Efficacy and Safety of Voglibose Plus Metformin in Patients with Type 2 Diabetes Mellitus: A Randomized Controlled Trial

BACKGROUND: Combination of metformin to reduce the fasting plasma glucose level and an α-glucosidase inhibitor to decrease the postprandial glucose level is expected to generate a complementary effect. We compared the efficacy and safety of a fixed-dose combination of voglibose plus metformin (vogmet) with metformin monotherapy in drug-naïve newly-diagnosed type 2 diabetes mellitus. METHODS: A total of 187 eligible patients aged 20 to 70 years, with a glycosylated hemoglobin (HbA1c) level of 7.0% to 11.0%, were randomized into either vogmet or metformin treatments for 24 weeks. A change in the HbA1c level from baseline was measured at week 24. RESULTS: The reduction in the levels of HbA1c was −1.62%±0.07% in the vogmet group and −1.31%±0.07% in the metformin group (P=0.003), and significantly more vogmet-treated patients achieved the target HbA1c levels of <6.5% (P=0.002) or <7% (P=0.039). Glycemic variability was also significantly improved with vogmet treatment, estimated by M-values (P=0.004). Gastrointestinal adverse events and hypoglycemia (%) were numerically lower in the vogmet-treated group. Moreover, a significant weight loss was observed with vogmet treatment compared with metformin (−1.63 kg vs. −0.86 kg, P=0.039). CONCLUSION: Vogmet is a safe antihyperglycemic agent that controls blood glucose level effectively, yields weight loss, and is superior to metformin in terms of various key glycemic parameters without increasing the risk of hypoglycemia.

Changes in the Diagnostic Efficiency of Thyroid Fine-Needle Aspiration Biopsy during the Era of Increased Thyroid Cancer Screening in Korea / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The volume of thyroid cancer screening and subsequent thyroid fine-needle aspiration (FNA) have rapidly increased in South Korea. We analyzed the thyroid cancer diagnoses/thyroid FNA ratio according to the annual number of FNA to evaluate changes in the diagnosticefficiency of FNA. MATERIALS AND METHODS: This was a nationwide population-based retrospective cohort study. The overall thyroid cancer diagnoses/thyroid FNA ratio and annual incremental thyroid cancer diagnoses/incremental thyroid FNA ratio were indirectly calculated using data obtained from the Korea Central Cancer Registry database and the Korean National Health Insurance Service claims database from 2004 to 2012. Pearson correlation analyses were performed to evaluate the strength of linear associations between variables. RESULTS: The number of thyroid FNA increased from 28,596 to 177,805 (6.2-fold increase) from 2004 to 2012. The overall thyroid cancer diagnoses/thyroid FNA ratio decreased from 36.5% in 2004 to 25.1% in 2012 and was negatively correlated to the number of FNA (R=‒0.977, p < 0.001). The annual incremental thyroid cancer diagnoses/incremental thyroid FNA ratios (range, 15.3% to 30.7%) were always lower than the overall thyroid cancer diagnoses/thyroid FNA ratio in each year and also worsened according to the increase in the number of FNA (R=‒0.853, p=0.007). CONCLUSION: The diagnostic performance of both overall and annual incremental thyroid FNA worsened, whereas the number of thyroid FNA procedures increased. More sophisticated indications for FNA are required to improve its diagnostic efficiency, considering the increased burden of screening-detected thyroid nodules.

Trends in Diabetes Incidence in the Last Decade Based on Korean National Health Insurance Claims Data

BACKGROUND: Epidemiological data is useful to estimate the necessary manpower and resources used for disease control and prevention of prevalent chronic diseases. We aimed to evaluate the incidence of diabetes and identify its trends based on the claims data from the National Health Insurance Service database over the last decade. METHODS: We extracted claims data on diabetes as the principal and first additional diagnoses of National Health Insurance from January 2003 to December 2012. We investigated the number of newly claimed subjects with diabetes codes, the number of claims and the demographic characteristics of this population. RESULTS: Total numbers of claimed cases and populations with diabetes continuously increased from 1,377,319 in 2003 to 2,571,067 by 2012. However, the annual number of newly claimed diabetic subjects decreased in the last decade. The total number of new claim patients with diabetes codes decreased as 30.9% over 2005 to 2009. Since 2009, the incidence of new diabetes claim patients has not experienced significant change. The 9-year average incidence rate was 0.98% and 1.01% in men and women, respectively. The data showed an increasing proportion of new diabetic subjects of younger age (<60 years) combined with a sharply decreasing proportion of subjects of older age (≥60 years). CONCLUSION: There were increasing numbers of newly claimed subjects with diabetes codes of younger age over the last 10 years. This increasing number of diabetic patients will require management throughout their life courses because Korea is rapidly becoming an aging society.

Epidemiology of Type 1 Diabetes Mellitus in Korea through an Investigation of the National Registration Project of Type 1 Diabetes for the Reimbursement of Glucometer Strips with Additional Analyses Using Claims Data

BACKGROUND: The aim of this study was to estimate the prevalence and incidence of type 1 diabetes mellitus (T1DM) in Korea. In addition, we planned to do a performance analysis of the Registration Project of Type 1 diabetes for the reimbursement of consumable materials. METHODS: To obtain nationwide data on the incidence and prevalence of T1DM, we extracted claims data from July 2011 to August 2013 from the Registration Project of Type 1 diabetes on the reimbursement of consumable materials in the National Health Insurance (NHI) Database. For a more detailed analysis of the T1DM population in Korea, stratification by gender, age, and area was performed, and prevalence and incidence were calculated. RESULTS: Of the 8,256 subjects enrolled over the 26 months, the male to female ratio was 1 to 1.12, the median age was 37.1 years, and an average of 136 new T1DM patients were registered to the T1DM registry each month, resulting in 1,632 newly diagnosed T1DM patients each year. We found that the incidence rate of new T1DM cases was 3.28 per 100,000 people. The average proportion of T1DM patients compared with each region's population was 0.0125%. The total number of insurance subscribers under the universal compulsory NHI in Korea was 49,662,097, and the total number of diabetes patients, excluding duplication, was 3,762,332. CONCLUSION: The prevalence of T1DM over the course of the study was approximately 0.017% to 0.021% of the entire population of Korea, and the annual incidence of T1DM was 3.28:100,000 overall and 3.25:100,000 for Koreans under 20 years old.

Background and Data Configuration Process of a Nationwide Population-Based Study Using the Korean National Health Insurance System

BACKGROUND: The National Health Insurance Service (NHIS) recently signed an agreement to provide limited open access to the databases within the Korean Diabetes Association for the benefit of Korean subjects with diabetes. Here, we present the history, structure, contents, and way to use data procurement in the Korean National Health Insurance (NHI) system for the benefit of Korean researchers. METHODS: The NHIS in Korea is a single-payer program and is mandatory for all residents in Korea. The three main healthcare programs of the NHI, Medical Aid, and long-term care insurance (LTCI) provide 100% coverage for the Korean population. The NHIS in Korea has adopted a fee-for-service system to pay health providers. Researchers can obtain health information from the four databases of the insured that contain data on health insurance claims, health check-ups and LTCI. RESULTS: Metabolic disease as chronic disease is increasing with aging society. NHIS data is based on mandatory, serial population data, so, this might show the time course of disease and predict some disease progress, and also be used in primary and secondary prevention of disease after data mining. CONCLUSION: The NHIS database represents the entire Korean population and can be used as a population-based database. The integrated information technology of the NHIS database makes it a world-leading population-based epidemiology and disease research platform.

Beneficial Effects of Omega-3 Fatty Acids on Low Density Lipoprotein Particle Size in Patients with Type 2 Diabetes Already under Statin Therapy

Beyond statin therapy for reducing low density lipoprotein cholesterol (LDL-C), additional therapeutic strategies are required to achieve more optimal reduction in cardiovascular risk among diabetic patients with dyslipidemia. To evaluate the effects and the safety of combined treatment with omega-3 fatty acids and statin in dyslipidemic patients with type 2 diabetes, we conducted a randomized, open-label study in Korea. Patients with persistent hypertriglyceridemia (> or =200 mg/dL) while taking statin for at least 6 weeks were eligible. Fifty-one patients were randomized to receive either omega-3 fatty acid 4, 2 g, or no drug for 8 weeks while continuing statin therapy. After 8 weeks of treatment, the mean percentage change of low density lipoprotein (LDL) particle size and triglyceride (TG) level was greater in patients who were prescribed 4 g of omega-3 fatty acid with statin than in patients receiving statin monotherapy (2.8%+/-3.1% vs. 2.3%+/-3.6%, P=0.024; -41.0%+/-24.1% vs. -24.2%+/-31.9%, P=0.049). Coadministration of omega-3 fatty acids with statin increased LDL particle size and decreased TG level in dyslipidemic patients with type 2 diabetes. The therapy was well tolerated without significant adverse effects.

Serum Cystatin C Reflects the Progress of Albuminuria

BACKGROUND: Research on the relationship between urinary albumin excretion and serum cystatin C in diabetes is restricted to cross-sectional studies. In this study, we investigated how well serial measurements of serum cystatin C level reflect changes in the urinary albumin excretion rate. METHODS: We enrolled and retrospectively collected data on 1,058 participants with type 2 diabetes who were older than 18 years and who had more than 3 years of follow-up with serial measurements of albuminuria and serum cystatin C at an outpatient clinic. RESULTS: With the use of a linear mixed model, we found that the albuminuria level for each patient over time corresponded with the annual change in serum cystatin C-based estimated glomerular filtration rate (cysC-eGFR) but did not correspond with the creatinine-based eGFR calculated by the modification of diet in renal disease formula (MDRD-eGFR). The discrepancy in the direction of the trend was smaller with cysC-eGFR than with MDRD-eGFR. CONCLUSION: Serum cystatin C level reflects the trend in albuminuria level more accurately than serum creatinine level in Korean type 2 diabetes mellitus patients.

The Effect of Red-Yeast-Rice Supplement on Serum Lipid Profile and Glucose Control in Subjects with Impaired Fasting Glucose or Impaired Glucose Tolerance

This study was aimed at evaluating the effect of red-yeast-rice supplementation on cholesterol-lowering and glucose control in subjects with impaired fasting glucose (IFT) or impaired glucose tolerance (IGT). We conducted a doubleblind, placebo-controlled study with 3 groups ; placebo, low dose group (red yeast rice 210.0 mg/capsule, 2.52 g/day)and high dose group (red yeast rice 420.0 mg/capsule, 5.04 g/day), which were randomly assigned to subjects with impaired fasting glucose or impaired glucose tolerance. We measured fasting serum concentrations of total-, LDL-, HDL-cholesterol, triglyceride, glucose, insulin, free fatty acid (FFA) and 2 h oral glucose tolerence test (OGTT) before and after the supplementation. Both low dose and high dose groups had significant decrease in LDL cholesterol and atherogenic index (AI) compared with placebo group (p < 0.05). Additionally, total and HDL cholesterol improved significantly in high dose group compared with placebo group (p < 0.05). Fasting serum glucose decreased in test groups and increased in placebo group after intervention. However, it was not significant differences. In subjects which fasting blood glucose is more than 110 mg/dL, fasting glucose had a tendency to decrease in high dose group (p < 0.1) and Hemoglobin A1c (HbA1c) had significant decrease in low dose group (p < 0.05), while insulin and HOMA-IR had a tendency to increase in placebo group after intervention. Mean changes of glucose related parameters (fasting glucose, insulin, HOMA-IR) compared with placebo group did not show significant differences. In conclusion, subjects with impaired fasting glucose or impaired glucose tolerance were significantly improved in serum lipid profile by red yeast rice supplementation without serious side effects. These are more effective in the case of a high dose. The effects of red yeast rice supplementation on glucose control were insignificant.

The association between insulin resistance and Framingham risk score among type 2 diabetes / 한국역학회지

BACKGROUND AND PURPOSE: Insulin resistance has been known to be associated with the risk of cardiovascular diseases. However, the relationship with Framingham risk score among type 2 diabetes has not been well known. We investigated the relationship between insulin resistance (IR) and the Framingham risk score(FRS) among type 2 diabetes in Korea. METHODS: We estimated the 5-year risk of ischemic heart disease(IHD) based on Framingham equation among 1,941 diabetes patients(1,294 men and 647 women), who visited Huh's clinic, enrolled from January 2003 to June 2006. IR, which was measured by insulin tolerance test (ITT), was divided into five groups(Q1 to Q5). High risk of IHD was defined as upper 10 percentile of FRS. Multivariate regression and logistic regression models were used to see independent association of higher quintiles of IR level, compared with lowest quintile(Q1) for the risk of IHD. RESULTS: Mean (+/-standard deviation) 5-year FRS of study subjects were 8.40%(+/-6.89) for men and 5.92%(+/-5.23) for women. There were significant correlation between IR, body mass index, HbA1C, fasting glucose, triglyceride, LDL-cholesterol, C-peptide and FRS in both men and women. After adjusting for triglyceride, LDL-cholesterol, C-peptide, multivariate regression model analysis showed that IR was independently associated with the FRS. A positive association between IR and high risk of IHD was observed in men: highest versus lowest quintile of IR (odds ratio 5.45 in men and 4.71 in women). CONCLUSION: Increased IR level was independently associated with risk of IHD measured by FRS among type 2 diabetes in Korea.

Therapeutic efficacy and factors that affect response of rosiglitazone in insulin-resistant type 2 diabetes / 대한내과학회지

BACKGROUND: Rosiglitazone, an insulin sensitizer of thiazolidinedione class, is known as a highly selective and potent agonist for the peroxisome proliferator-activated receptor-gamma. This study was performed to evaluate the antidiabetic activity and insulin sensitizing effect of rosiglitazone combination therapy in insulin-resistant type 2 diabetic patients who were poorly controlled with oral agents such as metformin and/or sulfonylurea. The factors affecting response of rosiglitazone were also evaluated on the basis of the degree of glycemic control. METHODS: One hundred twenty insulin-resistant (glucose disposal rate, Kitt < 2.5%/min) type 2 diabetic patients (M:F=42:78, mean age 58.6+/-9.2 years, body mass index 24.2+/-2.8 kg/m2) were enrolled and randomly divided into two groups. For 12 weeks, the treated group daily received 4 mg of rosiglitazone and the control group had diet and exercise therapy in addition to previous medications. The responders were defined as more than 20% decrease of fasting plasma glucose level or more than 1% decrease of HbA1c. As for the indices of insulin resistance and insulin secretory function, Kitt (Kitt=0.693/t1/2 X 100) by insulin tolerance test, HOMA(IR) and HOMA(beta-cell) function by 'HOMA index (Homeostasis model assessment)' were evaluated. RESULTS: In rosiglitazone treated group (60 patients, M:F=19:45), 12 weeks of rosiglitazone treatment decreased fasting plasma glucose (28.2%), postprandial 2-hour glucose (23.2%), and HbA1c (12.2%). Rosiglitazone also significantly decreased HOMA(IR) (41.2%), and increased Kitt (53.3%) and HOMA(beta-cell) function (46.9%). Forty-five patients (75%) satisfied responder. Females and those who had higher body mass index and waist-hip ratio showed better response. The basal fasting plasma glucose, HbA1c, and systolic blood pressure were also higher in responders. The responders showed significantly higher fasting serum insulin level and HOMA(IR), and also higher tendency of fasting serum C-peptide level and HOMA(beta-cell) function than nonresponders. CONCLUSION: From these results, rosiglitazone treatment can improve not only hyperglycemia and insulin resistance but also insulin secretory function in uncontrolled insulin-resistant type 2 diabetes. The factors that affect response of rosiglitazone are female, obesity (especially central obesity), high insulin secretory function, and severe insulin resistance. As a conclusion, the therapeutic efficacy or response of rosiglitazone is likely to depend on the degree of preserved pancreatic beta-cell function and the severity of insulin resistance.

A Case of Adrenal Cortical Carcinoma with Liver Metastasis / 대한내분비학회지

An adrenal cortical carcinoma is a rare malignancy associated with poor prognosis. On diagnosis, most patients present with large tumor masses, which are often detected at an advanced stage. The most effective treatment is a complete resection, which is the only curative treatment for adrenal cortical carcinomas. The most important prognostic factor is a successful resection of the primary tumor, as long as it is low-grade and has not spread to distant sites. However, with advanced adrenal cortical carcinomas, with distant metastasis, there is no strict effective treatment program, and the prognosis is poor. The case of a 50-year-old female patient, presenting with an adrenal cortical carcinoma and Cushing's syndrome, who had a long-term survival of 78 months, is reported. The mass was completely resected on diagnosis, but 16 months later liver metastasis was discovered. She had received chemotherapy, with cisplatin, etoposide and bleomycin, for the liver metastasis for a period of 15 months, but with no response, furthermore, the size had increased after 10 months. Afterward, she received her 10th session of intrahepatic artery cisplatin chemotherapy and her 3rd hepatic artery embolization. Although the patient had a large degree of liver metastasis, this was tolerated. The tumor mass is presently not aggravated, and she still survives after 78 months.

Development of standardized therapeutic model in Korean type 2 diabetic patients / 대한내과학회지

BACKGROUND: There are a few limitations in application of staged diabetes management (SDM) program to Korean type 2 diabetic patients because of their unique characteristics, such as non-obese but centrally obese anthropometry and variable relationships between insulin secretion and insulin resistance compared to western diabetic patients. Therefore, we proposed new therapeutic model which considers ethnic characteristics and assesses patient by insulin secretion and insulin resistance. METHODS: We have previously assessed patient's insulin secretion by serum fasting C-peptide level and insulin resistance by insulin tolerance test (ITT) and proposed new therapeutic model: by cut-off value of 2.5%/min in insulin resistance and 1.1 ng/dL, 1.7 ng/dL in insulin secretion. RESULTS: Total 183 patients were enrolled in this program and 59% of total subjects had to change the treatment modality according to this new therapeutic model. Mean fasting glucose level dropped from 177.0+/-38.6 mg/dL (9.83+/-2.14 mmol/L) to 148.2+/-31.2 mg/dL (8.23+/-1.73 mmol/L) (p<0.001), mean postprandial 2 hour glucose level dropped from 255.6+/-60.1 mg/dL (14.19+/-3.34 mmol/L) to 221.1+/-58.4 mg/dL (12.27+/-3.24 mmol/L) (p<0.001), mean HbA1c level dropped from 8.37+/-1.42% to 7.72+/-1.39% (p<0.001) even though baseline group already received conventional treatment. 51.4% of the post-treatment group achieved a HbA1c valued of less than 7.5% compared to 28.4% of the pre-treatment group. CONCLUSION: The new standardized therapeutic model strongly suggests its valuable clinical application in Korean type 2 diabetic patients.

A case of primary amenorrhea due to 17alpha- hydroxylase deficiency / 대한내과학회지

The enzyme, 17 -hydroxylase, is necessary for both cortisol and estrogen synthesis. Deficiency of the hormone results in increased adrenocorticotrophic hormone (ACTH), follicle-stimulating hormone (FSH). Synthesis of progesterone, 11-deoxycorticosterone (DOC), corticosterone and aldosterone don't require the enzyme. The lack of estrogen results in primary amenorrhea and absent sexual maturation. The replacement of dexamethasone and estrogens has lowered the blood pressure and produced feminization. A 19-year-old female had 46,XX genotype and presented amonorrhea, absence of sexual characteristics, hypertension and hypokalemia. Endocrinologic studies demonstrated increased plasma progesterone, ACTH levels and low production of 17 -hydroxyprogesterone and testosterone. We report a rare case of 17 -hydroxylase deficency with a brief history and review of the literature.

Drug Treatment of Obesity / 대한내과학회지

No abstract available.

A Case of Papillary Thyroid Carcinoma Combined with Multiple Endocrine Neoplasia Type 2A / 대한내분비학회지

Multiple endocrine neoplasia (MEN) type 2A is a syndrome of medullary thyroid carcinomas, pheochromocytomas and parathyroid hyperplasia. The simultaneous occurrence of medullary, and papillary, thyroid carcinomas is rare because they are derived from, apparently, different germ layers, the former from the neuroectoderm and the latter from the endoderm. We report a case of a papillary thyroid carcinoma, combined with a medullary thyroid carcinoma, in a patient with MEN type 2A. Molecular genetic studies for screening a RET proto-oncogene mutation revealed a point mutation in codon 631 on chromosome 10, which is reported as highly uncommon in MEN type 2A.

A Case of Panhypopituitarism Due to Craniopharyngioma with Slipped Capitalis Femoral Epiphysis / 대한내분비학회지

Craniopharyngioma accounts for 3% to 5% of intracranial tumors and is the second most common neoplasm in the sellar region. Panhypopituitarism associated with craniopharyngioma has been reported in 7% of all patients with craniopharyngioma. Slipped capital femoral epiphysis is the condition in which the femoral head slips downward and backward on the femoral neck at the epiphyseal plate due to growth disturbance of capital physis, the actual cause of which is unknown. It is a disease of adolescence, during which many physiologic hormonal changes occur. The clinical association between slipped capital femoral epiphysis and endocrine disease is well known. There have been four cases of slipped capital femoral epiphysis associated with endocrine disorders in Korea. This is the first Korean case report of slipped capital femoral epiphysis combined with craniopharyngioma caused by hypopituitarism

Effects of Tibolone and Active Vitamin D Combined Treatment on Bone Mineral Density in Korean Postmenopausal Women / 대한내분비학회지

BACKGROUND: Tibolone is a novel synthetic compound with tissue-specific effects in bone, breast tissue and the endometrium. Tibolone, and active vitamin D, effectively prevent bone loss, and the maintain skeletal integrity of postmenopausal women. The aim of the present study was to examine the effect of tibolone, and active vitamin D (1-hydroxyvitamin D3), therapies given alone, or in combination, against bone loss in postmenopausal women. METHODS: One hundred and three postmenopausal women were treated with tibolone (n=40), alphacalcidol (n=27) or both drugs (n=36) for 12 months. All subjects took supplemental calcium carbonate (500 mg daily). The bone mineral densities (BMD) of the lumbar spine and proximal femur were measured by dual-energy x-ray absorptiometry (DXA) at the baseline and after 12 months. RESULTS: Tibolone therapy produced significant increase of 4.1 and 1.8% in the BMD at the lumbar spine (p<0.001) and femoral neck (p=0.009), respectively. The combination of tibolone and active vitamin D increased the BMD by 8.0 and 4.4% (p<0.001) at the spine and femoral neck, respectively. The differences in the change of BMD from the baseline at the lumbar spine was significant (p=0.038) in the combination treatment group compared that in the tibolone alone group. CONCLUSION: Tibolone alone, and in combination with active vitamin D, effectively increased the BMD at all skeletal sites in postmenopausal women. Combination treatment for osteoporosis is emerging as a promising modality in Korean postmenopausal women.

Association of serum high sensitivity C-reactive protein with risk factors of cardiovascular diseases in type 2 diabetic and nondiabetic subjects without cardiovascular diseases / 대한내과학회지

BACKGROUND: High sensitivity C-reactive protein (hsCRP) is more sensitive than standard CRP assay for evaluation of risk of coronary heart diseases and other atherosclerotic events. But, there were no data of association of serum hsCRP with risk factors of cardiovascular diseases and nonalcoholic fatty liver in Korean type 2 diabetic and nondiabetic subjects. METHODS : A hundred type 2 diabetic subjects (51 men and 49 women) from Severance Hospital and 200 nondiabetic subjects participating medical checkup in Health Promotion Center (105 men and 95 women) were recruited and subjects with acute illnesses and chronic inflammatory diseases such as upper respiratory infection, rheumatoid arthritis, osteoarthritis, or viral hepatitis were excluded. A standardized interview was conducted by trained personnel; detailed information was collected on medical history, dietary habits and lifestyle characteristics, including smoking, alcohol and physical activity. Body mass index (BMI) was computed and biochemical study were undergone using fasting blood. All subjects were done abdominal ultrasonography for evaluation of fatty liver. Serum hsCRP concentration was measured by Nephelometer AnalyzerII (Behring Co.) and a lower detection limit of test was 0.18 mg/L. RESULTS : There was no difference in sex, BMI, presence of fatty liver, concentration of total cholesterol, triglyceride, high density lipoprotein-cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) and uric acid between diabetic and nondiabetic subjects. Age, total colesterol/HDL-C ratio, fasting blood glucose and incidence of hypertension were higher in diabetic than nondiabetic subjects, but a rate of smoking was higher in nondiabetic than diabetic subjects. The mean concentration of serum hsCRP was remarkably increased in type 2 diabetic subjects than nondiabetic subjects (1.34 +/- 1.87 vs 0.71 +/- 0.80 mg/L, p<0.05). After adjustment of different variables between both groups, there was significantly difference of the concentration of serum hsCRP (p<0.05). In nondiabetic subjects, by univariate analysis, there was a positive correlation between hsCRP and age (r=0.26, p<0.05), BMI (r=0.34, p<0.05), systolic blood pressure (r=0.21, p<0.05), diastolic blood pressure (r=0.16, p<0.05), triglyceride (r=0.27, p<0.05), total cholesterol/HDL-C ratio (r=0.22, p<0.05), uric acid (r=0.15, p<0.05) and a negative correlation between serum hsCRP and HDL-C (r=-0.16, p<0.05). Interestingly, subjects with fatty liver had shown increased serum hsCRP concentration than subjects without fatty liver (0.99 +/- 0.96 vs 0.58 +/- 0.69 mg/L, p<0.05). But there were no correlation of serum hsCRP with the history of smoking, sex, physical activity, fasting plasma glucose and presence of hypertension. After multiple regression analysis, only BMI and age were associated with serum hsCRP. In diabetic subjects, there were significant correlation of serum hsCRP with HDL-C and fasting plasma glucose, but other risk factors of cardiovascular diseases and fatty liver were not. When we compared serum hsCRP according to numbers of risk factors of cardiovascular diseases in nondiabetic subjects, group without risk factors had 0.41 +/- 0.55 mg/L, group with one risk factor had 0.48 +/- 0.40 mg/L, group with two risk factors had 0.75 +/- 0.88 mg/L, group with three risk factors had 1.08 +/- 0.87 mg/L and group with four risk factors had 1.55 +/- 1.21 mg/L. There was significant difference of serum hsCRP according to numbers of risk factors of cardiovascular diseases (p<0.05). CONCLUSION : Serum hsCRP is correlated with risk factors of cardiovascular diseases and may be useful tool for prediction of accelerated, atherosclerotic process in nondiabetic subjects. Although there is association of serum hsCRP with few risk factors of cardiovascular diseases, serum hsCRP is elevated in diabetic subjects. Therefore it is necessary to evaluate usefulness of serum hsCRP using carefully selected diabetic subjects. In addition, our study had shown that subjects with nonalcoholic fatty liver have increased risk of cardiovascular events.

A Case of Klinefelter's Syndrome with Rathke's Cleft Cyst / 대한내분비학회지

Klinefelter's syndrome is one of the most common forms of primary hypogonadism presenting with gynecomastia, azospermia and increased follicle-stimulating hormone. It is well known that this syndrome has an increased incidence of neoplasia, especially breast cancer and extragonadal germ cell tumors. However, it is rarely associated with an intracranial tumor of maldevelopmental origin, especially in the suprasellar area. We report, for the first time, a case of Klinefelter's syndrome, with a Rathke's cleft cyst is the patient was a 32-year-old male who was known to have an incidentaloma form brain computed tomography, which was clinically diagnosed as a suprasellar tumor. After operating, the suprasellar mass was confirmed as a Rathke's cleft cyst, and his hormonal abnormality, an elevated level of follicle-stimulating hormone, was not normalized. Therefore, we performed chromosomal analysis, and diagnosed Klinefelter's syndrome with the XXY karyotype.

A Case of Metastatic Pulmonary Calcification in Primary Hyperparathyroidism / 대한내분비학회지

Metastatic calcification is the deposition of calcium, in previously normal tissue, as a result of elevated plasma calcium and phosphorus product levels and has been reported in patients with parathyroid adenoma, parathyroid carcinoma, hyperparathyroidism due to chronic renal failure, vitamin D intoxication, and osteolytic bone tumors, such as multiple myelomas. The lungs are the most common site of metastatic calcification. We have experienced metastatic pulmonary calcification in a case of primary hyperparathyroidism. A 55-year old woman was admitted due to general weakness. From the laboratory evaluation, hypercalcemia and excess production of parathyroid hormone (PTH) were noted. technetium-99m-labelled sestamibi scintigraphy indicated an intense uptake in the lower pole area of the left thyroid gland, suggestive of a parathyroid adenoma. A technetium-99m phosphate (99mTc-MDP) bone scan showed increased uptakes in both lungs. A parathyroid lobectomy was performed, and primary hyperparathyroidism, due to a parathyroid adenoma, was finally diagnosed. A follow-up 99mTc-MDP bone scan showed the disappearance of the metastatic pulmonary calcification, with the clinical symptoms and biochemical parameters normalizing after 6 months.