A Case of Pseudohypoparathyroidism with Graves' Disease

Pseudohypoparathyroidism is a rare disease that is characterized by target cell resistance to the effects of parathyroid hormone and this disease is classified into various types depending on the phenotypic and biochemical findings. The patients with pseudohypoparathyroidism present with the clinical and biochemical features of hypoparathyroidism, but they have an increased serum level of parathyroid hormone. We experienced a case of pseudohypoparathyroidism in a 24 years old woman who had Graves' disease at that time. She had hypocalcemia, hyperphosphatemia, an elevated serum parathyroid hormone level and a normal urinary basal cyclic AMP(adenosine monophosphate) level. She also had a normal phenotypic appearance. Therefore, she was classified as suffering with pseudohypoparathyroidism type II. The clinical and laboratory abnormalities were improved by calcium supplementation in addition to vitamin D. To the best of our knowledge, this is the first case of pseudohypoparathyroidism combined with Graves' disease in Korea.

Effects of soybean supplementation on blood glucose, plasma lipid levels, and erythrocyte antioxidant enzyme activity in type 2 diabetes mellitus patients

The purpose of this study was to investigate the effect of soybean on blood glucose and lipid concentrations, and antioxidant enzyme activity in type 2 diabetes mellitus (DM) patients. We divided patients into two groups and fed them, respectively, a basal diet (control group) and a basal diet with 69 g/d of soybean (soybean group) for 4 weeks. Pills with roasted soybean powder were provided to the soybean supplementation group three times a day. Macronutrients intake except dietary fiber was similar between the two groups. No significant differences were observed in dietary intakes or body weight before and after the supplementation. Energy composition ratio of C:F:P was 65:19:16 in the control group, 64:20:16 in the soybean group. The blood parameters of subjects before supplementation, such as fasting blood glucose, postprandial glucose level, total cholesterol, triglyceride, LDL-cholesterol and HbA1C were not different between the two groups. After supplementation, fasting blood glucose (p<0.001), postprandial glucose level (p<0.001) and serum triglyceride level (p<0.05) were significantly reduced in the soybean group in comparison with the control group. The total cholesterol level was not significantly different between the control and the supplemented group after 4 weeks of treatment. TBARS levels of the soybean group were not significantly different from those of the control group. The activities of catalase (p<0.01) and glutathione peroxidase (p<0.05) were significantly higher in the soybean group compared to the control group. The results of this study suggest that soybean supplementation would be helpful to control blood glucose and serum lipid in diabetic patients. Also, soybean showed an antioxidant activity that may contribute to enhance the effect of antioxidant defense. This activity contributes to protection against oxidative damage in type 2 DM patients. Soybean may have potential use in the disease management of patients with DM.

A Case of Sporadic Nonfamilial Hypophosphatemic Osteomalacia / 대한내분비학회지

Acquired hypophosphatemic rickets, or osteomalacia, requires the recognition of the typical clinical and radiological features of osteomalacia in association with hypophosphatemia, which is caused by the decrease in intestinal absorption or impaired renal tubular phosphate reabsorption. The latter form may either be hereditary or acquired. Acquired hypophosphatemic osteomalacia includes oncogenic osteomalacia, neurofibromatosis, fibrous dysplasia, renal tubular acidosis and sporadic nonfamilial hypophosphatemic osteomalacia. A 33-year-old man presented with bone pain, progressive severe muscle weakness and a height loss of more than 10 cm over a 5 year period. The familiy history was negative for bone disease or other renal tubular defects. He was found to have hypophosphatemia, impaired phosphate reabsorption, normocalcemia, normal vitamin D metabolite levels, normal PTH and elevated alkaline phophatase. A bone biopsy showed thickened unmineralized osteoid compared to pelvic bone in control cases. Clinical symptoms, such as bone pain and muscle weakness, were improved after supplementation of oral phosphorus and calcitriol, although the serum phosphorus level did not normalize.

Long-Term Effect of Glucocorticoid on Differentiation of Bone Marrow Stromal Cells / 대한내분비학회지

BACKGROUND: Glucocorticoid-induced osteoporosis is characterized by decreased osteoblastic activity and replacement of bone marrow with adipocytes. Since osteoblast and adipocytes are derived from the same mesenchymal stem cell, one might speculate that there is an interaction between these two cells types. In fact, leptin that is secreted from adipocytes is known to stimulate differentiation of osteoblasts, while it inhibits the differentiation of adipocytes. Furthermore, it has been demonstrated that PPAR is present in osteoblasts and it is increased by leptin in adipocytes. However, the role of PPAR and leptin remains unknown in glucocorticoid-induced osteoporosis. The aims of this study are to investigate the effect of glucocorticoid on bone mineral density and gene expression in osteoblasts and adipocytes, and to study the role of PPAR and leptin in the mechanism of glucocorticoid-induced osteoporosis. METHODS: Methylprednisolone, 1 mg/200 g-weight, was injected into five rats (steroid group) and saline was given to five rats (control group) for eight weeks. The bone mineral density was determined by dual energy X-ray absoptiometry. Gene expression of osteocalcin, alkaline phosphatase, lipoptrotein lipase, and PPAR -2 was assessed by RT-PCR. Serum leptin level was measured using a commercial radioimmunoassay kit. RESULTS: 1) The body weight of the steroid group was significantly lower than that of the control group (451.4+/-12.9 g vs. 247.6+/-19.8 g, p0.05). 2) In the steroid group, the gene expressions of osteocalcin (1.00+/-0.08 vs. 0.23+/-0.16, p0.05) and+/-PAR 2 (0.17+/-0.08 vs. 0.22+/-0.12, p>0.05) tended to be increased compared to that in the contol group. 4) The serum leptin level of the steroid group tended to be lower than that of the control group (0.20+/-0.12 g/L vs. 0.10+/-0.09 g/L, p>0.05). CONCLUSION: These data suggest that long-term administration of a large dose of glucocorticoid suppresses differentiation of osteoblasts and enhances the differentiation of adipocytes, which may be mediated by increased expression of PPAR and decreased synthesis of leptin.