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증례 : 내분비-대사 ; 무균성 뇌수막염으로 오인된 뇌하수체졸증 1예
윤유선 ( Yu Seon Yun ),김은숙 ( Eun Sook Kim ),신정아 ( Jung Ah Shin ),강무일 ( Moo Il Kang ),윤건호 ( Kun Ho Yoon ),차봉연 ( Bong Yun Cha ),손호영 ( Ho Young Son ) 대한내과학회 2011 대한내과학회지 Vol.80 No.1
본 저자들은 뇌수막염 증상으로 오인되어 치료가 지연, 부신 위기 동반으로 악화된 후 진단된 뇌하수체 선종의 뇌하수체졸증 1예를 경험하여, 무균성 뇌수막염이 호전되지 않을 경우에는 드물지만 치명적인 경과를 보일 수 있는 뇌하수체졸증일 가능성을 상기하고자 이를 보고하는 바이다. Pituitary apoplexy is a clinical syndrome caused by an acute ischemic or hemorrhagic vascular accident. Although pituitary apoplexy is an emergency, it is often overlooked because it is rare and presents with various signs and symptoms, including those of neurologic and endocrine disorders. We describe a case of pituitary apoplexy misdiagnosed as aseptic meningitis accompanied by acute-onset headache and nausea, followed by fever. Subsequently, it was revealed as pituitary apoplexy by brain magnetic resonance imaging (MRI) performed when the clinical course worsened and ophthalmoplegia developed. We suggest that pituitary apoplexy be included in the differential diagnosis of patients presenting with headache or signs of meningeal irritation; when there is no clinical improvement, prompt steroid treatment should be started, while considering neurological decompression to prevent neurological sequelae. (Korean J Med 2011;80:102-107)
만성신부전증 환자에서 혈액투석, 복막투석 및 신장이식이 혈중 Apolipoprotein(a) 농도에 미치는 영향
윤건호 ( Kun Ho Yoon ),유순집 ( Soon Jip Yoo ),강무일 ( Moo Il Kang ),차봉연 ( Bong Yun Cha ),윤영석 ( Young Suk Yoon ),이광우 ( Kwang Woo Lee ),손호영 ( Ho Young Son ),강성구 ( Sung Koo Kang ),방병기 ( Byung Kee Bang ) 한국지질동맥경화학회(구 한국지질학회) 1996 韓國脂質學會誌 Vol.6 No.1
증례 : 내분비-대사 ; 아급성 갑상선염이 동반된 갑상선 자율기능성 결절 1예
강미자 ( Mi Ja Kang ),권혁상 ( Hyuk Sang Kwon ),최윤희 ( Yoon Hee Choi ),윤건호 ( Kun Ho Yoon ),차봉연 ( Bong Yun Cha ),손호영 ( Ho Young Son ),정찬권 ( Chan Kwon Jung ) 대한내과학회 2009 대한내과학회지 Vol.77 No.5
아급성 갑상선염은 갑상선의 바이러스 감염에 의해 유발되는 질환으로 수주에서 수개월 동안 갑상선 부위의 동통과 발열등 상기도 감염 유사 증상을 보인다. 그러므로 처음부터 갑상선 질환을 의심하는 경우보다는 상기도 감염으로 치료 중 호전을 보이지 않거나 갑상선의 결절이 촉지되면서 갑상선 질환을 의심하여 진단되는 경우가 많다. 저자 등은 압통성 갑상선 결절과 인후통을 주소로 내원한 환자에서 아급성 갑상선염으로 진단하고 치료 중 갑상선 스캔 검사에서 단일결절이외 조직에 방사능 섭취가 전혀 없는 갑상선 자율기능성 결절을 추가로 진단하였다. 저자들은 이들 질환의 병인에 대한 고찰을 통하여 연관성을 확인해보았으며, 특히 갑상선 자율기능성 결절에서 치료가 필요한 중독성 선종의 감별 진단법을 확인해 보았다. 정상 기능의 갑상선 자율기능성 결절도 아급성 갑상선염처럼 갑상선자극 호르몬이 억제되는 상태에서는 열 결절로 나타나게 되므로 추가 검사 없이도 자율성을 확인할 수 있었고, 서로 다른 병인을 가지기 때문에 드물게 볼 수 있는 아급성 갑상선염과 정상 기능을 갖는 갑상선 자율기능성 결절이 동반된 증례가 아직까지 국내에서 발표된 바 없어서 희귀한 증례로 보고하는 바이다. The most common cause of thyrotoxicosis is Graves` disease, followed by toxic adenoma, multiple nodular toxic goiter, and temporary thyroiditis. At initial presentation, however, it is often difficult to recognizinge subacute thyroiditis as a thyroid disease is often difficult. In many cases, subacute thyroiditis may be mistaken for certain upper respiratory infectious diseases, due to their similar clinical manifestations. Additionally, when subacute thyroiditis coexists with a thyroid nodule or is accompanied by severe thyrotoxicosis, it can be misdiagnosed as a thyroid tumor, toxic adenoma, or Graves` disease. Here we report the case of an autonomously functioning thyroid nodule combined with subacute thyroiditis, which was nearly misdiagnosed as toxic adenoma. This is the first reported case in Korea of a patient who had an autonomously functioning thyroid nodule combined with subacute thyroiditis, which was nearly misdiagnosed as toxic adenoma. (Korean J Med 77:630-636, 2009)
강무일(Moo Il Kang),이만영(Man Young Lee),한제호(Je Ho Han),손현식(Hyun Sik Son),윤건호(Kun Ho Yoon),홍관수(Kwan Soo Hong),차봉연(Bong Yun Cha),이광우(Kwang Woo Lee),손호영(Ho Young Son),강성구(Seung Ku Kang) 대한내과학회 1994 대한내과학회지 Vol.47 No.1
N/A Objectives: Amiodarone, a benzofuranic derivative containing 37. 2% iodine, is widely used for the long- term treatment of cardiac arrhythmias. It affects the peripheral metabolism of the thyroid hormones, and may induce hyperthyroidism and hypothyroidism. We performed this study to evaluate the effects of amiodarone on thyroid function. Methods: To evaluate the effects of amiodarone, antiarrhythmic drug, on thyroid function, we performed cross-sectional study in 30 patients (18 men and 12 women; mean age 61, 2 yr). All had a variety of cardiac diseases (ventricular tachycardia, supraventricular tachycardia, angina pectoris, cardiomyopathy) and taking long term amiodarone therapy (maintenance dose 200 mg; mean duration of treatment 18. 9 months). Thyroid status was assessed by clinical examination and thyroid function test (T3, T4, rT3, TSH, TRH test). Thyroid antimicrosomal antibody was measured using indirect agglutination method. All the tests were perfonned at the time of study only. Results: 1) Among 30 amiodarone treated patients, 3 were hyperthyroid and 1 was hypothyroid. So the incidence of amiodarone induced thyroid dysfunction was 13.3%(4/ 30). Including subclinical thyroid dysfunction, overall rate of thyroid dysfunction was 36.6%(11/30). 2) Antimicrosomal antibody was positive in 21,7% Sf patients (5/23). 3) Goiter was observed in 30%(9/30) of amiodarone treated patients and 63.6%(7/11) of patients with amiodarone induced thyroid dysfunction. 4) After TRH test in eleven euthyroid patients, 54,5% (6/11) showed abnormal response. 5) Between normal and abnormal responders in TRH test, there was no aignifieant difference in age and duration of amiodarone treatment (p>0,05). 6) In patients with thyroid dysfunction, duration of amiodarone treatment was significantly longer than euthyroid patients (p<0.02), but there was no significant difference in age between two groups (p>0.05), Conclusion: There results suggest that the incidence of thyroid dysfunction in amiadarone treated patients is high and further prospective study will be needed for more detailed information