A Case of Idiopathic Granulomatous Hypophysitis

Granulomatous hypophysitis is a rare pituitary condition that commonly presents with enlargement of the pituitary gland. A 31-year-old woman was admitted to the hospital with a severe headache and bitemporal hemianopsia. Magnetic resonance imaging (MRI) showed an 18 x 10-mm sellar mass with suprasellar extension and compression of the optic chiasm. Interestingly, brain MRI had shown no abnormal finding 4 months previously. On hormonal examination, hypopituitarism with mild hyperprolactinemia was noted. The biopsy revealed granulomatous changes with multinucleated giant cells. We herein report this rare case and discuss the relevant literature.

Mortality Predictors in Patients Treated with Continuous Renal Replacement / 대한신장학회지

PURPOSE: Acute kidney injury (AKI) is a frequent condition with a high mortality rate that requires continuous renal replacement therapy (CRRT). We evaluated the Simplified Acute Physiology Score 3 (SAPS 3) and Acute Physiology and Chronic Health Evaluation II (APACHE II) score, determined at the start of CRRT, for predicting mortality in AKI. METHODS: We retrospectively analyzed the demographic, clinical, and laboratory data of 89 patients with AKI or acute-on-chronic kidney disease who received CRRT between September 2006 and September 2009. We calculated the SAPS 3 and APACHE II score at the start of CRRT. RESULTS: The average age of the 89 patients was 64.4+/-13.9 (17-92) years. Fifty-nine (66.3%) were male. Eighteen (20.2%) patients had chronic kidney disease and 30 (33.7%) had diabetes. The overall mortality was 75.3%. The average SAPS 3 was 89.4+/-14.9 and the average APACHE II score was 28.4+/-5.2. The SAPS 3 was higher in non-survivors than survivors (p=0.038). Infection was more common in non-survivors (p=0.036). There were no significant differences between the two groups for other conditions. The variables influencing mortality on univariate analysis were SAPS 3 and presence of infection. The area under the receiver-operating characteristic curve for SAPS 3 was 0.69 (95% CI. 0.54-0.83). At a SAPS 3 of 84, the sensitivity for predicting mortality was 71.6% and the specificity was 69.2%. CONCLUSION: The SAPS 3 determined before starting CRRT could be a predictor of hospital mortality in patients with AKI.

Prevalence of Helicobacter pylori Infection on Peptic Ulcer in Dialysis Patients in One Center / 대한신장학회지

PURPOSE: Patients with chronic renal failure tend to have an increased incidence of peptic ulcer disease. Helicobacter pylori (H. pylori) infection is generally found to be the major cause of peptic ulcer disease. There are a few studies about the association between H. pylori and peptic ulcer disease in dialysis patients. In this retrospective study, we investigated the relationship between H. pylori and peptic ulcer disease in dialysis patients. METHODS: The participants enrolled in this study were hemodialysis (HD) or peritoneal dialysis (PD) patients in the period from February 2001 to March 2010, who had been diagnosed as having a peptic ulcer. The presence of H.pylori was identified by at least one of the following: the rapid urease test, the urea breath test or histologic findings. RESULTS: A total of 132 patients (100 HD and 32 PD patients) were enrolled. The mean age and duration of dialysis were 56.5+/-14.8 years and 27.6+/-45.3 months, respectively. The prevalence of H. pylori-positive patients amongst those with peptic ulcer disease was 43.1% (57/132). H. pylori-positive prevalence was 48.1% (38/79) in gastric ulcer patients, and 33.3% (11/33) in duodenal ulcer patients, but this difference was not significant (p=0.21). There were no significant differences in age, causes of chronic renal failure or dialysis method between the H. pylori-positive and H. pylori-negative groups. However, the duration of dialysis was significantly longer in the H. pylori-negative group (16.6+/-34.1 vs. 36.0+/-50.8 months, p=0.01). Furthermore, as the duration of dialysis increased, the prevalence of H. pylori infection decreased (p=0.004). CONCLUSION: There was little association between H. pylori and peptic ulcer disease in dialysis patients. Long-term dialysis appeared to decrease the prevalence of H. pylori infection in peptic ulcer disease.

A Case of Juxtaglomerular Cell Tumor Combined with Focal Segmental Glomerulosclerosis / 대한신장학회지

Juxtaglomerular cell tumor is a rare cause of secondary hypertension. Focal segmental glomerulosclerosis (FSGS) is a clinicopathological entity associated with renal insufficiency and proteinuria. The exact diagnosis and proper management are important in both juxtaglomerular cell tumor and FSGS. We experienced a 26-year-old male who complained of a palpable abdomen mass associated with proteinuria and hypertension. Ultimately, he was diagnosed with a juxtaglomerular cell tumor combined with FSGS after nephrectomy. After operation, his hypertension normalized, while his renal function deteriorated.

An Unusual Type of Hypertrophic Cardiomyopathy

An unusual type of hypertrophic cardiomyopathy was diagnosed in a 17-year-old girl who presented with dyspnea on exertion. The hypertrophied myocardium was localized to the anterior portion of the left ventricle from the base to the apex without left ventricular outflow tract obstruction. On cardiac magnetic resonance imaging (MRI), patchy and linear delayed hyperenhancement was shown in the anterior and inferior mid-wall, which is not concordant with the coronary artery territory.

Recurrence of thyroid tuberculosis after complete treatment of lymph node tuberculosis / 대한내과학회지

Thyroid tuberculosis is rare, and primary tuberculosis is extremely rare. In most cases, thyroid tuberculosis presents as a thyroid nodule, thyroiditis, thyroid abscess, or thyroid cancer, and is often diagnosed after thyroidectomy. We experienced a case of thyroid tuberculosis that presented as a palpable thyroid nodule in a 32-year-old female patient. The patient had been previously diagnosed with cervical tuberculous lymphadenitis and had been treated successfully 6 years ago. Fine needle aspiration of the thyroid gland showed a small number of neutrophils and macrophages in a necrotic background, and many acid-fast bacilli were found with AFB staining. The patient began anti-tuberculosis therapy as an outpatient and is currently being followed regularly. Here, we report a case of thyroid tuberculosis diagnosed after the apparent cure of cervical lymph node tuberculosis. Additionally, a review of the literature is included.

Recurrence of thyroid tuberculosis after complete treatment of lymph node tuberculosis / 대한내과학회지

Thyroid tuberculosis is rare, and primary tuberculosis is extremely rare. In most cases, thyroid tuberculosis presents as a thyroid nodule, thyroiditis, thyroid abscess, or thyroid cancer, and is often diagnosed after thyroidectomy. We experienced a case of thyroid tuberculosis that presented as a palpable thyroid nodule in a 32-year-old female patient. The patient had been previously diagnosed with cervical tuberculous lymphadenitis and had been treated successfully 6 years ago. Fine needle aspiration of the thyroid gland showed a small number of neutrophils and macrophages in a necrotic background, and many acid-fast bacilli were found with AFB staining. The patient began anti-tuberculosis therapy as an outpatient and is currently being followed regularly. Here, we report a case of thyroid tuberculosis diagnosed after the apparent cure of cervical lymph node tuberculosis. Additionally, a review of the literature is included.