뇌하수체 우연종의 특성과 추적

구철룡,이은직 대한내분비학회 2008 Endocrinology and metabolism Vol.23 No.2

The Effects of High Fat Diet and Resveratrol on Mitochondrial Activity of Brown Adipocytes (Endocrinol Metab 2016;31:328-35, Cheol Ryong Ku et al.)

구철룡,이은직 대한내분비학회 2016 Endocrinology and metabolism Vol.31 No.3

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COVID-19 Vaccination for Endocrine Patients: A Position Statement from the Korean Endocrine Society

구철룡,정경연,안창호,문준성,이주희,김은희,권혜미,김희경,서성환,홍상모,하정훈,노은,김진화,김미경,Committee of Clinical Practice Guideline of the Korean Endocrine Society 대한내분비학회 2021 Endocrinology and metabolism Vol.36 No.4

Since the first outbreak of coronavirus disease 2019 (COVID-19), ongoing efforts have been made to discover an efficacious vaccineagainst COVID-19 to combat the pandemic. In most countries, both mRNA and DNA vaccines have been administered, and theirside effects have also been reported. The clinical course of COVID-19 and the effects of vaccination against COVID-19 are both influenced by patients’ health status and involve a systemic physiological response. In view of the systemic function of endocrine hormones, endocrine disorders themselves and the therapeutics used to treat them can influence the outcomes of vaccination for COVID-19. However, there are very limited data to support the development of clinical guidelines for patients with specific medicalbackgrounds based on large clinical trials. In the current severe circumstances of the COVID-19 pandemic, position statements madeby clinical specialists are essential to provide appropriate recommendations based on both medical evidence and clinical experiences. As endocrinologists, we would like to present the medical background of COVID-19 vaccination, as well as precautions to prevent the side effects of COVID-19 vaccination in patients with specific endocrine disorders, including adrenal insufficiency, diabetesmellitus, osteoporosis, autoimmune thyroid disease, hypogonadism, and pituitary disorders.

The Effects of High Fat Diet and Resveratrol on Mitochondrial Activity of Brown Adipocytes

구철룡,조윤희,Zhen-Yu Hong,이하,이수지,홍승수,이은직 대한내분비학회 2016 Endocrinology and metabolism Vol.31 No.2

Background: Resveratrol (RSV) is a polyphenolic phytoalexin that has many effects on metabolic diseases such as diabetes andobesity. Given the importance of brown adipose tissue (BAT) for energy expenditure, we investigated the effects of RSV onbrown adipocytes. Methods: For the in vitro study, interscapular BAT was isolated from 7-week-old male Sprague Dawley rats. For the in vivostudy, 7-week-old male Otsuka Long Evans Tokushima Fatty (OLETF) rats were divided into four groups and treated for 27weeks with: standard diet (SD); SD+RSV (10 mg/kg body weight, daily); high fat diet (HFD); HFD+RSV. RSV was provided viaoral gavage once daily during the in vivo experiments. Results: RSV treatment of primary cultured brown preadipocytes promoted mitochondrial activity, along with over-expression ofestrogen receptor α (ER-α). In OLETF rats, both HFD and RSV treatment increased the weight of BAT and the differentiation ofBAT. However, only RSV increased the mitochondrial activity and ER-α expression of BAT in the HFD-fed group. Finally, RSVimproved the insulin sensitivity of OLETF rats by increasing the mitochondrial activity of BAT, despite having no effects onwhite adipocytes and muscles in either diet group. Conclusion: RSV could improve insulin resistance, which might be associated with mitochondrial activity of brown adipocyte. Further studies evaluating the activity of RSV for both the differentiation and mitochondrial activity of BAT could be helpful ininvestigating the effects of RSV on metabolic parameters.

무도병을 동반한 그레이브스병 1예

구철룡,박형준,홍성진,신동엽,이진하,정문재,조미애,노태웅,이병인,이은직 대한내분비학회 2008 Endocrinology and metabolism Vol.23 No.5

Hyperthyroidism is invariably accompanied by nervous system dysfunction. Specifically, irritability, emotional lability, and hyperkinesia are the signs and symptoms most frequently observed. In rare instances, chorea and/or choreoathetosis are associated with hyperthyroidism. Full evaluation for the etiology of chorea is necessary prior to initiating treatment. We recently encountered a 42-year-old female who initially presented with hyperthyroidism and showed subsequent development of progressive generalized chorea. The patient was diagnosed with chorea secondary to Graves’ disease after exclusion of other causes of chorea and improved after the initiation of pulse administration of intravenous methylprednisolone sodium succinate (Solu-medrol®, 1000 mg for 5 days) and oral antithyroid medication. This treatment strategy resulted in the resolution of involuntary movements. The steroid administration was eventually tapered, and the patient has been maintained on antithyroid and steroid therapy with considerable success since the initiation of treatment

Precision Therapy in Acromegaly: How Close Is It to Reality?

구철룡,Vladimir Melnikov,Zhaoyun Zhang,이은직 대한내분비학회 2020 Endocrinology and metabolism Vol.35 No.2

Acromegaly presents with an enigmatic range of symptoms and comorbidities caused by chronic and progressive growth hormoneelevations, commonly due to endocrinologic hypersecretion from a pituitary gland tumor. Comprehensive national acromegaly databases have been appearing over the years, allowing for international comparisons of data, although still presenting varying prevalence and incidence rates. Lack of large-scale analysis in geographical and ethnic differences in clinical presentation and management requires further research. Assessment of current and novel predictors of responsiveness to distinct therapy can lead to multilevel categorization of patients, allowing integration into new clinical guidelines and reduction of increased morbidity and mortality associated with acromegaly. This review compares current data from epidemiological studies and assesses the present-day applicationof prognostic factors in medical practice, the reality of precision therapy, as well as its future prospects in acromegaly, with a specialfocus on its relevance to the South Korean population.

비기능성 뇌하수체 선종 환자에게서 뇌하수체 기능 저하와 자기공명영상검사 소견과의 상관 관계

김현민,구철룡,이은영,이우경,임정수,황세나,이미정,이승구,김선호,이은직 대한내분비학회 2010 Endocrinology and metabolism Vol.25 No.4

Background: Non-functioning pituitary adenomas (NFPAs) are characterized by the absence of clinical and biochemical evidence of pituitary hormone hypersecretion, and these tumors constitute approximately one third of all the tumors of the anterior pituitary. Recently, hormonal deficiencies have gradually evolved to become the leading presenting signs and symptoms in patients with NFPAs. We investigated pituitary hormonal insufficiencies according to the magnetic resonance imaging (MRI) findings in patients with NFPA. Methods: We evaluated the patients who were newly diagnosed with NFPA from 1997 through 2009. Among them, we analyzed 387patients who were tested for their combined pituitary function and who underwent MRI. The severity of the hypopituitarism was determined by the number of deficient axes of the pituitary hormones. On the MRI study, the maximal diameter of the tumor, Hardy’s classification, the thickness of the pituitary gland and the presence of stalk compression were evaluated. Results: The mean age was 46.85 ± 12.93 years (range: 15-86) and 186 patients (48.1%) were male. As assessed on MRI, the tumor diameter was 27.87 ± 9.93 mm, the thickness of the normal pituitary gland was 1.42 ± 2.07 mm and stalk compression was observed in 201 patients (51.9%). Hypopituitarism was observed in 333 patients (86.0%). Deficiency for each pituitary hormone was most severe in the patients with Hardy type IIIA. Hypopituitarism was severe in the older age patients (P = 0.001) and the patients with a bigger tumor size (P < 0.001) and the presence of stalk compression (P < 0.001). However, the patients who had a thicker pituitary gland showed less severe hypopituitarism (P < 0.001). Multivariate analysis showed that age, tumor diameter and the thickness of pituitary gland were important determinants for pituitary deficiency (P = 0.004, P < 0.001, P = 0.022, respectively). Conclusion: The results suggest that the hormonal deficiencies in patient with NFPA were correlated with the MRI findings, and especially the tumor diameter and preservation of the pituitary gland.

Danshen Extracts Prevents Obesity and Activates Mitochondrial Function in Brown Adipose Tissue

조윤희,구철룡,Young-Suk Choi,이현정,이은직 대한내분비학회 2021 Endocrinology and metabolism Vol.36 No.1

Background: Danshen has been widely used in oriental medicine to improve body function. The purpose of this study is to investigate the effect of water-soluble Danshen extract (DE) on weight loss and on activation proteins involved in mitochondrial biogenesis in brown adipose tissue (BAT) in obese mice. Methods: BAT was isolated from 7-week-old male Sprague-Dawley rats, and expression of proteins related to mitochondrial biogenesis was confirmed in both brown preadipocytes and mature brown adipocytes treated with DE. For the in vivo study, low-density lipoprotein receptor knock out mice were divided into three groups and treated for 17 weeks with: standard diet; high fat diet (HFD); HFD+DE. Body weight was measured every week, and oral glucose tolerance test was performed after DE treatment in streptozotocin-induced diabetic mice. To observe the changes in markers related to thermogenesis and adipogenesis in the BAT, white adipose tissue (WAT) and liver of experimental animals, tissues were removed and immediately frozen in liquid nitrogen. Results: DE increased the expression of uncoupling protein 1 and peroxisome proliferator-activated receptor gamma coactivator 1-alpha in brown preadipocytes, and also promoted the brown adipocyte differentiation and mitochondrial function in the mature brown adipocytes. Reactive oxygen species production in brown preadipocytes was increased depending on the concentration of DE. DE activates thermogenesis in BAT and normalizes increased body weight and adipogenesis in the liver due to HFD. Browning of WAT was increased in WAT of DE treatment group. Conclusion: DE protects against obesity and activates mitochondrial function in BAT.

Early Prediction of Long-Term Response to Cabergoline in Patients with Macroprolactinomas

이영기,구철룡,김의현,홍재원,이은직,김선호 대한내분비학회 2014 Endocrinology and metabolism Vol.29 No.3

Background: Cabergoline is typically effective for treating prolactinomas; however, some patients display cabergoline resistance, and the early characteristics of these patients remain unclear. We analyzed early indicators predicting long-term response to cabergoline. Methods: We retrospectively reviewed the cases of 44 patients with macroprolactinomas who received cabergoline as first-line treatment; the patients were followed for a median of 16 months. The influence of various clinical parameters on outcomes was evaluated. Results: Forty patients (90.9%) were treated medically and displayed tumor volume reduction (TVR) of 74.7%, a prolactin normalization (NP) rate of 81.8%, and a complete response (CR; TVR >50% with NP, without surgery) rate of 70.5%. Most patients (93.1%) with TVR ≥25% and NP at 3 months eventually achieved CR, whereas only 50% of patients with TVR ≥25% without NP and no patients with TVR <25% achieved CR. TVR at 3 months was strongly correlated with final TVR (R=0.785). Patients with large macroadenomas exhibited a low NP rate at 3 months, but eventually achieved TVR and NP rates similar to those of patients with smaller tumors. Surgery independently reduced the final dose of cabergoline (β=−1.181 mg/week), and two of four patients who underwent surgery were able to discontinue cabergoline. Conclusion: Determining cabergoline response using TVR and NP 3 months after treatment is useful for predicting later outcomes. However, further cabergoline administration should be considered for patients with TVR >25% at 3 months without NP, particularly those with huge prolactinomas, because a delayed response may be achieved. As surgery can reduce the cabergoline dose necessary for successful disease control, it should be considered for cabergoline-resistant patients.

Characteristics of Acromegaly in Korea with a Literature Review

홍재원,구철룡,이은직,김선호 대한내분비학회 2013 Endocrinology and metabolism Vol.28 No.3

Acromegaly is a slowly progressive disease caused by excessive growth hormone (GH), which is related to a GH secreting pituitary tumor in most cases. Herein, we describe the epidemiology, clinical characteristics, and treatment of acromegaly in Korea with a literature review. The average annual incidence of acromegaly in Korea was 3.9 cases per million people, which was within the range of previous Western studies. The primary treatment for acromegaly was also transsphenoidal adenomectomy, which accounted for 90.4% of patients whose primary therapeutic options were known. The overall surgical remission rates were 89%, 87%, 64%, 70%, and 50% for modified Hardy classification I, II, IIIA, IIIB, and IV, respectively. An updated and larger study regarding the treatment outcome of medical/radiotherapy in Korean acromegalic patients is needed.