• Tuberculosis and Respiratory Diseases
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• 제78권4호
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• pp.436-439
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• 2015

Small cell lung cancer (SCLC), which originated from neuroendocrine tissue, can develop into paraneoplastic endocrine syndromes, such as Cushing syndrome, because of an inappropriate secretion of ectopic adrenocorticotropic hormone (ACTH). This paraneoplastic syndrome is known to be a poor prognostic factor in SCLC. The reason for poor survival may be because of a higher risk of infection associated with hypercortisolemia. Therefore, early detection and appropriate treatment for this syndrome is necessary. But the diagnosis is challenging and the source of ACTH production can be difficult to identify. We report a 69-year-old male patient who had severe hypokalemia, metabolic alkalosis, and hypertension as manifestations of an ACTH-secreting small cell carcinoma of the lung. He was treated with ketoconazole and spironolactone to control the ACTH dependent Cushing syndrome. He survived for 15 months after chemotherapy, which is unusual considering the poor outcome of the ectopic ATH syndrome associated with SCLC.

• Journal of Yeungnam Medical Science
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• 제32권2호
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• pp.132-137
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• 2015

Adrenocorticotropic hormone (ACTH)-producing pheochromocytoma has been rarely reported, whereas only a few cases of Cushing syndrome accompanied by opportunistic infections have been reported. We experienced a patient with pheochromocytoma with ectopic Cushing syndrome complicated by invasive aspergillosis. A 35-year-old woman presented with typical Cushingoid features. Her basal plasma cortisol, ACTH, and 24-hour urine free cortisol levels were significantly high, and 24-hour urine metanephrine and catecholamine levels were slightly elevated. The endogeneous cortisol secretion was not suppressed by either low- or high-dose dexamethasone. Abdominal computed tomography (CT) revealed a heterogeneous enhancing mass measuring approximately 2.5 cm in size in the left adrenal gland. No definitive mass lesion was observed on sellar magnetic resonance imaging. On fluorine-18 fluorodeoxyglucose positron emission tomography/CT, a hypermetabolic nodule was observed in the left upper lung. Thus, we performed a percutaneous needle biopsy, which revealed inflammation, not malignancy. Thereafter, we performed a laparoscopic left adrenalectomy, and its pathologic finding was a pheochromocytoma with positive immunohistostaining for ACTH. After surgery, the biochemistry was normalized, but the clinical course was fatal despite intensive care because of the invasive aspergillosis that included the lungs, retina, and central nervous system.

• 대한핵의학회:학술대회논문집
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• 대한핵의학회 1977년도 제16차 학술대회
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• pp.96.2-96.2
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• 1977

• Tuberculosis and Respiratory Diseases
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• 제42권6호
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• pp.934-940
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• 1995

기침, 호흡곤란 및 성한 전신 쇄약감을 주소로 내원하여 기관지 내시경 및 경부 림프절 생검을 통한 조직검사로 소세포 폐암을 확진하고, 병력상 심한 전신무력감 및 체중감소를 호소해며, 검사상 성한 저칼륨혈증 및 대사성 알칼리증의 소견이 있으며, 최근 발생된 고혈당, 고혈압 등의 증상이 있어 시행한 내분비학적 생화학 검사상 혈중 cortisol이 상승하고, cortisol의 일간 변동(diurnal variation)이 소실되었으며, 24시간 뇨 free cortisol의 현저한 상승으로 Cushing 증후군이 paraneoplastic syndrome으로 소세포 폐암에서 동반되었음을 확인한 1예를 경험하였기에 보고하는 바이다.

• 한국임상수의학회지
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• 제29권5호
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• pp.400-403
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• 2012

10년령의 수컷 푸들이 복부팽만, 등쪽 몸통 부위 탈모, 간비대와 혈청 알칼리인산분해효소의 지속적인 상승으로 전북대학교 수의과대학 동물병원에 내원하였다. 간 생검 및 미세침흡인세포 검사법과 PAS 염색을 실시한 결과 공포성 간병증 및 간세포에 글리코겐이 침착된 것을 확인 하였다. ACTH 자극 시험 실시 전 후 코티솔 및 부신과 관련된 성 호르몬의 농도를 측정하였다. 측정결과 안드로스텐디온, 프로게스테론 및 수산화 프로게스테론의 상승을 관찰할 수 있었으며 코티솔농도는 정상 범위내에 존재하였다. 진단은 성호르몬과 관련된 비정형의 부신피질 기능 항진증으로 내렸으며 치료는 트릴로스탄으로 하였다. 치료 8주 후 등 부위의 탈모를 포함한 임상증상들이 개선되었다.

• 생물정신의학
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• 제17권2호
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• pp.86-93
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• 2010

Objectives : The aim of this research is to determine the effects of depression and anxiety symptoms of schizophrenic psychopathology on the HPA axis. Methods : Twenty patients with schizophrenia were included and divided into the medication non-exposed group(n = 10) and the medication exposed group(n = 10). Evaluated scales were the Positive and Negative Syndrome Scale(PANSS), Scale for the Assessment of Negative Symptoms(SANS), Scale for the Assessment of Positive Symptoms(SAPS), Hamilton Depression Inventory(HAM-D) and Hamilton Anxiety Inventory (HAM-A), and then the combined Dexamethasone/Corticotropin Releasing Hormone(DEX/CRH) test was conducted to determine the basal level, the peak level and the area under the curve(AUC) of cortisol and adrenocorticotropic hormone(ACTH). Results : When the correlations between each psychopathology and cortisol level or ACTH AUC value were analyzed, HAM-D showed a negative correlation, whereas HAM-A showed a positive correlation. Also, the non-depression group(HAM-D ${\leq}$ 18) showed higher cortisol and ACTH concentrations than the depression group(HAM-D > 18), and the anxiety group(HAM-A ${\geq}$ 14) showed significantly higher concentrations than the non-anxiety group(HAM-D < 14)(p < 0.05). Also, as for the comparison between the medication non-exposed group and the medication exposed group, the non-exposed group showed significantly higher cortisol and ACTH concentration than exposed group(p < 0.05). Conclusion : This study suggest that anxiety symptoms rather than depression symptoms are related to the increased activity of the HPA axis of schizophrenics.

• Journal of Chest Surgery
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• 제51권2호
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• pp.109-113
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• 2018

Background: Low cardiac output syndrome (LCOS) after cardiac surgery usually requires inotropes. In this setting, critical illness-related corticosteroid insufficiency (CIRCI) may develop. We aimed to investigate the clinical features of CIRCI in the presence of LCOS and to assess the efficacy of steroid treatment. Methods: We reviewed 28 patients who underwent a rapid adrenocorticotropic hormone (ACTH) test due to the suspicion of CIRCI between February 2010 and September 2014. CIRCI was diagnosed by a change in serum cortisol of <$9{\mu}g/dL$ after the ACTH test or a random cortisol level of <$10{\mu}g/dL$. Results: Twenty of the 28 patients met the diagnostic criteria. The patients with CIRCI showed higher Sequential Organ Failure Assessment (SOFA) scores than those without CIRCI ($16.1{\pm}2.3$ vs. $11.4{\pm}3.5$, p=0.001). Six of the patients with CIRCI (30%) received glucocorticoids. With an average elevation of the mean blood pressure by $22.2{\pm}8.7mm\;Hg$ after steroid therapy, the duration of inotropic support was shorter in the steroid group than in the non-steroid group ($14.1{\pm}2.3days$ versus $30{\pm}22.8days$, p=0.001). Three infections (15%) developed in the non-steroid group, but this was not a significant between-group difference. Conclusion: CIRCI should be suspected in patients with LCOS after cardiac surgery, especially in patients with a high SOFA score. Glucocorticoid replacement therapy may be considered to reduce the use of inotropes without posing an additional risk of infection.

• The Korean Journal of Physiology and Pharmacology
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• 제22권1호
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• pp.23-33
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• 2018

Cushing's syndrome (CS) is a collection of symptoms caused by prolonged exposure to excess cortisol. Chronically elevated glucocorticoid (GC) levels contribute to hepatic steatosis. We hypothesized that histone deacetylase inhibitors (HDACi) could attenuate hepatic steatosis through glucocorticoid receptor (GR) acetylation in experimental CS. To induce CS, we administered adrenocorticotropic hormone (ACTH; 40 ng/kg/day) to Sprague-Dawley rats by subcutaneous infusion with osmotic mini-pumps. We administered the HDACi, sodium valproate (VPA; 0.71% w/v), in the drinking water. Treatment with the HDACi decreased steatosis and the expression of lipogenic genes in the livers of CS rats. The enrichment of GR at the promoters of the lipogenic genes, such as acetyl-CoA carboxylase (Acc), fatty acid synthase (Fasn), and sterol regulatory element binding protein 1c (Srebp1c), was markedly decreased by VPA. Pan-HDACi and an HDAC class I-specific inhibitor, but not an HDAC class II a-specific inhibitor, attenuated dexamethasone (DEX)-induced lipogenesis in HepG2 cells. The transcriptional activity of Fasn was decreased by pretreatment with VPA. In addition, pretreatment with VPA decreased DEX-induced binding of GR to the glucocorticoid response element (GRE). Treatment with VPA increased the acetylation of GR in ACTH-infused rats and DEX-induced HepG2 cells. Taken together, these results indicate that HDAC inhibition attenuates hepatic steatosis through GR acetylation in experimental CS.

• Journal of Oral Medicine and Pain
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• 제42권4호
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• pp.116-124
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• 2017

Purpose: Burning mouth syndrome (BMS) is a disabling pain that mostly occurs in elderly women, but rarely in men. It is characterized by an unremitting oral burning sensation and pain without detectable oral mucosal changes. We investigated the clinical and hematologic features of middle-aged men with BMS, and compared the results to those of men with oral mucositis. Methods: Five men with BMS ($48.60{\pm}6.19years$) and five age-matched controls with oral mucositis ($49.80{\pm}15.26years$) underwent clinical and psychological evaluations and blood tests. Psychological status was evaluated using the Symptom Checklist-90-Revised. Cortisol, estradiol, progesterone, testosterone, follicle-stimulating hormone (FSH), luteinizing hormone (LH), adrenocorticotropic hormone (ACTH), and antidiuretic hormone (ADH) levels and erythrocyte sedimentation rate (ESR) were determined from the blood samples. Results: ADH level was significantly lower in men with BMS than in the controls. ADH levels correlated with testosterone (p<0.01), and ACTH levels strongly correlated with ESR (p<0.05). Progesterone level positively correlated with FSH and LH levels. Pain intensity on a visual analogue scale correlated with estradiol level only in men with BMS. Among psychological factors, the obsessive-compulsive disorder, interpersonal-sensitivity, and anxiety scores were higher in men with BMS than in the controls (p<0.05). However, no correlations were observed between the psychological and hematologic factors in both groups. The BMS symptoms presented only on the tongue, with the lateral border being the most prevalent area. Conclusions: Men with BMS may experience dysregulated endocrinologic or psychoneuroendocrinologic interactions, which might affect oral BMS symptoms, aggravating the severity of the burning sensation.

• Clinical and Experimental Reproductive Medicine
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• 제21권3호
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• pp.227-232
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• 1994

In order to define the clinical characteristics of Korean women with polycystic ovary syndrome, clinical symptoms, biochemical features and ultrasonographic findings were determined in ninety PCO patients. Frequency of clinical manifestations were as follows:acne 42%, overweight 31 %, oily skin 14 %, hirsutism 10%. Relatively low frequencies of hirsutism is recognized in patients with Korean PCO syndrome. Mean(${\pm}$S.E.) of each hormone was:testosterone 1.18${\pm}$1.07ng/ml, LH 21.47${\pm}$${\pm}$2.6mIU/ml, FSH 7.26${\pm}$2.67mIU/ml, LH/FSH ratio 2.94${\pm}$1.29, prolactin 25.48${\pm}$46.33ng/ml, DHEA-S 333.78${\pm}$309.60ng/dl, 17-0HP 1.72${\pm}$1.74ng/ml. Mean 17-OHP after ACTH stimulation test was 5.07${\pm}$12.01ng/ml. Ultrasonographically measured mean ovarian volume were $11.02{\pm}5.92cm^3$ in right and $9.23{\pm}5.64cm^3$ in left and small sized multiple subcapsular follicular cysts were noted in 43 patients (47.9%) with PCO syndrome.