomycosis manifesting as osteomyelitis after the treatment of the patient for disseminated coccidioidal infection. The complement fixation test was a useful tool for the assessment of patient response and to evaluate suspected recurrenceope

알파-시뉴클린으로 코팅한 금 나노입자를 이용한 세포 내 약물과 유전자 수송

학위논문 (석사)-- 서울대학교 대학원 : 화학생물공학부, 2015. 2. 백승렬.Alpha-Synuclein, the protein related with Parkinson' s disease, has been reported that it can penetrate the cell membrane. Herein, we achieved successful intracellular delivery of drugs and gene using this membrane penetrating characteristic of alpha-synuclein. First, alpha-synuclein was immobilized on the gold-nanoparticles (AuNPs) by the cysteine mutant at the C-terminal and this binding orientation showed the highest delivery efficiency to the nucleus. Also, this alpha-synuclein-coated AuNP formed complexes with DNA and mesoporous silica nanoparticle (MSN) at acidic pH and our in vitro studies showed high intracellular uptake of these complexes into the mammalian cells. The MSN-AuNPasyn complex was constructed in which the pores of MSN were blocked by AuNPasyn thus preventing the leaking of the loaded drugs. We called this complex as Particles-on-a-particle (PoP) and the cells treated with Doxorubicin (DOX) loaded PoP showed severe cytotoxicity level implicating that the drugs were successfully delivered. Another complex constructed was the DNA-AuNPasyn complex for the purpose of gene delivery. A complex of GFP expressing plasmid and AuNPasyn was treated to the cells and by measuring the fluorescence intensity we determined the gene transfection efficiency. In comparison to lipofectamine, this AuNPasyn system showed significantly faster transfection rate. We suggest that AuNPasyn as the novel cell internalization agent for delivering drugs and gene. In future studies, we expect to evaluate the nucleus localization signal within the alpha-synuclein sequence.Ⅰ. Introduction 1 1.1 a-Synuclein and AuNPasyn 1 1.1.1. a-Synuclein 1 1.1.2. AuNPasyn 1 1.2. Mesoporous silica nanoparticles and drug delivery 4 1.2.1. Drug delivery system (DDS) using nanoparticles 4 1.2.2. Drug delivery system (DDS) using Mesoporous silica nanoparticles (MSNs) 4 1.3. Gene delivery 5 Ⅱ. Materials and Methods 6 2.1. Materials 6 2.2 Purification of a-Synuclein 6 2.3. Cell culture 7 2.4. Preparation of the protein coated gold nanoparticles 7 2.5. Transmission electron microscope(TEM) 7 2.6. Confocal laser scanning microscope(CLSM) 8 Ⅲ. Results and Discussion 9 3.1. Drug delivery into the cell 9 3.1.1. Confirmation of the intracellular delivery of PoP 9 3.1.2. Comparison of drug delivery with PoPDOX and MSNDOX 9 3.1.3. Ligand-responsive gate control system 10 3.2. DNA delivery into the cell 17 3.2.1. Nucleus transportation of a-synuclein and AuNPasyn 17 3.2.2. Formation of DNA-AuNPasyn complex 17 3.2.3. Confirmation and compare of transfection 19 3.2.4. Comparison of cell cytotoxicity 19 3.3. Mechanism of accumulating in the nucleus of AuNPasyn 20 Ⅳ. Conclusion 29 Ⅴ. References 31 국문초록 34Maste

고프로락틴혈증을 동반한 뇌하수체 종양 감별 진단을 위한 감별 진단을 위한 혈액내 microRNA 발굴

prohibition박

고프로락틴혈증을 동반한 비기능성 뇌하수체 종양과 프로락틴 분비 선종의 구분

Dept. of Medical Science/석사[한글] [영문]The objective of this study was to evaluate characteristics that discriminate prolactinoma from non-functioning pituitary macroadenoma with hyperprolactinemia. We included 117 patients with hyperprolactinemic pituitary macroadenomas. Patients were divided into three groups according to treatment outcomes and pathologic results: (A) prolactinoma that responded to dopamine agonist (DA) treatment, PRDA; (B) prolactinoma requiring surgical treatment, PRS; and (C) non-functioning pituitary adenoma with hyperprolactinemia, NFPAH. Old age, low serum prolactin levels, and extrasellar extension were associated with NFPAH. Most patients with NFPAH had serum prolactin levels less than 100 ng/ml. Visual defects and GH deficiency were more common in patients with NFPAH compared with patients with PRS and PRDA, without difference of tumor size. Galactorrhoea and amenorrhoea were less frequent in patients with NFPAH than in patients with PRS and PRDA. Post-operative remission of hyperprolactinemia was achieved in 100% of patients with NFPAH and in 72.5% of patients with PRS. DA administration was required in 25.5% of patients with PRS; however, no patients with NFPAH required DA administration. In conclusion, old age, extrasellar tumor extension with relatively low prolactin levels, visual defect and GH deficiency were considered suggestive of non-functioning pituitary adenoma rather than prolactinoma in hyperprolactinemic pituitary macroadenoma.ope

Carotid atheromatic plaque is commonly associated with hypopituitary men

Hypopituitarism increases the risks of many cardiovascular conditions and therefore, patients with this disease are more prone to cardiovascular disease. To our knowledge, there have been few studies on carotid artery plaque in male patients with hypopituitarism in assessing cardiovascular risks. The aim of this study was to specifically compare carotid artery plaque while examining other major cardiovascular risk factors between male patients with hypopituitarism and control subjects. Forty male patients aged 30-70 years with hypopituitarism and forty age, sex- matched control subjects were recruited at the Yonsei University Severance Hospital, Seoul, Korea. Carotid intima media thickness (IMT) and atheromatous plaque, anthropometry, lipid profile, and pituitary hormones were assessed. Atheromatous plaque in the carotid arteries was observed more frequently in patients with hypopituitarism than age- and sex-matched control subjects (59.5% vs. 2.5%, P<0.01) without differences of carotid IMTs. Patients with hypopituitarism also exhibited higher waist circumference, waist to hip ratio, total cholesterol and LDL cholesterol than control subjects. In subgroup analysis in male patients with hypopituitarism including GH deficiency, lower testosterone levels were associated with higher waist circumference (r=0.446, P=0.033). In conclusion, hypopituitary males exhibit an increased incidence of carotid artery plaque without differences of carotid IMTs, central obesity and higher total cholesterol level. Lower testosterone levels were associated with central obesity- a strong component of a metabolic syndrome, and unsubstituted testosterone deficiency might be an important cardiovascular risk factor in patients with hypopituitarism.ope