• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.30 no.6
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• pp.504-508
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• 2004

Surgical process of oral and maxillofacial area as well as dental treatment are stressful situations to the patients. It is well known that serum level of stress hormones including adrenocorticotropic hormone(ACTH) and cortisol increase when the body is exposed to stress. However, there have been few studies on demographic and clinical factors related with stress. Therefore, the purpose of this study was to supply data to cope with stress more comprehensively and efficiently by analyzing the effect of factors related with stress in addition to surgical procedure. Prospective cohort study method was selected. Serum levels of ACTH and cortisol were measured by sampling bloods pre-operatively and post-operatively from 45 patients who had been operated at the Bundang Jesaeng Hospital department of oral and maxillofacial surgery. To evaluate factors associated with stress, patients were classified according to gender, age, method of payment(insurance or self), experiences of operation, kind of operations(expected operations or unexpected operations). Relative risk was calculated to assess relationships between changes of serum level of ACTH and cortisol and factors related with stress, whereas Chi-square analysis was executed to evaluate statistical significance. With regard to serum level of ACTH, relative risk was 1.3 in the group of the patients who were less than 40 years old. With regard to serum level of cortisol, relative risk was 1.8 for women compared with men, 1.4 in the group of the patients who were less than 40 years old and 1.6 in the group of the patients who had not experienced any other operations. In addition to surgical procedure, factors related with stress included gender, age, method of payments, experiences of operation and kind of operations. Therefore, we should provide comprehensive schemes to reduce stress of the patients going through oral and maxillofacial surgery.

• Tuberculosis and Respiratory Diseases
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• v.42 no.6
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• pp.934-940
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• 1995

Small cell lung cancer(SCLC) is frequently associated with paraneoplastic syndromes, which occur in approximately 20% of patients at presentation. Clinical Cushing's syndrome secondary to ectopic ACTH production is uncommon, occurring in approximately 5% of all SCLC patients. However, biochemical evidence of hypercortisolism can be detected in up to 50% of patients. Patients with Cushing's syndrome from ectopic ACTH production show hypertension, weakness, hyperglycemia, and hypokalemic metabolic alkalosis, but differ from patients with classic Cushing's disease in that symptoms develop more rapidly. Ectopic ACTH production is associated with a poor response to chemotherapy, short survival, and a high risk of treatment-related complications. We report a case of Cushing's syndrome associated with ectopic corticotropin production in 59-year-old male patient with extensive stage of SCLC.

• Proceedings of the Korean Society of Veterinary Clinics Conference
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• 2008.05a
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• pp.121-121
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• 2008

• Journal of Korean Biological Nursing Science
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• v.15 no.4
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• pp.173-183
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• 2013

Purpose: The purpose of this study was to compare the stress level and HPA axis activity of an internet game addiction group and non-addiction group in adolescents. Methods: A cross-sectional comparative study was performed with 140 male high school students from 9 vocational high schools at W city. Data were collected from July to September, 2012, using a questionnaire for measuring internet game addiction and stress level, blood samples for serum ACTH, and cortisol level for HPA axis activity. Data were analyzed using descriptive analysis, $X^2$-test, t-test, ANOVA, and Pearson correlation coefficient with SPSS/WIN 15.0. Results: The stress level of the internet game addicted group was significantly higher than that of the non-addicted group (p<.001). The serum cortisol level was also significantly higher in the internet game addicted group than in the non-addicted group (p<.026). The serum ACTH level was higher in the internet game addicted group more than in the non-addicted group (p<.072). Conclusion: These results showed that internet game addiction could increase stress level and HPA axis activity in high school adolescents. Thus, a nursing approach to prevent and relieve internet game addiction should be initiated to stabilize the HPA axis of internet game addicted adolescents.

• Journal of Sasang Constitutional Medicine
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• v.3 no.1
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• pp.151-172
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• 1991

Comparative blood analysis was carried out to investigate the change of blood constituent in TAE-EUM-IN group and control group. RBC, WBC, hemoglobin, hematocrit, total protein, triglyceride, phospholipid, total cholesterol, LDL-cholesterol, HDL-cholesterol, BUN, creatinine, ACTH, cortisol and prostaglandin E and $F_2{\alpha}$ were measured. And the following results were obtained: 1. In the change of blood cell, the value of hematocrit showed significant difference, while that of RBC, WBC and himoglobin didn't. 2. In the change of protein, the value of total protein showed significant difference, but that of albumin didn't. 3. In the change of lipid and cholesterol in serum, the value of triglyceride, phospholipid, total cholesterol and LDL-cholesterol indicated significant difference, while that of HDL-cholesterol indicated significant difference, while that of HDL-cholesterol didn't. 4. The value of BUN in serum represented significant difference, but that of creatinine didn't. 5. The value of cortisol in plasma showed significant difference, but that of ACTH didn't. 6. The value of prostaglandin E and $F_2{\alpha}$ in plasma showed significant difference. These results suggest that investigation on hormones and blood constituents enables objectification in differentiation of four types of physical constitution.

• Journal of Veterinary Clinics
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• v.14 no.2
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• pp.208-214
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• 1997

The objective of this study was (a) to examine the change of bloodchemistry and (b) to investigate the secretion trend of endocrinological substance in a dog model after laser-beam radiation at different level of frequency (250 Hz, 2,000 Hz, 5,000 Hz and 8,000 Hz). The experimental groups were divided into four groups were divided into four groups on the basis of the level of frequency radiated and stimulated for five minutes. Before stimulation and after a lapse of time (10-minute, 30-minute and 60-minute) all dogs were checked the following parameters; cortisol, ACTH, RBC, hemoglobin, hematocrit, WBC, Ca, P, ALT, AST and creatinine. The results were as follow: ten minutes after stimulation, cortisol level of 250 Hz group, 2,000 Hz group, 5,000 Hz group and 8,000 Hz group was increased 18.8%, 20.5%, 23.2% and 309%, respectively. Ten minutes after stimulation, ACTH level of 250 Hz group, 2,000 Hz group, 5,000 Hz group and 8,000 Hz group was increased 26.7%, 26.6%, 30.5% and 29.5%, respectively. It began to decrease and at 30-minute after stimulation resturned to pre-stimulation level at 60-minute after stimulation. In blood examination RBC, hemaoglobin, hematocrit and WBC level showed slight increase and decrease and returned to pre-stimulation level at 60-minute after radiation. In bloodchemical examination serum calcium, inorganic phosphorus, ALT, AST and creatinine level were within normal physiological ranges.

• Tuberculosis and Respiratory Diseases
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• v.61 no.4
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• pp.356-365
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• 2006

Background: Corticosteroids are known to be significant prognostic parameters in sepsis. Recently, an absolute and relative insufficiency of the corticosteroids system has often been reported to often develop particularly in severe sepsis. Degree of such an adrenal insufficiency not only has prognostic implications but also can be used to guide corticosteroids replacement therapy. The 24-hour urinary cortisol levels as well as serum cortisol concentrations were measured to assess the clinical significance and their relationship with the other parameters of sepsis, and also evaluated the clinical implications of the relative adrenal insufficiency. Methods: 26 consecutive patients with sepsis were enrolled. The basal random serum cortisol, ACTH, ADH, lactate levels and 24-hour urinary free cortisol amount were measured. The rapid ACTH ($250{\mu}g$) stimulation test was also performed. Results: Basal serum cortisol levels were higher in the non-survivors than in the survivors. The 24-hour urinary free cortisol levels were higher in the patients with severe sepsis than in those without. The serum cortisol levels strongly correlated with the serum ADH and lactate levels. The 24-hour urinary free cortisol levels strongly correlated with the serum cortisol and lactate levels. The fractional changes in the cortisol levels after the rapid ACTH stimulation tests correlated with the serum cortisol, ADH, and lactate levels. Conclusion: Both the serum cortisol and 24-hour urinary cortisol were found to be significant prognostic factors in sepsis, and showed a strong correlation with the other parameters. The relative adrenal insufficiency might also be an important clinical parameter.

• Journal of Korean Neurosurgical Society
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• v.30 no.5
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• pp.611-621
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• 2001

Objective : We analyzed the clinical and endocrinological results of the transsphenoidal microsurgery for ACTH secreting pituitary adenomas. Marerials and Methods : From October 1995 to August 2000, 18 patients underwent transsphenoidal microsurgery for Cushing's disease. We analyzed the surgical results of 17 patients, one patient who was previously operated from other hospital was excluded. Age of the patients were 18 to 61 years old(mean 37.7), male to female ratio was 1 : 3.3, and follow-up period was 3 to 50 months(mean 20.3). The selection of candidates for transsphenoidal exploration was based on endocrinologic criteria. Magnetic resonance imaging was the preferred radiologic test. Selective inferior petrosal sinus sampling of adrenocorticotropic hormone futher refined the diagnosis when endocrinologic and radiologic procedures were not definitive. Results : Results of the preoperative endocrinological test were : level of serum ACTH 29.4 to $225{\mu}g/dL$(mean $93.88{\mu}g/dL$) ; serum cortisol 11.9 to $47.5{\mu}g/dL$(mean $27.49{\mu}g/dL$) ; 24-hour urine free cortisol 235 to $1019{\mu}g/day$(mean $571.0{\mu}g/day$). Inferior petrosal sinus sampling for ACTH was performed in 11 patients and all were confirmed by Cushing's disease and we could predict the laterality of the tumor in 9 of 11 patients. We performed transsphenoidal selective adenomectomy in 5 patients, adenomectomy and subtotal hypophysectomy in 2 patients, adenomectomy and partial hypophysectomy in 9 patients, and in the remaining one patient, hemihypophysectomy followed by total hypophysectomy due to remission failure. Fifteen of 17 patients(88.2%) showed endocrinological remission. Glucocorticoid replacement therapy was performed in all the patients who showed remission for 1 to 24 months(mean 5.9 months), and 6 patients received steroid over 6 months. Conclusion : We conclude that the direct demonstration of a tumor in the pituitary gland by MRI is the most important and definitive diagnostic tool and the location of a mass should be confirmed with increased level of ACTH by the inferior petrosal sinus sampling. Transsphenoidal microsurgery is effective treatment modality for Cushing's disease and the immediate postoperative evaluation of the surgical resection of the tumor is very important. The patients should show hypocortisolism, decreased, subnormal serum ACTH and cortisol levels and 24-hours urine free cortisol. We performed 18 transsphenoidal microsurgery for Cushing's disease in 17 patients and 15 patients(88.2%) showed endocrinological remission.

• Tuberculosis and Respiratory Diseases
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• v.39 no.3
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• pp.219-227
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• 1992

Background: Acute and chronic airway inflammation are important in the pathogenesis of bronchial asthma. Corticosteroids have proved to be very effective in the management of asthma. Although the mechanism by which they produce this effect is still debated, suppression of the inflammatory response is thought to be the most likely. Although inhaled steroids are known to be safe and have less side effects than oral steroids, the extent which inhaled steroids have beneficial and the detrimental effects in the treatment of asthma has remained open to question. Budesonide is a recently developed corticosteroid for inhalation treatment with a strong local effect combined with rapid inactivation in the systemic circulation. We set out to look in more detail at the time course of change in bronchial reactivity, clinical symptoms and the effects on the adrenal function during 6 weeks of treatment with budesonide (800 ug per day). Methods: Clinical symptoms, pulmonary function test, histamine $PC_{20}$, serum ACTH and cortisol (8 AM and 4 PM) were measured in 23 allergic asthmatic patients before and after 6 weeks of treatment with budesonide. Results: 1) Pulmonary function test; PEFR, FEV1 and FVC after 6 weeks of treatment with budesonide were higher than those before treatment. 2) Clinical symptoms; Clinical symptoms were significantly improved after 3 weeks and 6 weeks of treatment with budesonide. 3) Histamine provocation; Histamine $PC_{20}$ after 6 weeks of treatment with budesonide was significantly higher than that before treatment. 4) Adrenal function; 6 weeks of budesonide therapy did not significantly affect the level of serum ACTH and cortisol. Conclusion: From these results, it is concluded that budesonide therapy improved the clinical symptoms, pulmonary function and bronchial hyperreactivity after 3 weeks of treatment and the improvement after 6 weeks of treatment was higher than that after 3 weeks of treatment. During 6 weeks of treatment with budesonide, the inhibitory effect on the adrenal function was not obvious.

• Journal of Veterinary Clinics
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• v.30 no.5
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• pp.363-365
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• 2013

A 15-year-old, spayed female Maltese dog weighing 2.80 kg was referred with seizure of unknown origin. At presentation, serum biochemistry showed marked hypoglycemia (46 mg/dL; reference interval [RI], 65-118 mg/dL). There were, however, no abnormalities on electrolytes, complete blood counts, urinalysis, survey radiographs, and abdominal ultrasonography. In the adrenocorticotropic hormone (ACTH) stimulation test, pre-ACTH and post-ACTH cortisol concentrations were within normal reference ranges. Serum insulin level was normal and fructosamine level was slightly lower than reference ranges. The clinical signs, including seizure and collapse caused by hypoglycemia, were gradually resolved with oral administration of prednisolone (PDS) twice daily. Forty five weeks later, serum biochemistry revealed hypoglycemia with markedly increased insulin level. On abdominal ultrasonography, increased heterogenous echogenecity with hypoechoic lesion was found within pancreatic parenchyma. Based on these findings, the dog was presumptively diagnosed to insulinoma. Hypoglycemic seizure was resolved with higher dose of PDS (1 mg/kg, q12h). At 688 days after first presentation, the patient was still alive without recurrence of hypoglycemic seizure. This case describes long-term management with PDS monotherapy in a Maltese dog with insulinoma.