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당뇨병성 심혈관계 자율신경병증 환자에서 Corrected QT 간격 연장에 관한 연구
박종선(Jong Seon Park),이찬우(Chan Woo Lee),전준하(Jun Ha Jeun),정성복(Seong Pok Cheong),원규장(Kyu Chag Won),이충기(Choong Ki Lee),현명수(Myung Soo Hyun),최수봉(Soo Bong Choi),이현우(Hyun Woo Lee),이인규(In Kyu Lee) 대한내과학회 1992 대한내과학회지 Vol.43 No.1
Background: Diabetic cardiac autonomic neuropathy may result in sympathetic imbalance and QTc interval prolongation, predisposing these patients to arrhythmias and sudden death. A simple method for evaluating alterations in cardiac sympathetic innervation may be measurement of the QTc interval. We investigated the relations between QTc interval and diabetic cardiac autonomic neuropathy. Methods: Fifty five patients with type-II diabetics were separated into 4 groups based on the presence and degree of cardiac autonomic neuropathy (CAN) with noninvasive cardiovascular autonomic reflexes and blood pressure response. None of the patients had evidence of ischemic heart disease, or the idiopathic long QT interval syndrome. The corrected QT interval (QTc) was determined at rest with Bazett`s formula. Results: Diabetic patients with ³ 1 abnormality had a prolonged QTc interval compared with a control group of 55 healthy non-diabetic subjects (mean±SD 401±2msec) (p<0.001) and diabetic patients with ³2 abnormalities of cardiac autonomic function had a longer QTc interval than those with no evidence of CAN. There was a direct linear relationship between the severity of CAN and the QTc interval (r=0.559, p<0. 001), and the frequency of prolonged (>434msec, normal mean+2SD) resting QTc interval increased with the increasing number of abnormalities (CAN score 0, 1, 2, ³3:0%, 8%, 54%, and 63%), respectively. 15 patients had a prolonged QTe interval (mean 447msec) and 40 patients had a normal QTc interval (mean 414msec). The two groups were comparable in age (56 vs. 58yrs), and duration of diabetes (9 vs. 8yrs) and not comparable in degree of glycemic control (HbA1c 11.6 vs. 14.3%). All of 15 patients with a prolonged QTc interval had evidence of CAN. However, 32% (15 of 47) of patients with CAN had a prolonged QTc interval. Conclusion: These results suggest that the resting QTc interval may be an additional, noninvasive diagnostic tool in the assessment of CAN in patients with diabetes mellitus.
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박경식,이승현,최석영,박태규,이동화,이찬우,정성복,이인규 啓明大學校 醫科大學 1997 계명의대학술지 Vol.16 No.3
부신피질 자극호르몬 단독결핍은 국내에서 7례만이 보고된 희귀 질환이며 병인 및 경과 등 아직 불분명한 측면이 많다. 이는 질환지체의 희귀성도 있지만 치료후 자연경과에 대한 장기적인 추적검사가 이루어진 경우가 드물기 때문이기도 하다. 저자들은 비특이적인 전신증상을 주소로 내원한 폐경기후의 56세 여자 환자에서 자가면역질환의 증거없이 고프로릭틴혈증을 보인 부신피질 자극호르몬 단독결핍 1례를 경험하고 1년간의 부신피질호르몬 대치요법후 추적검사를 실시하였기에 문헌 고찰과 함께 보고하는 바이다. Isolated ACTH deficiency is a rare disorder which shows secondary adrenal insufficiency with normal states of other pituitary hormones. A 56-year-old postmenopausal woman complaining general weakness and intermittent mental confusion presented negligible serum cortisol and ACTH level with hyperprolactinemia and mild hyponatremia. Rapid ACTH stimulation test did not show significant increase of serum cortisol level. Combined pituitary stimulation test showed negligible response of cortisol and ACTH, and slightly decreased response of prolactin and gonadotropin. But the responses of TSH and GH were normal. There was no evidence of organic pituitary of hypothalamic lesion in brain MRI and antithyroid autoantibody was not detected in serum. After receiving 12 months of glucocorticoid replacement therapy, she skipped the medicine for 3 weeks and we performed follow-up endocrinologic tests. Serum ACTH and cortisol level was also negligible and prolonged ACTH simulation test showed normal response of serum cortisol. CRF stimulation test showed no response of serum ACTH. Basal prolactin level was decreased to near normal and combined pituitary stimulation test showed normal response of prolactin with slightly blunted response of TSH and GH. We concluded that the case was nonautoimmune origined isolated ACTH deficiency which was accompanied by hyperprolactinemia and resultant deficiency of gonadotropin, so we report this case with review of literatures.
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