MedClips

Diagnosis Adrenocortical carcinoma is a rare cancer that occurs in one to two patients per million per year. Adrenocortical carcinoma is thought to be a very malignant tumor, but it exhibits very different biological and clinical characteristics for each individual. Patients with large, suspected adrenal tumors should be treated with a multidisciplinary team of medical professionals including endocrine, cancer, surgeon, radiologist, and pathologist. A suspected adrenocortical carcinoma is not an indication for FNA. First, malignancy and benignity of the adrenal mass can not be distinguished either cytologically or pathologically. Second, FNAs invade cancer capsules and can lead to cancer metastasis. It is difficult to distinguish benign from malignant pathologically even when the whole cancer mass is present. The most commonly used pathological category is Weiss Score. Weiss Score considers high nuclear grade, rate of dissection (> 5 / HPF), atypical cleavage, clear cell of 25% or ...

Epidemiology Adrenal incidentaloma is an adrenal mass lesion with a diameter of more than 1 cm incidentally detected by imaging. Adrenal incidentaloma is found in at least 2% of the population, and the prevalence increases with age. Adrenal incidentaolma is found in 1% of 40s and 7% of 70s. Most adrenal incidentalomas are endocrine-inactive adrenocortical adenomas that do not release hormones. The prevalence of endocrine-inactive adrenocortical adenoma is 60 to 85% of endocrine-active adrenocortical adenoma, endocrine-active adrenocortical adenoma is 5 to 10% of cortisol producing adenoma, aldosterone-producing adenoma is 2 to 5%, and pheochromocytoma is 5 to 10 %. 2 to 5% of the unilateral adrenal mass is a malignant adrenocortical carcinoma and 15% is metastatic cancer at other sites. Diagnosis Diagnostic evaluation should be performed in patients with adrenal masses greater than 1 cm. Two important factors must be considered. First, does the tumor secrete hormones that can harm...

DKA and HHS are among the most urgent complications of diabetes. DKA is known as Diabetic and Ketoacidosis is found. It is mainly caused by lack of insulin administration or infection in patients with type 1 diabetes. HHS is the hyperglycemic hyperosmolar state most commonly caused by infection in patients with type 2 diabetes. In DKA, metabolic acidosis is frequently found and serum glucose is found to be less than 800 mg / dl. However, occasional severe DKA patients may exceed 900 mg / dl. HHS shows differences in the presence or absence of DKA and ketone acidosis and the elevation of blood glucose. However, DKA and HHS coexist in approximately one-third of all acute complications. Treatment The treatment of DKA and HHS is similar in that the fluid and electrolytes are matched and insulin is administered. The first step of treatment is the supplementation of the extracellular volume by administering isotonic saline. First, treatment is meaningful because it can stabilize cardio...

Causes Cushing's syndrome is a syndrome characterized by hypertension, fatigability, weakness, sexual dysfunction, striae, edema, osteoporosis, and truncal obesity of chronic glucocorticoid (cortisol). Cushing's syndrome is the cause of exogenous origin of cushing's syndrome caused by drugs such as glucocorticoid. The next is cushing's syndrome of endogenous origin. ACUT-dependent pituitary adenoma, cushing's disease, is a microadenoma of less than 10 mm mostly over 90%. It may also be caused by ectopic ACTH secretion. This may be caused by SCLC, thymoma, pancreatic islet cell tumor, MTC, and pheochromocytoma, which induces hypersecretion of ACTH at the origin, not the pituitary gland. ACTH independent causes are adrenal neoplasm and adrenal nodular hyperplasia. Adrenal neoplasm is usually unilateral, 8-10% of adenoma, and 8-10% of carcinoma. Therefore, it must be distinguished, and if it is uncertain as to the imaging test, postoperative biopsy is essential. It i...

Diagnosis The diagnosis of Cushing's syndrome begins with identifying and abolishing the history of the disease, such as when taking herbal medicines, taking steroids, or injecting intra-articular steroids. There were three screening tests: the first one was overnight 1 mg dexamethasone suppression test, and the first one was dexamethasone 1 mg at 11 o'clock the night before, and the next day at 8 o'clock, plasma cortisol was measured at 1.8 ug / dL Or more. This test is called pseudo-cushing's syndrome, which is very likely to be false, because it is very diverse, including obesity, depression, alcoholism, acute infection / trauma, and pregnancy. Re-measurement after removal and supplementation to other tests are necessary. The second is a 24hr urinary for cortisol excretion test, which is positive if the urine collected from the urine collected for 24 hours is higher than normal or the concentration is increased more than 3 times. The third screening test is positiv...

Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar status (HHS) are typical complications of diabetes mellitus. These are commonly characterized by insulin deficiency, volume depletion, and acid-base abnormalities. Generally, DKA has ketoacidosis associated with hyperglycemia and is known to occur mainly in diabetes mellitus (DM) type 1, but it also occurs in DM type 2 patients who do not show immunological characteristics of DM type 1. On the other hand, HHS is mainly found in DM type 2. DKA occurs well in younger patients under 65 years, whereas HHS tends to occur mainly in patients over 65 years of age Symptoms DKA generally has an acute tendency to develop for 24 hours. In some cases, DM type 1 is found through the diagnosis of DKA, but it is common in DM type 1 patients who are undergoing blood glucose control after diagnosis. Patients with DKA show nausea / vomiting and also thirst / polyuria due to hyperglycemia. In addition, increased osmolarity, dehydration, hypoten...

Bisphosphonate promotes the healing of osteolytic lesions and improves the histological features of the bone, so some clinicians believe that bisphosphonates should be prophylactically applied to prevent complications in young patients. However, there is a lack of data on whether this approach improves the long-term outcome. There is also insufficient data on whether maintaining ALP levels in the normal range reduces the risk of complications. In the 2009 PRISM study, bone pain control and maintenance of ALP normal range were compared between symptomatic treatment group and intensive bisphosphonate treatment group. In the group receiving symptomatic treatment alone, 50% maintained normal ALP for 2-4 years, and in the intentive treatment group, 80% could maintain normal ALP. However, there was no significant difference in rate of fractures, orthopedic procedure, and quality of life between the two groups. In the intensive treatment group, follow-up studies were performed in patients wit...

Pathogenesis Paget's disease of bone is characterized by increased bone remodeling and disorganization in the focal area of ​​the bone. One or more bones are involved, especially the axial skeletons pelvis (70%), femur (55%), lumbar spine (53%) and skull (42%). Paget's disease is rare in people under 55 years of age, but prevalence increases after age 55. In some countries it has been reported that 5% of women and 8% of men are lifelong. Especially in European people and rare in Africa and asian. This difference makes us suspect that this disease is not on a genetic basis. It is speculated that infections such as Paramyxovirus may act as triggers for the onset of Paget's disease. Paget's disease has a positive family history in 15% of patients, and the disease is inherited as an autosomal dominant, with incomplete penetrance. The SQSTM1 mutation is found in 40-50% of familial patients and 5-10% of sporadic disease patients. This gene codes for a protein that regulates ...

Diagnosis The most important diagnosis is the rapid ACTH stimulation test. This is a screening test to measure plasma cortisol and aldosterone 30-60 minutes after the administration of 250 ug of synthetic ACTH. Normal criteria were cortisol> 18 ug / dL or more than 7 ug / dL, aldosterone> 5 ng / dL or more. In the case of primary insufficiency, both cortisol and aldosterone did not respond. In case of secondary insufficiency, there was no cortisol response and aldosterone response was normal. Confirmatory test is a standard (prolonged) ACTH stimulation test, and continuous 24hr infusion is performed and measured. In addition, plasma ACTH levels are helpful for diagnosis. In the case of primary, the ACTH level is over 250 pg / mL, and in the case of secondary, it is in the range of 0-50 pg / mL. Treatments Treatment is hormone replacement. Primary adrenal insufficiency should supply both glucocorticoids and mineralocorticoids. Secondary adrenal insufficiency should be suppleme...

Causes The causes of primary adrenocortical insufficiency can be divided into the following five categories; Gland destruction (chronic & acute), impaired hormone production, ACTH-blocking antibodies, mutation of ACTH receptor gene, adrenal hypoplasia congenital. More than 90% of both glands must be destroyed before adrenal insufficiency develops. The most common cause of gland destruction is tuberculosis infection in Korea, and the most common cause of gland destruction is caused by autoimmune among idiopathic atrophy. This autoimmune destruction is due to cytotoxic T lymphocyte. Other causes of gland destruction include surgical removal, tuberculosis, infection with fungi and viruses, hemorrhagic infarction due to anticoagulation, and invasion of the tumor. Secondary adrenocortical insufficiency is a disease that lacks ACTH in the pituitary. Therefore, hypothyroid-pituitary disease-induced hypopituitarism, exogenous steroids, or endogenous steroids produced by tumors may cause...

Multiple endocrine neoplasia (MEN) is a tumor that occurs in two or more endocrine organs, and can be classified into four types: MEN 1,2,3,4. Each MEN can be inherited dominantly or sporadically without family history. The diagnosis of MEN is based on the following: (1) two or more clinical features according to the associated tumor, (2) family history, (3) genetic mutation associated with MEN, . In particular, genetic testing is crucial for the clinical diagnosis of MEN, and it is also very important for screening people who have genetic mutations in their families and for early treatment. Men type 1 (Wermer's syndrome) is characterized by the presence of parathyroids, pancreatic islets, and anterior pituitary tumors, and adrenal cortical tumors, carcinoid tumors of the foregut, meningiomas, facial angiofibromas, collagenomas, and lipomas . The prevalence of MEN1 is approximately 0.25%, ranging from 1-18% in primary hyperparathyroidism, 16-38% in pancreatic islet tumors, and les...

Symptoms In Graves' disease, all of the clinical features of thyrotoxicosis mentioned above may occur. In addition, diffuse thickening of the thyroid gland, protrusion of the eye, lid retraction, lid lag, ocular motility disorder, optic nerve disorder may occur. The patient seemed to have a slight protrusion of the eyeball, and the professor asked him to try the thyroid gland, but he could definitely touch the enlarged thyroid gland. Among the clinical features mentioned above, thyroid ophthalmopathy is a characteristic feature of Graves' disease, which is not seen in other thyrotoxicosis. It is caused by thickening of the autoantibody in the extraocular muscle and elevation of the intraocular pressure. It is rarely seen in other thyroid diseases with autoantibody besides Graves' disease. Diagnosis The first thing to do in a patient suspected of elevated thyroid function is to measure TSH and free T4. If TSH decreases and free T4 increases, it can be classified as prima...

Lactotroph adenoma (prolactinoma) is a pituitary adenoma that secretes prolactin. It is called a macroadenoma if the size is more than 1 cm and a microadenoma if it is smaller than 1 cm. Treatment is essential if the size of the adenoma is large enough to cause a neurologic symptom such as headache or visual impairment. It is also advisable to treat the adenoma if it goes beyond the sella or if the size continues to increase. Prolactinoma is well tolerated in drug therapy compared to other types of pituitary adenomas. Dopamine agonist reduces prolactinoma size and prolactin secretion. The secretion of prolactin by Lactotroph adenoma is generally proportional to the size of adenoma. Serum prolactin values ​​are usually no greater than 200 ng / mL for diameters less than 1 cm, 200 to 1000 ng / mL for diameters of 1.0 to 2.0 cm, and between 1000 ng / mL to 50,000 ng / mL for diameters exceeding 2 cm, ML. However, prolactinomas with poor differentiation do not secrete prolactin in large am...

Pathogenesis Osteogenesis imperfect (OI), also called brittle bone disease, is a type of connective tissue disease that causes skeletal fragility and growth deficiency in the bones. Currently, several genes have been identified as contributing to the disease. However, until now, mainly OI has been involved in the collagen structure-changing mutation of COL1A1 and COL1A2, which encode α1 and α2 chains that form collagen type I It has been known as an autosomal dominant disease. Several studies have also shown that a number of genes, including BRIL, PEDF, CRTAP, P3H1, CYPB, HSP47, WNT1 and BMP1, induce OI by mechanisms other than collagen formation. Symptoms Osteogenesis imperfecta is characterized by mild trauma or multiple fractures without any external factors. OI is initially diagnosed by clinical and radiographical findings. Clinical symptoms include mild trauma fractures, long bone curves Bowing, and growth abnormalities. In addition, the characteristic clinical features may in...

The treatment of DM depends on the type of DM. In the case of DM type I, insulin deficiency arising from the destruction of B cells due to autoimmunity is a direct problem. On the other hand, DM type II does not regulate blood glucose by insulin resistance. Therefore, treatment should be different according to etiology. Treatment of DM type I is aimed at lowering blood glucose by injecting insufficient insulin from the outside. Insulin is an injectable drug, and it is the most definitive hypoglycemic agent. However, there are problems such as hypoglycemia and weight gain. Human insulin and insulin analogue are present as insulin types. Regular insulin, which has a short duration in human insulin, can be expected to lower the blood sugar level for one meal because it takes about 1-2 hours. The human insulin intermediate type NPH insulin is available and has a working time of 12 hours. Insulin analogues include insulin lipro, insulin aspart, insulin glulisine, insulin detemir, and susta...

Diabetes mellitus is one of the most common diseases in our society. The American Diabetes Association (ADA) recommends that one of the following four tests be used to diagnose DM: glycated hemoglobin (A1C), fasting plasma glucose (FPG), random elevated glucose with symptoms, or abnormal oral glucose Tolerance test. In addition, people with impaired fasting glucose or impaired glucose tolerance are known to have a high rate of progression to DM and should receive periodic diagnostic tests. Symptoms Clinical symptoms are known to vary according to the type of DM. In general, DM type II is the most common type of DM occurring in adults (> 90%), which can be expressed by hyperglycemia and insulin resistance. The most typical clinical symptoms are asymptomatic and hyperglycemia. Many patients do not have any special symptoms, but hyperglycemia is often seen in screening tests such as health screenings. Asymptomatic patients have more than 126 mg / dL of fasting plasma glucose (FPG), ...