Apixaban versus Warfarin in Patients with Chronic Kidney Disease; A Systematic Review and Meta-analysis

Background@#Patients with chronic kidney disease (CKD) are at a high risk of stroke-related morbidity, mortality, and bleeding. However, the overall risk/benefit of anticoagulant therapy among patients with CKD remains unclear. @*Methods@#The MEDLINE, EMBASE, and CENTRAL databases were comprehensively searched until July 31, 2020, to investigate the safety and efficacy of apixaban in patients with stage 4 or 5 CKD, as compared with warfarin. The primary outcome was an incidence of major bleeding. Secondary outcomes included composite bleeding (major, clinically relevant, and minor bleeding), venous thromboembolism (VTE), stroke, and death. @*Results@#In total, seven studies consisting of 10,816 patients were included. Compared with warfarin, apixaban was associated with a reduced risk of major bleeding (OR 0.49, 95% CI 0.41-0.58). In terms of composite bleeding, apixaban tended to pose a significantly lower risk than warfarin (OR 0.51, 95% CI 0.37-0.71). There was no difference between apixaban and warfarin with respect to the risk of stroke or death (stroke: OR 1.23, 95% CI 0.49-3.12; death: OR 0.73, 95% CI 0.45-1.18). @*Conclusion@#Among patients with stage 4 or 5 CKD, the use of apixaban was associated with a lower risk of bleeding compared to warfarin and was also found to pose no excess risk of thromboembolic events.

Apixaban versus Warfarin in Patients with Chronic Kidney Disease; A Systematic Review and Meta-analysis

Background@#Patients with chronic kidney disease (CKD) are at a high risk of stroke-related morbidity, mortality, and bleeding. However, the overall risk/benefit of anticoagulant therapy among patients with CKD remains unclear. @*Methods@#The MEDLINE, EMBASE, and CENTRAL databases were comprehensively searched until July 31, 2020, to investigate the safety and efficacy of apixaban in patients with stage 4 or 5 CKD, as compared with warfarin. The primary outcome was an incidence of major bleeding. Secondary outcomes included composite bleeding (major, clinically relevant, and minor bleeding), venous thromboembolism (VTE), stroke, and death. @*Results@#In total, seven studies consisting of 10,816 patients were included. Compared with warfarin, apixaban was associated with a reduced risk of major bleeding (OR 0.49, 95% CI 0.41-0.58). In terms of composite bleeding, apixaban tended to pose a significantly lower risk than warfarin (OR 0.51, 95% CI 0.37-0.71). There was no difference between apixaban and warfarin with respect to the risk of stroke or death (stroke: OR 1.23, 95% CI 0.49-3.12; death: OR 0.73, 95% CI 0.45-1.18). @*Conclusion@#Among patients with stage 4 or 5 CKD, the use of apixaban was associated with a lower risk of bleeding compared to warfarin and was also found to pose no excess risk of thromboembolic events.

Association of Abdominal Obesity with Atherosclerosis in Type 2 Diabetes Mellitus (T2DM) in Korea

The aim of this study was to investigate the relationship between obesity, insulin resistance and atherosclerosis in type 2 diabetes mellitus (T2DM) patients. Total 530 patients with T2DM were included. To evaluate the severity of atherosclerosis, we measured the coronary artery calcification (CAC) score, intima-media thickness (IMT) of the common carotid artery, and the ankle-brachial pressure index (ABPI). Subjects were classified according to body mass index (BMI), a marker of general obesity, and waist-to-hip ratio (WHR), a marker of regional obesity. The insulin sensitivity index (ISI) was measured by the short insulin tolerance test. All subjects were classified into four groups, according to BMI: the under-weight group, the normal-weight (NW) group, the over-weight (OW) group, and the obese (OB) group. WHR and systolic blood pressure, triglycerides (TG), HDL-cholesterol (HDLC), free fatty acids (FFA), fibrinogen, and fasting c-peptide levels were significantly different between BMI groups. TG, HDL-C, FFA, fibrinogen and ISI were significantly different between patients with and without abdominal obesity. In the OW group as well as in the NW group, carotid IMT, ABPI and CAC score were significantly different between patients with and without abdominal obesity. This study indicates that abdominal obesity was associated with atherosclerosis in T2DM patients.

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 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 Primary Amenorrhea due to 17 -Hydroxylase Deficiency / 대한내분비학회지

17 -Hydroxylase deficiency is a rare form of congenital adrenal hyperplasia that is characterized by primary amenorrhea, absence of secondary sex characteristics, hypertension, and a hypokalemic alkalosis that has resulted resulting from increased production of deoxycorticosterone and corticosterone by the adrenal. The diagnosis of this enzyme deficiency can be recognized by the increasing serum concentrations of steroid precursors, DOC and corticosterone and the decreasing concentrations of cortisol, and adrenal androgens. We diagnosed this in a 19 year old female who presented with primary amenorrhea. We report this case with a review of the literatures.

Mutations in Thyroid Hormone Receptor-beta Associated with Patients with Generalized Resistance and Pituitary Resistance to Thyroid Hormone / 대한내분비학회지

We report a point mutation in the TRbeta gene in korean patients with generalized resistance and pituitary resistance to thyroid hormone. One mutation at TRbeta (P453S) were detected in patient with pituitary resistance to thyroid, which showed different phenotype, generalized resistance to thyroid hormone, in her mothers. But, the other (C31Y), did not show clear relations with the disease. Therefore, further study of molecular and cellular basis will be warranted to explain the clear mechanism of the resistance to thyroid hormone.

Two Cases of Malignant Lymphoma Involving Bilateral Adrenal Glands as Huge Masses / 대한내분비학회지

Adrenal gland is a common site of metastatic tumors such as breast cancer, lung cancer, and colon cancer. When adrenal mass is found incidentally, adenoma is the most common among single adrenal masses. But in the case of bilateral adrenal masses, infection, bilateral metastases and hemorrhage are common. Secondary involvement of the adrenal gland is found in 25% of autopsy cases of non-Hodgkin's lymphoma. However, adrenal insufficiency is rare because it becomes apparent only when approximately 90% of adrenal cortex is destructed. We exprienced two cases of malignant lymphoma which involved the adrenal glands bilaterally. One case in which adrenal insufficiency was suspicious, was accompanied by hypovolemic shock and sepsis at the initial presentation. He died of sepsis combined with DIC even though hydrocortisone, intravenous saline infusion, and antibiotics therapy were started immediately. The other one was found incidentally, in which adrenal infiltraion was confirmed by CT scan. Hormonal level was normal and adrenal masses disappeared after chemotherapy.

A Case of Adult Fanconi's Syndrome with Glomerular Podocyte Foot Process Effacement and osteomalacia Induced by k Light Chain Disease / 대한내분비학회지

The Fanconi's syndrome is characterized by generalized disturbance of proximal tubular function. It leads to excessive losses of amino acids, glucose, phosphate, bicarbonate, and other substrates handled by the proximal tubules. The metabolic consequences are acidosis, hypophosphatemia, hypocalcemia, osteomalacia, osteoporosis, and growth retardation. Adult Fanconi's syndrome is mostly secondary form caused by multiple myeloma, primary amyloidosis, light chain nephropathy, and heavy metal poisoning. We experienced 50-year-old woman with kappa light chain disease whose chief complaints were weakness of both lower extremities and multiple bone pain. This patient had renal glycosuria, hypercalciuria, normal anion gap type metabolic acidosis, osteomalacia and normal distal tubule acidification. Her bone marrow biopsy showed inappropriate proliferation of plasma cell. The patient underwent percutaneous renal biopsy in which was exceptionally observed focal effacement of podocyte foot process. So we report a case of osteomalacia caused by adult Fanconi's syndrome and foot process effacement by kappa -light chain disease.

SR (Slow-Replase) Lanreotide Treatment in Acromegalic Patients / 대한내분비학회지

BACKGROUND: Several clinical studies reported the efficacy of the long-acting SRIH analog, octreotide (Octreotide, Sandoz) in the treattnent of acromegaly. Recently, another SRIH analog (BIM 23014, Ipsen Biotech) was shown to decrease plasma GH levels in acromegalic patients. The recent availability of a long-acting formulation of BIM 23014 [slow release (SR) lanreotide] could avoid repeated sc injections or continuous sc infusions. The objective of this study was to determine the tolerability and effectiveness of the slow release (SR) somatostatin analog, SR lanreotide in active acromegaly. METHOD: Between March 1998 and May 1998, 10 patients were recruited in the prospective study carried out at Yonsei University. The effects of 6 weeks of SR lanreotide, given every 14 days at a dosage of 30 mg, im, were analyzed. All the patients completed the 6-week period of therapy. RESULTS: SR lanreotide injection produced 45% suppression of area under the curve of GH levels from the basal value on oral glucose tolerance test(OGTT). GH values on OGTT were normalized (< 2ng/mL) in 30% of patients after 6 weeks, whereas insulin-like growth factor I (IGF-I) levels were normalized in 50% of patients. No correlation was found between pretreatment GH levels and GH response to SR lanreotide or between changes in GH and IGF-I during therapy, The significant differences in response to SR lanreotide were shown between the patients with residual mass and no visible mass. During treatment, there was the significant reduction in the percentage of patients complaining of joint pain, hyperhydrosis, and paresthesias. Changes in soft tissue swelling were documented by a significant decrease in the diameter of fingers. Mild diarrhea and fatigue were the most frequent side-effects (20 30%) when SR lanreotide therapy was started. However, these side effects decreased progressively. Significant changes were noted in carbohydrate tolerance. CONCLUSIONS: These data indicate that SR lanreotide at a dose of 30 mg, im, every 14 days is an effective treatment in most unselected acromegalic patients, especially in patients with no visible mass. Tolerability to SR lanreotide therapy is high. The use of a new sustained release formulation of somatostatin analog is clearly advantageous in improving patient compliance with medical treatment for acromegaly.

Anabolic Effects of Recombinant Human Parathyroid Hormone (1-84) on Bone Histomorphometry in Overiectomized Rats / 대한내분비학회지

To evaluate the anabolic effects of human recombinant parathyroid hormone [hrPTH(1-84)], we examined effect of low-dose and high-dose of [hrPTH(1-84)] and estradiol on bone histomorphometry in ovariectomized rats. Sixty Sprague-Dawley female rats aged 8~10 weeks were used. Eight weeks after ovariectomy, or sham operation, rats were given daily sc injection of hrPTH (1-84), 30 pg/kg (OVX+L group), 150 pg/kg (OVX+H group), 17-estradiol (30 pg/kg, OVX+E group) or vehicle (OVX+V group) for 4 weeks. After double tetracycline labeling, all rats were killed at day 84. We completed the histomorphometric analysis of distal femoral metaphyseal cancellous bone for trabecular bone volume (TBV), mean trabecular plate thickness (MTPT), mean trabecular plate density (MTPD), mean trabecular plate separation (MTPS), mean osteoid seam width (OSW) and appositional rate (AR). The histomorphometric parameters (TBV, MTPT, OSW and AR) of trabecular bone mass in (OVX+E) group were higher than those in (OVX+V) group. The TBV of trabecular bone in PTH treated groups were higher than that in sham operated, (OVX+V) and (OVX+E) group. The histomorphometric parameters (TBV, MTPD, OSW and AR) of trabecular bone mass in (OVX+H) group showed a tendency to be higher than those in (OVX+L) group, but statistically not significant. In conclusion, Low dose (30 mg/kg) hrPTH (1-84) also shows a sufficient anabolic effect on trabecular bone.

Clinical characteristics and causes of primary male osteoporosis in Korea / 대한내과학회지

Osteoporosis in men has recently been recognized as an important public health problem. In women, pathophysiology, risk factors, etiology and treatment of osteoporosis have become well defined. However, less information has been availabe concerning men until now. Male osteoporosis has been known to be associated with drugs and diseases that threaten bone health. However, the causes of male osteoporosis are not apparent in some instances. This study was designed to evaluate the clinical characteristics and causes of primary osteoporosis in Korean men. METHODS: The BMD was measured with DEXA in 327 healthy adult Korean men who were employed by the same company in Seoul. Among them, we studied 20 patients who visited the department of internal medicine at Yonsei University Medical Center for evaluation of osteoporosis. Osteoporosis was defined by WHO criteria for women. We performed history taking, physical examination, nutritional assessment and laboratory examination. RESULTS: The mean age of patients was 52 years. None of them have taken corticosteroid or any other medicine. None of them had suffered from any other medical illness. The mean BMI was 22.1 kg/m2 and the values of 7 patients were less than the age-matched normal value of healthy Korean men. Six patients were current smokers and there were no heavy drinkers. Urinary calcium excretion was elevated in 5 patients and dietary calcium intake was less than 400mg/day in 4 patients. Vitamin D deficiency, as evidenced by serum 25(OH) D levels below 12 ng/mL, was detected in 2 patients, however, subclinical hypovitaminosis D (below 20 ng/mL) was observed in 8 patients. Serum free testosterone levels below normal value were observed in 5 patients. The mean serum IGF-I level was 183.7 ng/mL and that was lower than for normal Korean men. Lower IGF-I levels than age-matched normal values were observed in 5 patients. CONCLUSION: The clinical characteristics of Korean male osteroporosis were heterogenous in many aspects of its features. Several factors could be suggested as possible causes of idiopathic male osteoporosis. Men with osteoporosis in this study revealed low BMI(7 patients), family history of osteoporosis(1 patient), low calcium intake(4 patients), hypercalciuria(5 patients), Vitamin D deficiency(2 patients), subclinical hypovitaminosis D(8 patients), testosterone deficiency (5 patients) and low IGF-I level(5 patients). Multiple causes of osteoporosis were found in 6 patients.

Two Cases of Extensive Pituitary Calcification / 대한내분비학회지

Although calcification of such endocrine gland as adrenal or pineal gland is common, extensive calcification of the pituitary gland is unusual. Calcification is a well recognized but uncommon feature of prolactin-secreting, growth hormone-secreting and non-functioning pituitary tumours. The calcification varies in extent, but rarely exceeds a tiny amount histologically or radiologically. Recently, we had the opportunity to investigate two patients with radiologically demonstrated "pituitary stone" (severely calcified pituitary adenoma). The first Patient, a 51 year-old female, initially presented with general weakness, dizziness, visual disturbance, and loss of hair for 2 months. She was suspected to have a pituitary lesion. Decreased secretion of GH, TSH, LH, and FSH was demonstrated by dynamic tests. On CT scan, she was found to have multilobulated calcified sella mass. She was successfully managed by medical treatment. The second patient, a 65 year-old male, presented with general weakness, nausea, vomiting and polyuria for 2 months. Combined pituitary stimulation test showed subnormal response of GH and prolactine. Radiologic studies revealed pituitary stone which was managed with medical treatment of hormone replacement. We suggest that calcific changes in the pituitary adenoma might be common and occur to the extent of pituitary stone formation with the possible alteration of hormonal secretion.

A Case of Osteosarcoma induced Oncogenic Osteomalacia Detected by MRI / 대한내분비학회지

Oncogenic osteomalacia is a syndrome characterized by phosphaturia, hypophosphatemia, decreased 1,25-dihydroxyvitamin D level and specific signs and symptoms of osteomalacia. It is associated with the presence of neoplasm originated from mesenchyme. Until now, less than 100 cases of oncogenic osteomalacia have been reported. The pathophysiology of oncogenic osteomalacia has not been fully understood, but it has been suggested that a certain substance released by tumor may inhibit not only la-hydroxylase activity and reduce 1,25-dihydroxyvitamin D level in part, but directly inhibit reabsorption of phosphate. And then, reduced phosphaturia, hypophosphatemia and eventually osteomalacia develop. We report a case of osteosarcoma induced oncogenic osteomalacia detected by MRI in 59 year old woman.

Seroepidemiologic Study of Brucellosis in Cheju Island / 감염

BACKGROUND: Brucellosis is a zoonosis caused by the gram-negative coccobacilli Brucella. Humans are infected by ingestion of unpasteurized milk or dairy products from or by direct contact with infected animals. Although human brucellosis is known to be rare, there has been an increase in bovine brucellosis in Cheju island since the 1980s. The purpose of this study was to investigate the prevalence of anti- Brucella antibody in people from endemic areas. METHODS: Sera obtained from 2,372 residents in Cheju island were screened for anti-Brucella antibody by slide agglutination test and confirmed by duplicated tube agglutination test. Sera with titers equal to or above 1:80 were considered positive. RESULTS: Fourteen of 2,372 sera were positive (0.59%). Positive rate was 0.34% in males and 0.82% in females. There was no significant difference in the positive rates between males and females. Seropositive rate was slightly higher in persons at 40 years or older. Seropositive rates in different areas of Cheju island were as follows : South Cheju-gun 0.97%, North Cheju-gun 0.64%, Cheju city 0.46%, and Sogwipo city 0.0%. The antibody titers of positive sera were determined: 7 sera were positive at 1:80, 4 at 1:160, and 3 were positive at 1:320. Occupations of seropositive persons were as follows : 7 farmers; 3 stockbreeders; 1 engaged in service trade; 1 engaged in food processing; 1 working at a stable; one unknown. Seropositive rates among people at a relatively high risk were 0.94%. Seropositive rate of people who were proven to be not at risk for Brucella infection was 0.51%. There was no significant difference in the seropositive rates between the two groups(P>0.05). CONCLUSION: These findings confirmed the occurrence of human Brucella infection in Cheju island and suggest the need for surveillance in other parts of the country as well.

Glucokinase gene mutation in non-insulin-dependent diabetes mellitus (NIDDM), and secondary diabetes in Koreans / 대한내과학회지

OBJECTIVES: Mutations in the glucokinase (GCK) gene are considered a possible cause of maturity-onset diabetes of the young. The purpose of this study was to evaluate the contribution of this gene to the development of non insulin dependent diabetes mellitus (NIDDM), gestational diabetes mellitus (GDM) and post-renal transplantation diabetes mellitus (PTDM). METHOD: Identification of GCK mutation was attempted on 39 NIDDM patients, 2 GDM patients and 58 selected renal allograft recipients with PTDM and 45 normal controls. The exons in the GCK gene were examined by polymerase chain reaction (PCR), followed by analysis of single-stranded DNA conformational polymorphism (SSCP). The abnormal bands were also confirmed by DNA sequenc- ing analysis. The exons of affected family members were also investigated for mutations of the GCK gene. RESULTS: Two of the 58 PTDM patients (3.4%) were found to have GCK mutations. One had the mutation on exon 5 and the other on intron 7. One control subject had the mutation on intron 9. The mutation of exon 5 was identified as a substitution of CCT(proline) for CTT (leucine) at codon 164, which has not ever reported before. The family members of the PTDM patient with mutation of exon 5 were analyzed by PCR followed by SSCP, and two of them revealed the same mutation. The abnormal band on the SSCP analysis of exon 7 was identified as the insertion of base C/T at the 39th nucleotide in intron 7. Two family members of this patients also had same band on SSCP. The one mutation of 45 normal controls was CT located at the 8th nucleotide in intron 9, which was a common polymorphism. CONCLUSON: We found GCK mutations in subjects with PTDM and we speculate that these mutations may be one of the contributing cause of PTDM.

Aldosterone-Producing Adenoma Diagnosed by Selective Adrenal Venous Catheterization / 대한내분비학회지

Primary aldosteronism, not a common cause of high blood pressure, is a syndrome which results from excessively secreted aldosterone from adrenal gland and it accounts for 0.05-2.2% of unselected hypertension. In this case the lesion was not visualized on routine abdominal computed tomographic scan due to its small size. Therefore the selective adrenal venous catherterization & venous sampling was done. As there is some difficulty of sampling from Rt. adrenal vein, the method of measuring aldosterone vs. cortisol ratio of Lt. adrenal vein and inferior vena cava was used to localize the aldosterone-producing adenoma. Clinical symptoms normalized and laboratory data returned to normal range after the surgical adrenalectomy.

A Case of Central Diabetes Insipidus Caused by Metastatin Malignant Lymphoma / 대한내분비학회지

The causes of central diabetes insipidus (CDI) are numerous; some primary cases are idiopathic while most secondary cases are surgically induced or the result of tumor. The frequency of metastatic tumor as a cause of DI is 6% to 20% of cases, Variety of malignancies including breast, lung, colon, prostate cancer, and leukemia/lymphoma have been reported to metastasize to the pituitary, although most patients are asymptomatic. Clinical manifestations of pituitary metastases include anterior pituitary failure, visual disturbance, and extraocular muscle weakness. DI is the most common clinical manifestation of hypothalamic-pituitary axis (HPA) metastases. Anatomical basis far this clinical picture is that most metastases occur in the posterior lobe. We report on a 35-year-old male patient with meningeal involvement of malignant lymphoma that was thought to be associated with DI. Confirmation of primary malignancy was made by biopsy at site of cervical lymph node and tonsil, Pituitary involvement was suspected on brain MRI, and satisfactory symptornatic relief was obtained with vasopressin. Because of the progres-sion of underlying lymphorna that has shown no response to combined anticancer chemotherapy, the patient expired on 60th hospital day.

A Case of Turner's Syndrome with Hypothyroidism and Pericardial Effusion / 대한내분비학회지

Clinical manifestations of hypothyroidism are very various and these degree are related to the severity and duration of the disease. Pericardial effusions, one of the manifestations of hypothy-roidism, were relatively common in the past. However, recently they may not be so frequent representative of hypothyroid subjects. The higher frequency of Hashimotos thyroiditis in Turners syndrome, especially those with an X-isochromosome, compared with the general population is well known. The pathophysiological process of autoimmunity is thought to be linked with the presence of an abnormal X-chromosome. Recently we experienced a case of X-isochromosome Turners syndrome with hypothyroidism and pericardial effusion and report it with reviews of the literatures.