• Clinics in Shoulder and Elbow
• /
• v.18 no.2
• /
• pp.80-85
• /
• 2015

Background: This study measured the rate of adrenal insufficiency among rotator cuff tear patients, and determined the roles of steroid treatment and herbal medicine as specific risk factors of adrenal insufficiency. Methods: We prospectively evaluated the 53 patients who agreed to participate in the study and underwent arthroscopic rotator cuff repair due to a chronic full-thickness tear from March 2012 to September 2013. The diagnosis of adrenal insufficieny was made by rapid adrenocortical hormone test before the operation. We collected information regarding their history of steroid and herbal medicine treatment within the last 12 months. Results: The rate of adrenal insufficiency among the rotator cuff tear patients in our study was 18.9% (10 of 53 patients). Steroid treatment (p=0.034), frequency of local steroid injection (p=0.008), and herbal medicine treatment (p=0.02) showed significant association with the risk of adrenal insufficiency. Conclusions: In this study, careful taking of a patient's medical history, such as the use of steroids and herbal medicine, is important when investigating adrenal function before surgery.

• Clinical and Experimental Pediatrics
• /
• v.51 no.9
• /
• pp.1018-1022
• /
• 2008

Testicular adrenal rest tumors are a well-known complication in male patients with congenital adrenal hyperplasia. Corticosteroid suppressive therapy usually results in the regression of these tumors. We describe a patient with 21-hydroxylase deficiency who developed bilateral testicular masses. Despite steroid suppressive therapy, the tumors did not regress and hormonal control was poor. Consequently, bilateral partial orchiectomies were performed.

• Development and Reproduction
• /
• v.2 no.1
• /
• pp.39-43
• /
• 1998

The synthesis of steroid hormone starts from cholesterol. Steroidogenic acute regulatory protein(StAR) transfers cholesterol acutely from the outer mitochondrial membranes to the inner in the early step of steroidogenesis. Many kinds of steroid hormones are mainly synthesized in adrenal grand, ovary and testis. The purpose of this study is to determine the distribution of StAR mRNA in the rat ovary and adrenal gland and to confirm the functions of StAR in these organs. In the ovary, StAR mRNAs were strongly expressed in the corpus luteum, where progesterone is synthesized, and these were weakly expressed in the theca layer of follicles, where androgen is synthesized. However, StAR mRNAs were not detected in the estrogen producing granulosa cells of growing follicles. In the corpus luteum, StAR mRNAs were strongly loclized in the zona fasciculata and zona reticularis, where glucocorticoid is mainly synthesized. StAR mRNAs were weakly expressed in the zona gromerulosa, where mineralcorticoid is synthesized. StAR mRNAs were not detected in the adrenal medulla. In our results, StAR mRNAs were expressed differentially in the steroidogenic cells of ovary and adrenal gland according to the types of steroid hormones, and the statges of corpus luteum development. We conclude that StAR is involved in the steroidogenesis at the very early step of steroid synthesis cascade.

• Mass Spectrometry Letters
• /
• v.2 no.3
• /
• pp.69-72
• /
• 2011

Defective synthesis of the steroid hormones by the adrenal cortex has profound effects on human development and homeostasis. Due to the time-consuming chromatography procedure combined with mass spectrometry, the matrix-assisted laser desorption ionization method coupled to the linear ion-trap tandem mass spectrometry (MALDI-LTQ-MS/MS) was developed for quantitative analysis of 10 adrenal steroids in human serum. Although MALDI-MS can be introduced for its applicability as a high-throughput screening method, it has a limitation on reproducibility within and between samples, which renders poor reproducibility for quantification. For quantitative MALDI-MS/MS analysis, the stable-isotope labeled internal standards were used and the conditions of crystallization were tested. The precision and accuracy were 3.1~35.5% and 83.8~138.5%, respectively, when a mixture of 10 mg/mL ${\alpha}$-cyano-4-hydroxycinnamic acid in 0.2% TFA of 70% acetonitrile was used as the MALDI matrix. The limit of quantification ranged from 5 to 340 ng/mL, and the linearity as a correlation coefficient was higher than 0.988 for all analytes in the calibration range. Clinical applications include quantitative analyses of patients with congenital adrenal hyperplasia. The devised MALDI-MS/MS technique could be successfully applied to diagnosis of clinical samples.

• Mass Spectrometry Letters
• /
• v.5 no.2
• /
• pp.35-41
• /
• 2014

Gas chromatography-mass spectrometry (GC-MS) methods have been used extensively in clinical steroid analyses. Evaluating the metabolic ratios of precursors to products by accurate quantification of individual steroid levels in biological samples can reveal the activities of enzymes associated with steroid metabolism. This review article discusses the impact of GC-MS-based steroid profiling on our understanding of the biochemical role of steroids and their metabolic enzymes in hormone-dependent diseases, such as congenital adrenal hyperplasia (CAH), cortisol-mediated hypertension, apparent mineralocorticoid excess (AME), male-pattern baldness, and breast and thyroid cancers. Steroid profiling is a comprehensive analytical technique that can be applied whenever the highest specificity is required and may be a reasonable initial diagnostic approach.

• The Journal of Internal Korean Medicine
• /
• v.38 no.5
• /
• pp.583-591
• /
• 2017

Adrenal insufficiency is caused by adrenal failure or impairment of the hypothalamic-pituitary-adrenal axis. The main symptoms of adrenal insufficiency are chronic fatigue, nausea, vomiting, anorexia, and weight loss. We report a case of adrenal insufficiency in a 38-year-old female. The patient complained of headache, dizziness, anorexia, and general weakness. We treated her with Iggisaengjin-tang and acupuncture. After treatment, the patient's symptoms were improved and serum cortisol levels rose to a normal range without the aid of steroid supplementation therapy. This case suggests that Korean medicine can be effective in the treatment of adrenal insufficiency, but more clinical reports are needed.

• The Korean Journal of Nuclear Medicine
• /
• v.28 no.1
• /
• pp.148-152
• /
• 1994

The benign adrenal cortical adenoma usually secretes cortisol and its size is less than 3 cm in diameter. Though adrenal cortical carcinoma also secretes cortisol and other steroid hormones, its size is usually over 6 cm. We present a huge glucocorticoid producing adrenal cortical adenoma ($15{\times}11{\times}12 cm$), which was diagnosed by NP-59 scan and confirmed by surgery, with a review of the literature.

• Clinical and Experimental Pediatrics
• /
• v.60 no.2
• /
• pp.31-37
• /
• 2017

Steroid 21-hydroxylase deficiency is the most prevalent form of congenital adrenal hyperplasia (CAH), accounting for approximately 95% of cases. With the advent of newborn screening and hormone replacement therapy, most children with CAH survive into adulthood. Adolescents and adults with CAH experience a number of complications, including short stature, obesity, infertility, tumor, osteoporosis, and reduced quality of life. Transition from pediatric to adult care and management of long-term complications are challenging for both patients and health-care providers. Psychosocial issues frequently affect adherence to glucocorticoid treatment. Therefore, the safe transition of adolescents to adult care requires regular follow-up of patients by a multidisciplinary team including pediatric and adult endocrinologists. The major goals for management of adults with 21-hydroxylase deficiency are to minimize the long-term complications of glucocorticoid therapy, reduce hyperandrogenism, prevent adrenal or testicular adrenal rest tumors, maintain fertility, and improve quality of life. Optimized medical or surgical treatment strategies should be developed through coordinated care, both during transition periods and throughout patients' lifetimes. This review will summarize current knowledge on the management of adults with CAH, and suggested appropriate approaches to the transition from pediatric to adult care.

• 대한임상약리학회:학술대회논문집
• /
• 2001.06a
• /
• pp.9-10
• /
• 2001

• Mass Spectrometry Letters
• /
• v.13 no.1
• /
• pp.11-19
• /
• 2022

Although translational research is referred to clinical chemistry measures, correct weighting factors for linear and quadratic calibration curves with least-squares regression algorithm have not been carefully considered in bioanalytical assays yet. The objective of this study was to identify steroidogenic roles in preeclampsia and verify accuracy of quantitative results by comparing two different linear regression models with weighting factor of 1 and 1/x². A liquid chromatography-mass spectrometry (LC-MS)-based adrenal steroid assay was conducted to reveal metabolic signatures of preeclampsia in both serum and placenta samples obtained 15 preeclamptic patients and 17 age-matched control pregnant women (33.9 ± 4.2 vs. 32.8 ± 5.6 yr, respectively) at 34~36 gestational weeks. Percent biases in the unweighted model (w_i = 1) were inversely proportional to concentrations (-739.4 ~ 852.9%) while those of weighted regression (w_i = 1/x²) were < 18% for all variables. The optimized LC-MS combined with the weighted linear regression resulted in significantly increased maternal serum levels of pregnenolone, 21-deoxycortisol, and tetrahydrocortisone (P < 0.05 for all) in preeclampsia. Serum metabolic ratio of (tetrahydrocortisol + allo-tetrahydrocortisol) / tetrahydrocortisone indicating 11β-hydroxysteroid dehydrogenase type 2 was decreased (P < 0.005) in patients. In placenta, local concentrations of androstenedione were changed while its metabolic ratio to 17α-hydroxyprogesterone responsible for 17,20-lyase activity was significantly decreased in patients (P = 0.002). The current bioanalytical LC-MS assay with corrected weighting factor of 1/x² may provide reliable and accurate quantitative outcomes, suggesting altered steroidogenesis in preeclampsia patients at late gestational weeks in the third trimester.