비정형 기관지 유암종에 의한 이소성 ACTH 증후군 1례

이창훈,천남일,홍세인,정진욱,윤인석,조동혁,강호철,정동진,정민영 全南大醫大 2001 전남의대학술지 Vol.37 No.2

외측 미칩 갑상선에서 발생하여 다발성 전이로 발현된 유두상 갑상선암 1예

천남일,이창훈,홍세인,정진욱,윤인석,조동혁,강호철,정동진,정민영 대한내분비학회 2001 Endocrinology and metabolism Vol.16 No.4-5

Associations among Body Mass Index, Insulin Resistance, and Pancreatic ß-Cell Function in Korean Patients with New-Onset Type 2 Diabetes

( Jin Ook Chung ),( Dong Hyeok Cho ),( Dong Jin Chung ),( Min Young Chung ) 대한내과학회 2012 The Korean Journal of Internal Medicine Vol.27 No.1

Background/Aims: We investigated the associations among body mass index (BMI), insulin resistance, and β-cell function in Korean patients newly presenting with type 2 diabetes. Methods: In total, 132 patients with new-onset type 2 diabetes mellitus were investigated. A standard 75-g oral glucose tolerance test was performed, and the indices of insulin secretion and insulin resistance were calculated. Results: A higher BMI was associated with higher homeostasis model assessment values for insulin resistance (HOMAIR), homeostasis model assessment of β-cell function (HOMA-β), and insulinogenic index as well as lower levels of insulin sensitivity index composite (ISIcomp) and disposition index (DI). In multiple regression models, BMI had independent positive associations with HOMA-IR, ISIcomp, and HOMA-β and inverse associations with the DI. Conclusions: Our results showed that BMI had independent positive associations with indices of insulin resistance and an inverse association with β-cell function adjusted for insulin resistance in Korean patients newly presenting with type 2 diabetes.

Ultrasonographic Features of Papillary Thyroid Carcinoma in Patients with Graves` Disease

( Jin Ook Chung ),( Dong Hyeok Cho ),( Dong Jin Chung ),( Min Young Chung ) 대한내과학회 2010 The Korean Journal of Internal Medicine Vol.25 No.1

Background/Aims: To characterize ultrasonographic findings in papillary thyroid carcinoma (PTC) combined with Graves` disease. Methods: Medical records and ultrasonographic findings of 1,013 patients with Graves` disease and 3,380 patients without Graves` disease were analyzed retrospectively. A diagnosis of PTC was based on a pathologic examination. Results: The frequency of hypoechogenicity was lower in patients with PTC and Graves` disease than in patients with PTC alone (p<0.05). The frequency of perinodular blood flow in patients with PTC and Graves` disease was significantly higher than in those with PTC alone (p<0.05). PTC combined with Graves` disease was characterized by more ill-defined borders and less frequency of overall calcification, punctate calcification, and heterogeneous echogenicity, although the difference was not statistically significant. Conclusions: Our results suggest that patients with Graves` disease more frequently have atypical PTC findings on ultrasonography. (Korean J Intern Med 2010;25:71-76)

Associations between serum apolipoproteins, urinary albumin excretion rate, estimated glomerular filtration rate, and diabetic retinopathy in individuals with type 2 diabetes :

Chung, Jin Ook,Park, Seon-Young,Cho, Dong Hyeok,Chung, Dong Jin,Chung, Min Young Williams & Wilkins Co 2019 Medicine Vol.98 No.20

associations between Hemoglobin concentrations and the clinical characteristics of Patients with type 2 Diabetes

( Jin Ook Chung ),( Dong Hyeok Cho ),( Dong Jin Chung ),( Min Young Chung ) 대한내과학회 2012 The Korean Journal of Internal Medicine Vol.27 No.3

Background/Aims: Many studies have demonstrated an association between hemoglobin levels and cardiovascular disease in diabetic patients. The aim of this study was to determine whether there is an association between hemoglobin concentrations and various clinical parameters, including metabolic factors, plasma C-peptide response after a meal tolerance test, and microvascular complications, in Korean patients with type 2 diabetes. Methods: In total, 337 male patients with type 2 diabetes were recruited. All subjects were subjected to a meal tolerance test and underwent assessment of hemoglobin levels, fasting and postprandial β-cell responsiveness, and microvascular complications. Results: Patients with lower hemoglobin concentrations had a longer duration of diabetes, a lower body mass index, and lower concentrations of total cholesterol, triglycerides, and low-density lipoprotein cholesterol. They also had lower levels of postprandial C-peptide, Δ C-peptide, and postprandial β-cell responsiveness. They had a higher prevalence of retinopathy and nephropathy. In multivariate analyses, there was a significant association between nephropathy and hemoglobin concentration. Also, hemoglobin concentrations were independently associated with Δ C-peptide levels and postprandial β-cell responsiveness. Conclusions: Hemoglobin concentrations are associated with postprandial C-peptide responses and diabetic nephropathy in patients with type 2 diabetes.

터너증후군과 동반된 그레이브스병 1예

정진욱 ( Jin Ook Chung ),조동혁 ( Dong Hyeok Cho ),정동진 ( Dong Jin Chung ),정민영 ( Min Young Chung ) 대한내과학회 2008 대한내과학회지 Vol.74 No.3

저자들은 터너증후군으로 에스트로겐-프로게스테론 치료를 받고 있던 환자가 경부종대, 심계항진을 주소로 내원하여 갑상선호르몬검사, 갑상선자가항체검사, 방사선 동위원소 요오드섭취율 검사 등을 통하여 그레이브스병을 진단하였다. 터너증후군에서 동반되는 갑상선 기능이상은 불현성 또는 현성 갑상선 기능저하증이 비교적 흔한 것으로 알려져 있으나 그레이브스병도 드물게 나타날 수 있다고 알려져 있다. 저자들은 터너증후군에 동반된 그레이브스병 1예을 경험하였기에 문헌고찰과 함께 보고하는 바이다. It is becoming increasingly evident that adults with Turner`s syndrome are susceptible to endocrine autoimmunity. An increased prevalence of thyroid autoantibodies and hypothyroidism in patients with Turner`s syndrome has been reported, but the involvement of Graves` disease in these patients is relatively rare. We describe a case of Graves` disease associated with Turner`s syndrome. A 28-year-old woman was referred for diffuse anterior neck swelling and palpitation. She had been diagnosed with Turner`s syndrome with monosomy 45,X before the age of 9 years and she took estrogen together with progesterone. The physical examination revealed a firm, non-tender goiter. The T3 level was 632 ng/dL, the free T4 level was 5.68 ng/dL, the TSH level was 0.02 uIU/mL, the % of TSH-binding inhibiting immunoglobulin was 24% and the anti-thyroid autoantibodies were positive. The radioactive iodine uptake was increased. Therefore, she was diagnosed as having Graves` disease. (Korean J Med 74:325-329, 2008)

성인 당뇨병환자에서 GAD 자가항체 유무와 만성 합병증과의 관계

정진욱 ( Jin Ook Chung ),조동혁 ( Dong Hyeok Cho ),정동진 ( Dong Jin Chung ),정민영 ( Min Young Chung ) 대한당뇨병학회 2009 Diabetes and Metabolism Journal Vol.33 No.2

연구배경: 제2형 당뇨병환자의 대부분은 비면역학적 기전에 의해 발생하지만 초기에 제2형 당뇨병으로 진단되었던 일부 환자에서는 GAD에 대한 항체를 지니고 있다. 이러한 환자에서는 베타세포 기능 감소가 더 현저하며 마른 체형 및 고혈당의 빈도가 더 높다고 보고된다. 따라서 이러한 점들은 만성 미세혈관 합병증이나 대혈관 합병증의 발생에 있어서 인슐린저항성을 특징으로 하는 전형적인 제2형 당뇨병과는 다른 양상을 보일 수 있을 것으로 생각된다. 본 연구는 성인 당뇨병환자에서 GAD 자가항체 유무와 당뇨병성 만성미세혈관 합병증 및 대혈관 합병증 발생과의 관련성을 알아 보고자 하였다. 방법: 35세 이후에 임상적으로 제2형 당뇨병으로 진단된 환자들 중 GAD 자가항체 측정과 당뇨병성 합병증에 대한 평가가 이루어진 환자들을 대상으로 단면적 분석을 실시하였다. 신장, 체중, 체질량지수 및 허리둘레를 측정하였고, 혈장 혈당, C-펩티드, GAD 자가항체, 인슐린 농도, 당화혈색소, 총 콜레스테롤, 중성 지방, 고밀도지단백 콜레스테롤, 저밀도지단백 콜레스테롤, 유리지방산을 측정하였다. GAD 자가항체는 0.9 U/mL를 초과하는 경우 GAD 자가항체 양성으로 정의하였다. 당뇨병성 미세혈관합병증에 대한 평가를 위해서 안저촬영, 진동감각 역치 검사, 신경전도 검사 및 미세알부민뇨검사를 실시하였다. 대혈관 합병증의 유무를 확인하기 위해 관상동맥질환, 허혈성 뇌혈관질환 및 말초동맥혈관질환을 평가하였다. 결과: 총 427명의 환자 중 GAD 자가항체 양성인 환자는 26명이었으며 GAD 자가항체 음성인 환자는 401명이었다. GAD 자가항체 양성 환자에서 수축기 혈압이 낮았으며 고밀도지단백 콜레스테롤은 높았다(P<0.05). 또한 GAD 자가항체 양성 환자에서 공복 C-펩티드와 식후 C-펩티드 모두 유의하게 낮았다(P<0.001). 당뇨병성 미세혈관합병증의 유병률을 비교하였을 때 당뇨병성 망막병증은 GAD 자가항체 양성 환자가 19.2%, GAD 자가항체 음성 환자가 47.9%로 GAD 자가항체 양성 환자에서 유의하게 낮았다(P<0.05). 그 외 신증, 말초신경병증 및 심혈관계 자율신경병증은 두 군 사이에 유의한 차이를 보이지 않았다. 대혈관 합병증의 유병률을 비교하였을 때 관상동맥질환의 유병률은 GAD 자가항체 양성 환자에서 7.7%, GAD 자가항체 음성환자에서 11.2%로 두 군 사이에 유의한 차이는 없었다(P=0.755). 또한 허혈성 뇌혈관질환 및 말초동맥혈관질환의 유병률을 비교했을 때 두 군 사이에 유의한 차이는 관찰되지 않았다. 결론: GAD 자가항체 양성인 환자에서 자가항체 음성 환자에 비해 당뇨병성 망막병증의 유병률이 더 낮았으나 그 외 미세혈관 합병증과 대혈관 합병증의 유병률의 차이는 없었다. 따라서 GAD 자가항체 양성 환자에서 자가항체 음성환자에 비해 망막병증이 더 낮게 발생하는 요인에 대해서 더 많은 환자 군을 대상으로 한 전향적 연구가 필요할 것으로 사료된다. Background: Although the majority of diabetes mellitus (DM) patients diagnosed as adults have non-autoimmune forms of the disease, islet autoimmunity is encountered in some patients initially thought to have type 2 DM. The phenotype of DM patients with glutamic acid decarboxylase (GAD) antibodies is different from that of patients with GAD antibody-negative type 2 DM, with features such as relative leanness and hyperglycemia which may influence the development of complications. We sought to compare the prevalence of chronic complications in patients with and without the GAD antibody. Methods: We recruited 427 patients (M: 218, F: 209) that were clinically diagnosed with type 2 DM after the age of 35 years. We measured GAD antibody and assessed the factors associated with chronic microvascular and macrovascular complications. Results: Of these patients, 26 were GAD antibody-positive. The patients with GAD antibody had lower systolic blood pressure, higher high-density lipoprotein cholesterol value, and lower level of fasting and stimulated C-peptide than patients without GAD antibody (P<0.05). Also, the patients with GAD antibody had lower prevalence of retinopathy compared with the patients without GAD antibody (19.2 vs. 47.9%; P<0.05). The prevalence of nephropathy, peripheral neuropathy and cardiovascular autonomic neuropathy did not differ between the groups. In addition, the prevalence of coronary heart disease, cerebrovascular disease and peripheral arterial disease did not differ between the two groups. Conclusion: This study suggests that diabetic patients with GAD antibody have a lower risk for the development of retinopathy compared with patients without GAD antibody. (Korean Diabetes J 33:124-133, 2009)

증례 : 내분비-대사 ; 알도스테론 분비 부신샘종과 동측의 신장동맥혈관협착이 동반된 1예

진준 ( Joon Jin ),임철환 ( Chur Hoan Lim ),정진욱 ( Jin Ook Chung ),조동혁 ( Dong Hyeok Cho ),정동진 ( Dong Jin Chung ),정민영 ( Min Young Chung ),최유덕 ( Yoo Duk Choi ) 대한내과학회 2015 대한내과학회지 Vol.89 No.1

알도스테론 분비 부신샘종과 신장동맥협착을 동시에 보이는 예는 극히 드물다. 저자들은 약물로 조절되지 않은 고혈압을 주소로 내원한 52세 여자에게서 고알도스테론증을 시사하는 검사 소견이 있어 알도스테론 분비 부신샘종을 진단하였고 복강경하 좌측 부신절제술을 시행하였다. 수술로 제거하였음에도 불구하고 지속된 고혈압에 대해 평가하던 중 신장 동맥혈관조영술로 좌측 신장동맥협착을 진단하였고 풍선혈 관성형술을 시행하였다. 그 후 혈압은 항고혈압제 요구량이 감소하면서 조절된 양상을 보였다. 본 증례는 고알도스테론증을 보이는 환자를 평가하는 데 있어 신장동맥협착 동반 여부에 대한 평가가 필요함을 강조한다. The simultaneous occurrence of renovascular hypertension and an aldosterone-producing adrenal adenoma is a rare entity. Here, we report the case of a 52-year-old female who had a coexisting aldosterone-producing adrenal adenoma and ipsilateral renal artery stenosis. She was diagnosed with the aldosterone-producing adrenal adenoma and then underwent a laparoscopic left adrenalectomy. Her blood pressure was uncontrolled after the adrenalectomy. Selective renal angiography showed left renal artery stenosis; thus, she underwent balloon angioplasty at the same sitting. Subsequently, her blood pressure returned to normal after administration of a single antihypertensive drug. This case suggests that it is important to recognize the possible coexistence of renal artery stenosis in a patient with an aldosterone-producing adrenal adenoma. (Korean J Med 2015;89:97-101)

제2형 당뇨병 환자에서 알부민뇨와 말초동맥 질환과의 관계

박승환 ( Seong Hwan Park ),정진욱 ( Jin Ook Chung ),조동혁 ( Dong Hyeok Cho ),정동진 ( Dong Jin Chung ),정민영 ( Min Young Chung ) 대한내과학회 2011 대한내과학회지 Vol.81 No.1

Background/Aims: Albuminuria is an early indicator of renal damage in type 2 diabetes mellitus, and has been recognized as a risk factor for peripheral arterial disease (PAD). The aim of this study was to assess the association between albuminuria and PAD in Korean type 2 diabetes patients. Methods: Our retrospective study included 390 consecutive patients with type 2 diabetes mellitus. The ankle-brachial index (ABI) and toe-brachial index (TBI) were used to assess PAD. The urinary albumin-creatinine excretion ratio (UAE) was evaluated by determining the albumin/creatinine ratio (ACR) in the first voided morning urine sample. Results: Duration of diabetes, serum creatinine levels, and UAE were significantly higher in patients with low ABI scores (<0.9) than in those with normal ABI scores (≥0.9). Age, duration of diabetes, and UAE were significantly higher in patients with low TBI scores (<0.6) than in those with normal TBI scores (≥0.6). Albuminuria was independently associated with low ABI (OR=1.980,95% CI=1.001-3.918). It was also independently associated with low TBI and normal ABI (OR=3.149, 95% CI=1.260-7.871). Conclusions: The results of this study suggest that albuminuria may be associated with PAD, including in arteries distal to the ankle joint. (Korean J Med 2011;81:73-81)