중추성 성조숙증 및 조기 사춘기 여아에서 성선자극호르몬 방출호르몬작용제의 용량에 따른 사춘기 억제 효과 비교

심계식,배종우,양유정 대한소아청소년과학회 2008 Clinical and Experimental Pediatrics (CEP) Vol.51 No.6

Purpose:There has been considerable disagreement regarding the most appropriate dosage of gonadotropin-releasing hormone agonist in cases of central precocious puberty. The aim of this study was to determine the appropriate dosage for suppression of the puberty in girls with central precocious or early puberty. Methods:Twenty-two girls with early puberty were randomly subjected to 3 types of dosages of leuprolide acetate for at least 6 months. The number of cases in groups 1, 2, and 3 were 7, 7, and 8, and dosages were 70, 90, and 110 µg/ kg/-month, respectively. Height, weight, bone age, Tanner stage of breast development, and serum levels of LH, FSH, estradiol, and progesterone were measured before treatment and after 6 months of treatment. The number of cases of puberty suppression was compared using a modified puberty suppression score with a nonparametric chi-square test. Results:There were no significant differences of chronologic and bone ages among the groups. There was a significant decrease in height SDS gain after 6 months in group 3 (P<0.05) compared with groups 1 and 2. Serum levels of LH, FSH, estradiol and progesterone were all significantly decreased after treatment in all 3 groups (P<0.05). The number of cases of puberty suppression in each group were 4 (57%), 5 (71%), and 8 (100%). There was a significantly increased proportion of suppression of puberty in group 3 (P<0.05). Conclusion:It was necessary to use a higher dose of gonadotropin-releasing hormone agonist to suppress early puberty in girls; however further longitudinal study will be needed for their prognosis of final adult height. (Korean J Pediatr 2008;51:635-639) Purpose:There has been considerable disagreement regarding the most appropriate dosage of gonadotropin-releasing hormone agonist in cases of central precocious puberty. The aim of this study was to determine the appropriate dosage for suppression of the puberty in girls with central precocious or early puberty. Methods:Twenty-two girls with early puberty were randomly subjected to 3 types of dosages of leuprolide acetate for at least 6 months. The number of cases in groups 1, 2, and 3 were 7, 7, and 8, and dosages were 70, 90, and 110 µg/ kg/-month, respectively. Height, weight, bone age, Tanner stage of breast development, and serum levels of LH, FSH, estradiol, and progesterone were measured before treatment and after 6 months of treatment. The number of cases of puberty suppression was compared using a modified puberty suppression score with a nonparametric chi-square test. Results:There were no significant differences of chronologic and bone ages among the groups. There was a significant decrease in height SDS gain after 6 months in group 3 (P<0.05) compared with groups 1 and 2. Serum levels of LH, FSH, estradiol and progesterone were all significantly decreased after treatment in all 3 groups (P<0.05). The number of cases of puberty suppression in each group were 4 (57%), 5 (71%), and 8 (100%). There was a significantly increased proportion of suppression of puberty in group 3 (P<0.05). Conclusion:It was necessary to use a higher dose of gonadotropin-releasing hormone agonist to suppress early puberty in girls; however further longitudinal study will be needed for their prognosis of final adult height. (Korean J Pediatr 2008;51:635-639)

소아청소년기 특발성 성조숙증의 치료

심계식,김정태 대한의사협회 2011 대한의사협회지 Vol.54 No.9

The incidence of idiopathic precocious puberty is rapidly increasing in Korea. The most common medication used for treatment is a gonadotropin releasing hormone agonist. However, there is some debate regarding the indication and timing of treatment, and the dosage of the medication, because there are many factors that can affect growth in children after delaying puberty. Also, there are new medications that can potentially delay the puberty with children, for example, gonadotropin releasing hormone antagonists and aromatase inhibitors which require extensive further study.

에스트로겐 수용체의 조직특이성 결손이 있는 암컷마우스의 성장과 사춘기 발달

심계식 대한소아내분비학회 2011 Annals of Pediatirc Endocrinology & Metabolism Vol.16 No.2

The roles of estrogen and its receptors are important for control of puberty, pubertal growth spurt, epiphyseal fusion of long bone, and accretion of bone mineral content in adolescent. But, the mechanism of functions of them is not fully understood. The female mice with tissue-specific knock out (KO) of estrogen receptor (ER) were generated to determine the roles of them in the growth and reproductive axis. The serum levels of growth hormone (GH) were decreased but the body lengths were not in somatotrope-specific ERα KO mice compared with wild ones. The onset of puberty was delayed in gonadotropin releasing hormone (GnRH) neuron -specific ERα KO mice. The reproductive axis was disturbed in gonadotrope-specific ERα KO mice. Additional studies are required to evaluate the various roles of estrogen and its receptors in growth and pubertal development. Future works will focus on the phenomes of tissue-specific KO of ERβ or aromatase in mice, other animal models, and in vitro or vivo studies of ER agonists or antagonists. (J Korean Soc Pediatr Endocrinol 2011;16:67-72)

Graves병 관해의 예측 지표

심계식 대한소아내분비학회 2007 Annals of Pediatirc Endocrinology & Metabolism Vol.12 No.1

한국소아 그레이브스 병 및 하시모투 갑상선염의 발생기전에서 HLA-DQ유전자의 역할

심계식,최규철,양세원 凡石學術奬學財團 2000 凡石學術論文集 Vol.4 No.-

Pubertal growth and epiphyseal fusion

심계식 대한소아내분비학회 2015 Annals of Pediatirc Endocrinology & Metabolism Vol.20 No.1

The complex networks of nutritional, cellular, paracrine, and endocrine factors are closely related with pubertal growth and epiphyseal fusion. Important influencing factors include chondrocyte differentiation capacity, multiple molecular pathways active in the growth plate, and growth hormone-insulin-like growth factor-I axis activation and epiphyseal fusion through estrogen and its receptors. However, the exact mechanisms of these phenomena are still unclear. A better understanding of the detailed processes involved in the pubertal growth spurt and growth plate closure in longitudinal bone growth will help us develop methods to efficiently promote pubertal growth and delay epiphyseal fusion with fewer adverse effects.

당뇨병 산모에서 출생한 신생아의 임상적 고찰

심계식 ( Kye Shik Shim ),이호석 ( Ho Seok Lee ),배종우 ( Chong Woo Bae ),차성호 ( Sung Ho Cha ),정사준 ( Sa Jun Chung ) 대한주산의학회 1995 Perinatology Vol.6 No.4

Cerebellar cavernous hemangioma that presented with posterior neck myalgia

백승아,심계식,방재승,윤경림 대한소아청소년과학회 2008 Clinical and Experimental Pediatrics (CEP) Vol.51 No.12

Cavernous hemangioma can occur in the entire brain but rarely in cerebellum, especially in the pediatric age group. Headache, seizure, gait disturbance, recurrent bleeding may be seen. This tumor is a relatively benign condition but if the lesion located in the posterior fossa or the brain stem bleeds, irreversible brain damage may occur because of its restrictive space. Moreover, it must be differentiated from malignant tumors. We report 12.6 year-old boy who represented posterior neck myalgia as the presenting symptom. The pain continued for about a month despite analgesic medications. Brain MRI showed intracranial hemorrhage in the left cerebellum (4.5 cm) representing repeated hemorrhages at different times and originated from the cavernous hemangioma accompanied by mild hydrocephalus. The lesion was surgically removed successfully and the cavernous hemangioma was confirmed by pathologic findings. After the follow-up period of 14 months, he is in good condition without any complications.

소아에서 성장촉진대체요법으로 사용된 한약의 예측성인신장에 대한 영향 분석

정환희,심계식 대한소아내분비학회 2008 Annals of Pediatirc Endocrinology & Metabolism Vol.13 No.2

Purpose : A lot of complementary therapies to increase final adult heights have been used in Korean children. We are going to investigate the effects of herbal medicines on predicted adult heights of children. Methods : Subjects were 29 children (13 boys & 16 girls) who visited to the growth clinic of the department of pediatrics in Kyunghee East-West Neo medical center from June 1st 2006 to June 30th 2008 and treated with herbal medicines and followed up over 1 year. At first visit, their mid-parental target height standard deviation score (MPHSDS), bone age, height SDS, height SDS adjusted for their bone ages (BAHSDS) and predicted adult height SDS (PAHSDS) were checked. After 1 year of complementary therapy, they were checked those parameters again. The differences of their MPHSDS, BAHSDS and PAHSDS before and after the therapy were compared with Wilcoxon signed rank test using SPSS 12.0. Results : The mean changes in BAHSDS after therapy in boys and girls were -0.17 and -0.05. The mean changes in predicted adult height SDS after therapy in boys and girls were -0.28 and 0.03. There were no significant differences between BAHSDS and PAHSDS before and after the therapy. Conclusion : There is little evidence that the use of herbal medicines to improve the final adult heights of the children was effective. It is necessary to evaluate the long-term effects or the side effects of these therapies on final adult heights in more children.

신생아 선별검사의 TSH치와 선천성 갑상선 기능저하증의 예후와의 연관성

박홍선,심계식,최규철 대한소아청소년과학회 2001 Clinical and Experimental Pediatrics (CEP) Vol.44 No.1

Purpose : It is important to diagnose and treat newborn patients with congenital hypothyroidism as soon as possible because of neurodevelopmental outcome. If we can detect more severe forms of congenital hypothyroidism with neonatal screening test, the results of treatment will improve. Methods : Sixty-four term infants whose TSH levels in neonatal screening test had been higher than 20■IU were recalled. Their serum levels of T3, T4, TSH and thyroid scans were checked. They were divided into two groups according to the results, in which T group had transient thyroid disease and P group had permanent congenital hypothyroidism. The TSH levels in neonatal screening test between the two groups were compared and correlated with T3, T4 and TSH levels in their serum. Results : The number of patients of T and P groups were 43 and 13 respectively. The mean TSH level of both group in neonatal screening test was 28.6■IU/mL and 55.7■IU/mL respectively. The mean TSH level in neonatal screening test is significantly higher in P than T group(P<0.05). If we choose 48■IU/mL as a cutoff value, the sensitivity of detecting the P group is 77% and the specificity is 100%. The TSH levels in neonatal screening test had a positive correlation with the serum TSH levels and a negative correlation with the serum T4 levels(r=0.56 P<0.01, r=-0.53 P<0.01). Conclusion : If the TSH level in neonatal screening test is greater than 48uIU/mL, there is a greater possibility of the permanent and severe congenital hypothyroidism. So we should try to diagnose and treat them more quickly. 목 적 : 선천성 갑상선 기능저하증 중 심한 경우는 조기치료를 하지 않으면 지능에 영구적인 손상을 줄 수 있으며, 또한 조기 치료군에서도 학습능력이나 미세 운동 기능에 있어서 장애를 보일 수 있다는 논문들이 최근에 많이 보고되고 있다. 따라서 신생아 선별검사로써 보다 조기에 이들을 구분하여 충분한 용량의 갑상선 호르몬 치료를 시작한다면 예후를 더욱 호전시킬 수 있을 것이다.방 법 : 1995년 1월부터 1999년 7월까지 을지의과대학교병원에서 출생한 신생아 중 주산기 문제가 없었던 만삭아를 대상으로 하였으며, 정상분만인 경우 생후 3일째, 제왕절개인 경우 생후 5일째 여과지에 혈액을 채취하여 TSH를 enzyme-linked immunosorbent assay(ELISA)법에 의해 측정하고, 수치가 20 μIU/mL 이상인 경우 외래로 소환하여 혈청에서 TSH(IRMA법), T4(RIA법), T3(RIA법)을 측정하고 갑상선 스캔을 시행하여 선천성 갑상선 기능저하증 유무를 확인하였다. 진단된 갑상선 기능저하증 소아를 영구적인 경우와 일과성인 경우로 구분하여 신생아 선별검사의 TSH치를 Wilcoxon rank sum test로 비교하였고, 혈청 TSH, T4, T3치와는 Spearman 상관계수에 의해 상관관계를 분석하였다.결 과 : 대상 환아 9,113명 중 신생아 선별검사의 TSH가 20μIU/mL 이상인 경우는 64명으로 0.7%의 양성률을 보였으며 이중 영구적인 선천성 갑상선 기능 저하증은 13명이었고, 일과성 질환인 경우는 43명이었으며 3명은 아직 분류가 안된 상태이며 5명은 소환에 불응하여 외래추적이 안 되었다. 영구적인 질환군에서 신생아 선별검사의 TSH치는 평균 55.7μIU/ mL였으며 일과성 질환군에서는 평균 28.6μIU/mL로서 P<0.01의 의미 있는 차이를 보였다. 또한 그 수치가 48μIU/mL 이상인 경우 심한 영구적 질환군일 가능성이 높다.