Tae-Seo Sohn

Serum 25-hydroxyvitamin D concentration and arterial stiffness among type 2 diabetes

AIM To evaluate the association between serum 25-hydroxyvitamin D [25(OH)D] and arterial stiffness in patients with type 2 diabetes. METHODS Serum 25(OH)D was measured in a cross-sectional sample of 131 men and 174 women aged 30 years and over in Korea. Arterial stiffness was assessed by pulse wave velocity (PWV) obtained with a VP-2000 pulse wave unit. Fasting plasma glucose, insulin, lipid profile, HbA1c, calcium, phosphorous, and HS-CRP were measured. RESULTS The prevalence of vitamin D deficiency was high (85.9%). Those with lower vitamin D levels had increased PWV. Using multivariate regression analysis, low 25(OH)D concentrations independently predicted PWV (p<0.001) in people with type 2 diabetes after adjustment for other risk factors such as age, smoking, hypertension, HS-CRP, diabetes duration, hypertension duration, HbA1c, and BMI. CONCLUSIONS Vitamin D deficiency is common in type 2 diabetes, and a low 25(OH)D level is significantly associated with increased arterial stiffness in these patients. Vitamin D may influence the development of cardiovascular disease. Clinical intervention studies are needed to clarify whether treatment with vitamin D decreases the risk of cardiovascular disease in patients with type 2 diabetes.

Comparison of cystatin C‐ and creatinine‐based estimation of glomerular filtration rate according to glycaemic status in Type 2 diabetes

Diabet. Med. 29, e121–e125 (2012)

Angiotensin II Inhibits Insulin Binding to Endothelial Cells

Background Insulin-mediated glucose uptake in insulin target tissues is correlated with interstitial insulin concentration, rather than plasma insulin concentration. Therefore, insulin delivery to the interstitium of target tissues is very important, and the endothelium may also play an important role in the development of insulin resistance. Methods After treating bovine aortic endothelial cells with angiotensin II (ATII), we observed the changes in insulin binding capacity and the amounts of insulin receptor (IR) on the cell membranes and in the cytosol. Results After treatment of 10-7M ATII, insulin binding was decreased progressively, up to 60% at 60 minutes (P<0.05). ATII receptor blocker (eprosartan) dose dependently improved the insulin binding capacity which was reduced by ATII (P<0.05). At 200 µM, eprosartan fully restored insulin binding capacity, althogh it resulted in only a 20% to 30% restoration at the therapeutic concentration. ATII did not affect the total amount of IR, but it did reduce the amount of IR on the plasma membrane and increased that in the cytosol. Conclusion ATII decreased the insulin binding capacity of the tested cells. ATII did not affect the total amount of IR but did decrease the amount of IR on the plasma membrane. Our data indicate that ATII decreases insulin binding by translocating IR from the plasma membrane to the cytosol. The binding of insulin to IR is important for insulin-induced vasodilation and transendothelial insulin transport. Therefore, ATII may cause insulin resistance through this endothelium-based mechanism.

Clinical Image: Gold thread acupuncture, a hedgehog‐like appearance

Gupta MA, et al. Recall of emotional states in posttraumatic stress disorder: an fMRI investigation. Biol Psychiatry 2003;53:204–10. 47. Mountz JM, Bradley LA, Modell JG, Alexander RW, TrianaAlexander M, Aaron LA, et al. Fibromyalgia in women: abnormalities of regional cerebral blood flow in the thalamus and the caudate nucleus are associated with low pain threshold levels. Arthritis Rheum 1995;38:926–38. 48. Davis KD. The neural circuitry of pain as explored with functional MRI. Neurol Res 2000;22:313–7. 49. Geuze E, Westenberg HG, Jochims A, de Kloet CS, Bohus M, Vermetten E, et al. Altered pain processing in veterans with posttraumatic stress disorder. Arch Gen Psychiatry 2007;64: 76–85. 50. Staud R, Rodriguez ME. Mechanisms of disease: pain in fibromyalgia syndrome. Nat Clin Pract Rheumatol 2006;2:90–8. 51. Stoeter P, Bauermann T, Nickel R, Corluka L, Gawehn J, Vucurevic G, et al. Cerebral activation in patients with somatoform pain disorder exposed to pain and stress: an fMRI study. Neuroimage 2007;36:418–30. 52. Bohr TW. Fibromyalgia syndrome and myofascial pain syndrome: do they exist? Neurol Clin 1995;13:365–84.

A giant carotid aneurysm with intrasellar extension: a rare cause of panhypopituitarism.

A 73-year-old woman presented at our institution with a 1-day history of drowsy mental status and a 2-month history of headache and general weakness. She had not taken any medications. Laboratory investigations showed severe hyponatremia (Na, 114 mEq/L) and a potassium level of 3.2 mEq/L. A computed tomography (CT) angiogram showed an intrasellar 3.0-cm aneurysm arising from the left internal carotid artery (Fig. 1A and 1B). Basal pituitary hormone profiles showed morning cortisol, 1.43 µg/dL; adrenocorticotrophic hormone, 21.86 pg/mL; thyroid stimulating hormone, 1.36 mIU/L; free thyroxine, 0.6 ng/dL; follicle stimulating hormone, 2.46 IU/L; luteinizing hormone, 0.23 IU/L; and prolactin, 45.72 ng/mL, suggesting panhypopituitarism. A T1-weighted magnetic resonance image (MRI) revealed an aneurysm compressing the pituitary gland that was enhanced heterogeneously after injecting gadolinium (Fig. 1C).

A case of Mayer-Rokitansky-Küster-Hauser syndrome presenting as Graves disease.

Abstract The Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is a congenital disorder characterized by aplasia of the uterus and the upper part of the vagina in an XX individual with normal development of secondary sexual characteristics. Individuals with this syndrome may also present with renal and skeletal abnormalities. We report a case of a 16-year-old girl presenting with thyrotoxicosis and primary amenorrhea. After being diagnosed with Graves disease, this patient was placed on antithyroid medication. Although her thyroid function normalized, she did not start to menstruate. Therefore, we assessed her primary amenorrhea and diagnosed the patient with MRKH syndrome through pelvic imaging. To our knowledge, an association between Graves disease and MRKH syndrome has not yet been reported.

Effects of glucose control on arterial stiffness in patients with type 2 diabetes mellitus and hypertension: An observational study

Objective We evaluated the association of glucose control with changes in arterial stiffness, inflammatory markers, and oxidative stress markers. Methods Sixty-four patients with uncontrolled type 2 diabetes mellitus (glycated hemoglobin [HbA1c] ≥ 9%) and hypertension were enrolled in this study. The patients were divided into two groups based on their post-treatment HbA1c level: HbA1c ≤ 7% (well-controlled group, n = 28) and HbA1c > 7% (uncontrolled group, n = 36). The pulse wave velocity, augmentation index, and markers of inflammation and oxidative stress were measured and analyzed. Results The patients’ mean baseline HbA1c level was 11.7%. There were no differences in any baseline parameters between the two groups except the duration of diabetes. The mean HbA1c level was significantly lower at 12 weeks in the well-controlled than uncontrolled group (6.1% vs. 9.0%, respectively), but there were no significant differences in the pulse wave velocity (0.33 ± 0.95 vs. 0.36 ± 1.44 m/s), aortic augmentation index (5.1 ± 8.3 vs. 0.7 ± 11.6), or markers of inflammation and oxidative stress. Conclusions Short-term glycemic control did not influence the arterial stiffness in patients with type 2 diabetes mellitus and hypertension.

Dual ectopic thyroid presenting with an anterior neck mass

A 34-year-old woman presented with a 2-year history of anterior midline neck swelling. The physical examination revealed a soft, mobile, nontender, 2 × 1 cm, anterior midline neck mass. Ultrasonography showed a heterogeneously isoechoic mass (2.23 × 1.18 cm) in the subhyoid region, while a thyroid gland was not seen in the normal position (Fig. 1A). A 99mTc-pertechnetate scan demonstrated two distinct focal areas of radiotracer uptake in the sublingual and subhyoid regions, without uptake in the region of the normal thyroid gland (Fig. 1B). Neck computed tomography (CT) revealed two heterogeneous hyperdense enhancing masses, one in the sublingual region and the other in the subhyoid region (Fig. 1C). The thyroid function tests suggested subclinical hypothyroid status with a T4 level of 4.95 µg/dL (normal range, 4.7 to 12.5) and thyroid stimulating hormone level of 15.26 mIU/L (normal range, 0.17 to 4.65). Anti-microsomal antibody and anti-thyroglobulin antibody were negative. A dual ectopic thyroid was diagnosed based on the radiological findings and replacement therapy with levothyroxine was initiated. Figure 1 (A) Neck ultrasonography shows a heterogeneously isoechoic neck mass in the subhyoid region. (B) 99mTc pertechnetate thyroid scan shows two focal areas of uptake in the sublingual (upper arrow) and subhyoid regions (lower arrow)