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Jun Goo Kang1*, Sin Gon Kim2*, You-Cheol Hwang3, Jeong Taek Woo3, Hong-Woo Nam4, Committee of Education, Korean Diabetes Association 1Division of Endocrinology & Metabolism, Department of Internal Medicine, Hallym University College of Medicine, Anyang 2Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, 3Division of Endocrinology & Metabolism, Department of Internal Medicine, Kyung Hee University School of Medicine, 4Division of Endocrinology & Metabolism, Department of Internal Medicine, National Medical Center, Seoul, Korea

The aim of the study was to assess the association between usual dietary nutrient intake and obesity in Korean type 2 diabetic patients. We examined 2,832 type 2 diabetic patients from the Korean National Diabetes Program cohort who completed dietary assessment and clinical evaluation in this cross-sectional study. In men, higher dietary fiber intake was associated with a lower odds of being obese (P(trend) = 0.003) and in women, higher protein intake was associated with a lower odds of being obese (P(trend) = 0.03) after adjustment for age, diabetes duration, HbA1c, alcohol drinking, income, education level, and calorie intake. In men, higher fiber intake was associated with lower odds of obesity after further adjustment for diastolic blood pressure, physical activity, and possible confounding nutritional intake and medication. The multivariable adjusted odds ratio for the highest quintile of fiber intake was 0.37 (P(trend)0.001). In women, protein intake was not associated with obesity after further adjustment. In conclusion, higher intake of dietary fiber is associated with lower odds of being obese in type 2 diabetic men, suggesting a role for dietary fiber in the management and prevention of obesity in type 2 diabetes (ClinicalTrials.gov: NCT 01212198).

Several lines of evidence suggest a strong genetic component to NIDDM. To clarify the role of glucokinase gene in the development of NIDDM, restriction fragment length polymorphism (RFLP) of glucokinase gene and 3' microsatellite polymorphism analyses by polymerase chain reaction-single strand conformational polymorphism (PCR-SSCP) were performed in NIDDM and control subjects. Compared to NIDDM with 1.3 kb allele/Pvu I digestion of glucokinase, 10% of NIDDM did not demonstrate 1.3 kb allele and these patients were characterized by increased insulin secretion. In 3' microsatellite polymorphism analysis, autoradiography of PCR products revealed three different alleles, including Z, Z + 2 and Z + 4. Z was the most common allele in both NIDDM and nondiabetic controls. There was no significant allele associated with NIDDM. Frequency of the homozygote Z/Z genotype was significantly lower in NIDDM subjects (16.7%) compared to normal control (46.7%)(p < 0.05). There was no difference in clinical findings according to 3' microsatellite genotypes in NIDDM. These data suggest that there does not appear to be a significant glucokinase allele associated with NIDDM but Z/Z genotype may play a suppressive role in the pathogenesis of a certain type of NIDDM in Korea. Further studies may be required to identify the molecular basis of this association.

Received: 8 July 2010, Accepted: 2 September 2010 Corresponding author: Sang Youl Rhee Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, 1 Hoegi-dong, Dongdaemun-gu, Seoul 130-702, Korea Tel: +82-2-958-8200, Fax: +82-2-968-1848, E-mail: bard95@hanmail.net A Case of Type Ia Glycogen Storage Disease Diagnosed in the Military Hospital Tae Woong Lee, Sang Youl Rhee, Joo Young Kim, Gu-Hwan Kim, Han-Wook Yoo, Jeong-Taek Woo, Byung Ho Kim Department of Internal Medicine, Incheon Christian Hospital, Incheon; Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul; Research Institute of Endocrinology, Kyung Hee University, Seoul; Department of Internal Medicine, Dongsuwon Hospital, Suwon; Medical Genetics Clinic and Laboratory, Asan Medical Center, Seoul; Department of Pediatrics, University of Ulsan College of Medicine, Seoul; Department of Gastroenterology and Hepatology, Kyung Hee University School of Medicine, Seoul, Korea

Background Although many anti-diabetic drugs have been used to control hyperglycemia for decades, the efficacy of commonly-used oral glucose-lowering agents in Korean type 2 diabetic patients has yet to be clearly demonstrated. Methods We evaluated the efficacy of glimepiride, metformin, and rosiglitazone as initial treatment for drug-naïve type 2 diabetes mellitus patients in a 48-week, double-blind, randomized controlled study that included 349 Korean patients. Our primary goal was to determine the change in HbA1c levels from baseline to end point. Our secondary goal was to evaluate changes in fasting plasma glucose (FPG) levels, body weight, frequency of adverse events, and the proportion of participants achieving target HbA1c levels. Results HbA1c levels decreased from 7.8% to 6.9% in the glimepiride group (P

The aim of this study was to investigate whether a water extract of L. cladonioides (LC) has an anti-obesity effect in 3T3-L1 cells and obese mice. Treatment of differentiated 3T3-L1 adipocytes with LC caused a significant increase in glycerol release and reduced the protein expression of the adipogenic transcription factors, PPARγ and C/EBPα. In an animal model, obese mice were artificially induced by a high fat diet for 10 weeks. Experimental groups were treated with LC (100 mg/kg/day) by gavage for the next 10 weeks. At the end of experiment, the body weight of the LC group mice was reduced by 14.2% compared to the high fat diet (HFD) group. The treatment also decreased liver (31.0%), epididymal (18.0%) and retroperitoneal (19.3%) adipose tissue, and kidney (6.7%) weights, respectively, compared with those of the HFD group. LC prevented diet-induced increases in the serum level of TC (22.6%), TG (11.6%), and glucose (35.0%), respectively, compared with the HFD group. However, the HDL-C level was higher in the LC group (26.1%) than the HFD group. The results of this study thus suggest that LC suppressed lipid accumulation and expression of adipogenic transcription factors, and increased the amount of glycerol release. LC also indicated an anti-obese and anti-hyperlipidemic effect.

Received: 10 June 2010, Accepted: 6 January 2011 Corresponding author: In-Kyung Jeong Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, 1 Hoegi-dong, Dongdaemun-gu, Seoul 130-702, Korea Tel: +82-2-440-6126, Fax: +82-2-440-6295, E-mail: jik1016@khu.ac.kr A Case of Primary Adrenal Insufficiency in a Patient with Acquired Immunodeficiency Syndrome Jae Ho Choi, Suk Chon, Yu Chul Hwang, Jun Seong Son, Seung Joon Oh, Kyu Jeung Ahn, Ho Yeon Chung, Jeong Taek Woo, Sung Woon Kim, Jin Woo Kim, Young Seol Kim, In-Kyung Jeong Department of Endocrinology and Metabolism, Infection, College of Medicine, Kyung Hee University, Seoul, Korea

Apolipoprotein E (apo E) plays a role in the regulation of the lipid metabolism of humans. Apo E, 229 amino acid polypeptide, is classified into three major isoform (E2, E3, E4) according to the differences of amino acid in position 112 and 158. In the normal population apo E3 isoform is most prevalent and apo E2 or E4 is frequently associated with hyperlipoproteinemia. To find out the frequency of apo E isoform distribution in the Korean population, apo E genotyping was performed. After amplification of apoE gene by polymerase chain reaction (PCR), restriction isotyping was done by cleavage with restriction enzyme Hha I and polyacrylamide gel electrophoresis. The apo E allele frequency in 73 normal subjects was 4.8% for E2, 84.9% for E3 and 10.3% for E4. In diabetic patient with hyperlipoproteinemia, the frequency of apo E allele was 6.3% for E2, 81.0% for E3 and 12.7% for E4. There was no significant difference in apo E isoform distribution between diabetics and normal populations. But in patients with cardiovascular disease with hyperlipidemia, the apo E4 allele frequency was significantly higher than normal (20.0% vs 10.3%, p < 0.005). Apo E3 was the most common isoform in normal and diabetic subjects and apo E2 isoform was rather low frequency compared to Caucasians. This pattern is similar to the Japanese population but somewhat different from other populations. From the data of a high association of apo E4 allele and cardiovascular disease with hypercholesterolemia, apo E isoform may be one of the determinants of hyperlipoproteinemia. The PCR method may be useful in apo E genotyping.

Background/Aims: This study was conducted to examine the relationship between family history of type 2 diabetes (T2DM) and risk of developing gestational diabetes mellitus (GDM) in Korean women. Methods: We performed a 100-g oral glucose tolerance test in 858 pregnant women who had abnormal glucose tolerance in 50-g oral glucose challenge. In addition, we reviewed the incidence of T2DM in the parents and siblings and analyzed the association between the familial history of T2DM and the risk of GDM. Results: Of the 858 subjects, 427 were normal, and 431 were diagnosed with GDM. Compared with women with no family history of T2DM, women with first degree family history of T2DM displayed higher risk of T2DM (odd ratio: parent only 1.91, sibling only 6.24, any 2.27). Conclusions: The risk of developing GDM was significantly increased in Korean women with a family history of T2DM in first-degree relatives. (Korean J Intern Med 2010;25:269-272)

SUMMARY We suspected the presence of pheochromocytoma and were able to confirm our diagnosis in a patient presenting with symp-toms of fatal cardiogenic shock due to catecholamine-induced car-diomyopathy. Furthermore, we evaluated the possibility of MEN 2A as the source of the thyroid nodules and diagnosed MTC using various tests and surgery. The patient had a younger sister who un-derwent follow-up observation for benign thyroid nodules, and as a result, the diagnosis of MTC was established during selective test-ing for MEN 2A. Genetic testing for the RET gene demonstrated that the diagnosis of MEN 2A was due to a mutation of C634R on exon 11. Using a selective test for familial genes, mutations of the same genes were confirmed, and a family of MEN 2A individuals was identified. ACKNOWLEDGEMENT The authors appreciate the efforts of Young Ji Yoon in the prepa-ration of the manuscript. REFERENCES 1. Mulligan LM, Kwok JB, Healey CS, Elsdon MJ, Eng C, Gardner E, LoveDR, Mole SE, Moore JK, Papi L, Ponder MA, Telenius H, Tunnacliffe A, Ponder BJ: Germ-line mutations of the RET proto-oncogene in multiple endocrine neoplasia type 2A. Nature 363:458-460, 1993

BACKGROUND Identification of dietary patterns is important for glycemic management in elderly patients with type 2 diabetes mellitus (T2DM). METHODS Elderly T2DM patients (> 65 years of age, n = 48) were categorized based on their concentration of glycated hemoglobin (HbA(1c)). Subjects with HbA(1c) levels below 7% were placed in the good control (GC) group and those with HbA(1c) levels equal to or above 8% were placed in the poor control (PC) group. Anthropometric data, blood parameters, and dietary intake records were compared between the groups. Statistical analysis included Student's t-test, chi-square test, and Pearson correlation coefficient test. RESULTS Anthropometric data, including body mass index (24.7 ± 2.9 kg/m(2)), did not differ between the GC and PC groups. Significant abnormalities in blood glucose levels (P < 0.01), lean body mass (P < 0.01), and plasma protein and albumin levels (P < 0.05, P < 0.01) were found in the PC group. In contrast to the GC group, the PC group depended on carbohydrate (P = 0.014) rather than protein (P = 0.013) or fat (P = 0.005) as a major source of energy, and had a lower index of nutritional quality for nutrients such as protein (P = 0.001), and all vitamins and minerals (P < 0.001, 0.01, or 0.05 for individual nutrients), except vitamin C, in their usual diet. Negative correlations between HbA(1c) levels and protein (r = -0.338, P < 0.05) or fat (r = -0.385, P < 0.01) intakes were also found. CONCLUSIONS Healthcare professionals should encourage elderly diabetic patients to consume a balanced diet to maintain good glycemic control.

배경: 지방조직은 골수 유래의 중간엽 줄기세포와 같은 다분화 능력을 가진 성체줄기세포를 포함한다. 지방조직으로부터 추출한 지방유래 줄기세포가 다양한 분화 유도를 통해 지방세포, 골세포, 근육세포로 분화할 수 있음이 밝혀졌다. 본 연구에서는 지방조직으로부터 얻은 기질세포에서 지방세포로의 탁월한 분화능력을 가지고 있는 순수한 지방유래 줄기세포를 추출해 낼 수 있는 지 알아보았다. 방법: 수컷 Sprague-Dawley 쥐(n=15)의 4부위 지방조직(피하 지방, 부고환 지방, 장간막 지방, 후복막 지방)에서 불필요한 조직을 제거한 나머지 기질세포만을 얻는다. Nycodenz를 이용하여 기질세포를 밀도차등원심분리하여 4개의 분획을 얻어 각각을 배양시킨다. 포화 상태에 이른 지방줄기세포를 지방세포로 분화를 유도하여 세포 내 지방 축적 여부를 염색을 통해 확인한다. 결과: 밀도차등 원심불리로 지방조직 기질세포는 4개의 분획(Fx-1, Fx-2, Fx-3, Fx-4)으로 나뉘었으며, 4부위 지방조직 모두 세 번째 분획(Fx-3)의 세포 수가 가장 많았다. 그러나 지방세포로의 분화는 4부위 지방조직 모두 두 번째 분획(Fx-2)에서 탁월했으며 분획을 나누지 않은 것(control)과 비교했을 때 더 나은 분화 능력을 보였다. 지방으로 분화가 가장 잘 되는 지방 조직은 retroperitoneal fat tissue였으며 그 다음이 subcutaneous fat tissue였고, epididymal fat tissue는 상대적으로 분화율이 떨어지는 것을 관찰하였다, Mesenteric fat tissue는 분화가 거의 되지 않았다. 결과: 지방조직별, 밀도별로 지방조직 기질세포를 나누어 분리함으로써 지방조직으로의 분화 능력이 우수한 지방줄기세포를 찾을 수 있었다. 향후 지방줄기세포를 이용한 연구 및 활용에 있어서 지방조직별, 분획별 기질세포의 이용으로 일관된 결과를 얻는 데 도움이 될 것이다.

Background/Aims We used flexible starting doses and early titration of atorvastatin to determine the rate of achievement of a low-density lipoprotein cholesterol (LDL-C) target for hyperlipidemic patients with type 2 diabetes mellitus. Methods This study was a multicenter, open-label, prospective trial of atorvastatin therapy in hyperlipidemic patients with type 2 diabetes. The patients were divided into three groups according to initial LDL-C levels (130-149, 150-159 and≥160 mg/dL), and 10, 20, and 40 mg of atorvastatin was administered to each group, respectively. If LDL-C did not reach the 100 mg/dL target level at four weeks after initiation of treatment, the doses were increased by one step. Endothelial function tests and plasminogen activator inhibitor (PAI)-1 levels were measured in 41 patients. Results Groups of 62, 18, and 69 patients were started on 10, 20, and 40 mg of atorvastatin, respectively, and 91% of the patients achieved the LDL-C target after four weeks of treatment. The overall percentage of patients achieving the LDL-C target after eight weeks of treatment was 89.3%: 87.5% in the 10 mg group, 86.4% in the 20 mg group, 93.9% in the 40 mg group, and 66.7% in the 80 mg group. A statistically significant reduction was observed in the mean percentage change in flow-mediated endothelium-dependent dilatation after eight weeks of treatment (p

Currently finger pricking is the common method of blood glucose measurement in patients with diabetes mellitus. However, diabetes patients have proven to be reluctant to check their glucose profiles regularly because of the discomfort associated with this technique. Recently, a non-invasive and continuous Reverse Iontophoresis based Glucose Monitoring Device (RIGMD) was developed in Korea. The study was conducted during the period November 2003-January 2004 on 19 in-patients. Glucose measurements were performed using RIGMD between 10 a.m. and 4 p.m. Concurrent plasma glucose levels were checked hourly and subsequently compared with RIGMD data. The mean error of RIGMD measurements was -3.45 +/- 52.99 mg/dL with a mean absolute relative error of 20+/-15.16%. Measurements obtained by RIGMD were correlated with plasma glucose levels (correlation coefficient; 0.784 (p

Osteogenesis imperfecta (OI) is a genetic disease that is caused by a synthetic anomaly of type I collagen. It is characterized by such features as low bone density, multiple fractures, bone deformities and chronic bone pain. According to the hereditary pattern and degree of phenotypical expression, it also has various extraskeletal manifestations such as blue sclera, hearing deformities and dentinogenesis imperfecta. Recently, an expanded seven subgroup classification of OI has been suggested by means of its clinical severity and mutational characteristics. However, most of the OI cases reported in Korea have been classified as type II or III that can be diagnosed easily and present with severe clinical manifestations. Only rare type I OI cases have been currently reported in Korea. Herein, we report a case of type I OI that was differentially diagnosed as a cause of a spinal compression fracture. (J Kor Endocr Soc 22:446~452, 2007)

Background : The expression of c-FLIP (cellular Fas-associated death domain-like interleukin-1 β-converting enzyme (FLICE)-inhibitory protein), which is a member of the family of inhibitors of apoptosis, has been associated with tumor development and progression. The aim of this study was to evaluate the expression of c-FLIP in gastric cancer and its correlation with tumor cell proliferation, apoptosis and the clinicopathologic features. Methods : Immunohistochemical staining with anti-c-FLIP antibody was performed in 98 tissue samples obtained from gastric cancer patients who underwent surgical treatment. The apoptotic cells were visualized by terminal deoxynucleotidyl transferase (TdT) mediated deoxyuridine triphosphate (dUTP) nick-end labeling (TUNEL), and the proliferative cells were visualized by staining with Ki-67 antibody. Results : The positive expression of c-FLIP in the gastric cancer tissues was demonstrated in 57.1% of the cases. The expression of c-FLIP was increased in the gastric cancer tissues compared with the matched normal gastric mucosa. The expression of c-FLIP was significantly associated with histologic differentiation (p=0.038). However, there was no association between the c-FLIP expression and the other clinicopathological parameters, including patient survival. The Ki-67 labeling index (KI) for the 98 tumors ranged from 7.6 to 85.0 with a mean KI of 50.4±15.7. The mean KI value of the c-FLIP positive tumors was 54.1±15.3 and this was significantly higher than that of the c-FLIP negative tumors (p=0.005). The apoptotic index (AI) for the 98 tumors ranged from 0.0 to 10.0 with a mean AI of 7.4±2.3. There was no significant difference between the c-FLIP expression and the AI (p=0.347). Conclusions : These results suggest that the c-FLIP expression may be associated with tumor cell proliferation of gastric cancer.

Background: Mechanism for glucose toxicity is known to be an increased oxidative stress produced by multiple pathways. In our previous report, 2-deoxy-d-ribose (dRib) promoted apoptosis by increasing oxidative stress in a pancreatic β-cell line. We performed this study to investigate the mechanism of dRib-induced damage of β-cells. Methods: HIT-T15 cells were cultured in RPMI-1640 medium with 40 mM dRib for 24 hours after pretreatment with various concentrations of a metal chelator (DTPA) and inhibitors of protein glycation (aminoguanidine and pyridoxamine). Cell viability was determined by MTT assay. Apoptosis was analyzed by flow cytometry with annexin V/PI double staining.Results: DTPA, which inhibits the monosaccharide autoxidation, partially reversed dRib-induced cytotoxicity in a dose-dependent manner (P

Vitamin D is a kind of hormone that can be synthesized in the skin or it is supplied in the diet it is involved in a central role in bone and calcium homeostasis in vivo. Metabolic bone diseases such as rickets in children and osteomalacia in adults can also be caused by deficiency or metabolic defects in the vitamin D hormone related system. However, there has been a lack of generalized epidemiologic studies about the vitamin D deficiency status in Koreans. We recently experienced a case of osteomalacia caused by severe vitamin D deficiency. These kinds of case have not been reported elsewhere in Korea for the last twenty years. (J Kor Endocrinol Soc 22:55~61, 2007)

Malignant insulinomas are very rare endocrine tumours with a variable clinical course. Here, a case of a malignant insulinoma, resected from the tail of the pancreas 10 years previously, which was found to have hepatic metastasis, is reported. A pancreatic mass, without evidence of metastasis, has been found using an abdominal CT scan and intra-operative ultrasonography 10 years previously. Recently, the patient has suffered from dizziness, sweating and an altered mentality. Hyperinsulinemia was diagnosed from the biochemical laboratory finding. An abdominal CT scan and intra-operative abdominal sonography showed multiple hepatic metastasis, without local recurrence in pancreas. Therefore, a partial hepatic segmentectomy was performed. Immunohistochemical staining of the postoperative specimen was strongly positive for insulin. The postoperative biochemical response was normalized, and the patient experienced no further hypoglycemic symptom (J Kor Soc Endocrinol 21:68~73, 2006).

Background: Self monitoring of blood glucose plays an important role in the management of diabetes. However, traditional finger prick testing causes pain and so compliance with self monitoring of blood glucose is usually poor. Using an alternative site for sampling may reduce the level of pain and be beneficial for improving the compliance of diabetic patients. We evaluated the accuracy and acceptability of blood glucose testing from the forearm by analyzing the performance of the CareSens ® (i-Sens, Inc. Korea) device for

An empty sella is defined as a sella which, regardless of its size, is completely or partly filled with cerebrospinal fluid. The endocrine function of primary empty sella syndrome is usually normal, but sometimes this syndrome is associated with complete or partial pituitary insufficiency and rarely hypersecretion of pituitary hormone. Primary empty sella syndrome combined with Cushing's disease has rarely been reported. A 45-years-old woman presented with cushingoid feature. Her urinary cortisol and 17-hydroxycorticosteroid excretion were increased. The results of endocrine function testing were suggestive of Cushing's disease. Sella MRI showed of partially empty sella and pituitary microadenoma. The pituitary microadenoma was removed by the trans-sphenoidal approach. We report here on this case together with a review of the literature. (J Kor Soc Endocrinol 21:567~571, 2006)

Background: Recently, the number of young diabetic patients is increasing. It is important to understand the characteristics of young diabetes and classify it correctly to manage these patients successfully. We aimed to classify young onset diabetes according to etiology and evaluate the clinical characteristics. Methods: Young patients (1530 years old) who have been treated diabetes in Kyunghee medical center in 2004 were included. We investigated family history of diabetes, disease duration, body mass index (BMI), the history of diabetic ketoacidosis, HbA1c, fasting C-peptide, autoantibody, lipid profile and treatment method via medical records. Result: Total 85 patients (M:F 40:45) were evaluated. Type 1 diabetes was 45.9%, type 2 diabetes was 23.5% and unclassified group was 25.9%. Many type 2 diabetic patients were overweight or obese (94.8%). Most young diabetic patients were using insulin (95.4%). Many type 1 diabetic patients have been treated by insulin only and many type 2 diabetic patients have been received combined therapy of insulin and oral hypoglycemic agent. The recent HbA1c was average 8.32 2.7%. The prevalence of diabetic retinopathy, neuropathy and nephropathy was 32.9%, 22.4% and 16.4% as each. Conclusion: Nearly half of young onset diabetes was type 1 diabetes but many others were also classified to type 2 diabetes or unclassified group. It is important to provide a consistent algorithm for assessment and investigation for newly diagnosed young diabetic patients. More education and effort are required to control diabetes strictly and prevent its complication.

Background: To develop somatic gene therapy model for diabetes mellitus, it is the most important to control it by glucose concentration. In order to develop the myoblasts that produce insulin by glucose concentration, the transfection of genes of human insulin, rat glucokinase and rat GLUT2 was conducted using C2C12, the murine myoblast cell line. Methods: pMLC-hINSmut plasmid vector to which human insulin cDNA was inserted in C2C12 cell line, pCB7/GLUT2 and pCB7/GK to which GLUT2 and glucokinase were inserted. Based on the inserted gene, C2C12/INS-GLUT2, C2C12/INS-GK and C2C12/INS-GK-GLUT2 were prepared. In each cell line, its mRNA and protein expression were measured. Also, the capability of producing insulin in low glucose (2.7 mM) and high glucose (25 mM) were compared. Results: 1. It was observed that C2C12/INS-GLUT2, C2C12/INS-GK, C2C12/INS-GK-GLUT2 cell line expressed mRNA and protein of transfected genes, respectively. 2. As for the insulin production depending on the glucose concentration in C2C12/INS, it slightly increased from 0.049 ± 0.003 μU/10 6 cells/hr to 0.197 ± 0.022 μU/10 6 cells/hr. However, in C2C12/GK-GLUT2-INS, it showed the most evident increase: from 0.251 ± 0.074 μU/10

Background: The angiotensin converting enzyme inhibitor (ACEi) improves the vascular endothelial cell function and has a better clinical outcome by decreasing the LDL cholesterol oxidation, hypercoagulability, oxidative stress and improving the level of endothelial nitric oxide synthesis in patients with type 2 diabetes and hypertension. However, the correlations between the ACEi and the serum markers for the vascular endothelial function in previous studies were not consistent. Subjects and Methods: Between July 2003 and April 2005, 104 type 2 diabetes patients with hypertension, who had been admitted to 9 major university hospitals in Korea, were examined. The subjects were randomly allocated to the cilazapril (2.55 mg/day) and atenolol (50100 mg/day) treatment group and given a combination of hydrochlorothiazide and amlodipine. The lipid profile and the markers for endothelial function, such as vWF, VCAM, E-selectin, tPA, fibrinogen, adiponectin, hsCRP, nitrotyrosine were evaluated and the differences in the variables were compared with those obtained 6 months later. Results: A total 56 subjects completed the 6-months follow up period. Regarding the baseline characteristics, there were no significant differences in the variables observed in the two groups except for HbA1c (P = 0.037), vWF (P = 0.048), and hsCRP (P = 0.038). After 6 months, both groups showed a significant and identical decrease in the systolic and diastolic blood pressure compared with the baseline (P

Acute suppurative thyroiditis is an uncommon disease, which usually affects patients with pre-existing thyroid gland pathology. Here, a case of thyroid abscess associated with lymphocytic thyroiditis, was experienced in a 35-year-old female. She had a fever, chill, sore throat and tenderness in the area of the left thyroid of 10 days duration. She visited our hospital due to her persistent sore throat, which did not subside after antibiotics treatment for 5 days. On neck ultrasonography, a heterogeneous nodule (1.3×1.5×2.1 cm) in the right lobe and cyst-like nodule (1.8×1.5×2.8 cm) in the left lobe of the thyroid were found. The thyroid gland showed slightly increased, uneven uptake of Tc-99m on a thyroid scan. Pus-like fluid aspirated from the left nodule showed numerous neutrophils and necrotic materials on cytological examination. Abundant lymphocytes were found in aspirates from the right thyroid nodule. Neither a finding suggestive of pyriform sinus nor other anomaly was discovered in the neck CT scan and UGI series. After further antibiotic treatments for 2 weeks, the inflammatory symptoms and thyroid tenderness completely subsided. However, the nodule in the right lobe of the thyroid was still palpable, but without tenderness when examined after 4 weeks (J Kor Soc Endocrinol 20:385~389, 2005).

Primary aldosteronism is due to either a unilateral adrenal adenoma or bilateral hyperplasia of the adrenal cortex in most cases. A unilateral adrenalectomy in hypertensive and hypokalemic patients, with a well-documented adrenal adenoma, is usually followed by the correction of hypokalemia in all subjects, with the cure of hypertension in 60 to 87% of patients. Here, a unique case, in which a unilateral adrenalectomy for the removal of an adrenal adenoma was followed by severe hyperkalemia, low levels of plasma renin activity and serum aldosterone, suggestive of chronic suppression of the renin-aldosterone axis, is reported. In a follow-up Lasix stimulation test on the 70th day after surgery, the suppression of the renin-aldosterone axis was resolved, indicating the suppression was transient. Patients undergoing a unilateral adrenalectomy for an aldosterone-producing adenoma should be closely followed up to avoid severe hyperkalemia (J Kor Soc Endocrinol 20:502~506, 2005). ꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏ

Short stature and gonadal dysgenesis are two characteristic clinical features of Turners syndrome. Very rarely, patients with Turners syndrome may menstruate and even be fertile. We experienced a case of Turners syndrome with spontaneous sexual development and menstruation. A 16-year-old girl was referred for severe anemia and menometrorrahgia. She had nearly normal features, wi th the exception of a short stature and a single right kidney. Also, she had spontaneous development of secondary sexual characteristics. We performed and anemia study and evaluated her short stature. In chromosomal study of her bone marrow and peripheral blood lymphocytes, she was revealed to have monosomy 45,X. Herein, this case is reported, with a brief review of literature (J Kor Soc Endocrinol 20:160～167, 2005).

Background: Fibrous dysplasia of the bone (FD) is a benign fibrous bone lesion which usually involves the long bones of the extremities. FD may be asymptomatic, but often leads to bone deformity and pathological fracture. The disease is caused by a somatic mutation in the Gsα protein, which is responsible for intracellular signal transduction. Methods: Mutations in the GNAS1 gene, which codes for Gsα protein, was investigated in 34 patients with monostotic and polyostotic FD and McCune-Albright syndrome. DNA was extracted from formalin-fixed, paraffin embedded bone tissues, and exons 8 and 9 of the GNAS1 gene amplified using a polymerase chain reaction (PCR). Subsequently, plasmid cloning and DNA sequencing analysis were performed. Results: The PCR was successfully performed in 5 patients with monostotic FD. However, the sequencing analysis failed to identify any significant point mutations in exons 8 or 9 of GNAS1. Nevertheless, 3 point mutations were observed in the intron of the GNAS1 gene in 2 samples. Conclusion: In addition to the previously known somatic mutations of the GNAS1 gene, this study suggests that fibrous dysplasia of the bone might be associated with another point mutations of the GNAS1 gene (J Kor Soc Endocrinol 20:142~147, 2005).

T cell immunity and phagocytic activity were studied in the blood of patients with IgA nephropathy in order to clarify their roles in the pathogenesis of IgA nephropathy. The percentages of total T lymphocytes, helper T cell and suppressor T cells were significantly reduced in patients. A significantly elevated helper T cell/suppressor T cell ratio in patients showed a predominant reduction in suppressor T cells. There was a significant relationship between histologic findings and helper T cell/suppressor T cell ratio in patients. Natural Killer (NK) cell activity was significantly reduced but the lymphocyte response after phytohemagglutinin (PHA) stimulation was not in patients. ConA-induced suppressor cell activity was not depressed despite of a decrease in suppressor T cells in patients. Phagocytic activity of polymorphonuclear leucocytes (PMNs) ingesting yeasts was significantly reduced in patients. Also an inverse correlation was found between serum IgA levels and phagocytic activity of PMN. It is concluded that suppressor T cell defects, depressed phagocytic activity and impaired NK cell activity may play a role in the pathogenesis of IgA nephropathy.