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허규연 ( Kyu Yeon Hur ) 대한간학회 2018 Postgraduate Courses (PG) Vol.2018 No.1
Metabolic syndrome (MetS) is a disease composed of different risk factors such as obesity, type 2 diabetes or dyslipidemia. The prevalence of this syndrome is increasing worldwide in parallel with the rise in obesity. Nonalcoholic fatty liver disease (NAFLD), hepatic insulin resistance, and type 2 diabetes are all strongly associated, whether there is a causal link between NAFLD and hepatic insulin resistance is controversial. There is accumulating evidence supporting an association between NAFLD and MetS. Indeed, NAFLD is recognized as the liver manifestation of MetS. Insulin resistance is recognized as a key factor linking MetS and NAFLD. We will review the definition MetS and NAFLD, provide an overview of the common pathophysiological mechanisms linking MetS and NAFLD, and give a perspective regarding proper treatment of obesity, hyperglycemia, and dyslipidemia in patients with NAFLD.
제2형 당뇨병 환자에서 장기간의 Sodium-glucose Cotransporter 2 억제제 치료가 신장기능에 미치는 효과
백종하 ( Jong Ha Baek ),오태정 ( Tae Jung Oh ),문주영 ( Ju-young Moon ),김태희 ( Taehee Kim ),고승현 ( Seung Hyun Ko ),문민경 ( Min Kyong Moon ),김현정 ( Hyun Jung Kim ),이동원 ( Dong Won Lee ),허규연 ( Kyu Yeon Hur ) 대한내과학회 2020 대한내과학회지 Vol.95 No.4
Chronic kidney disease is developed commonly in type 2 diabetes mellitus (T2DM) and is the most common cause of end-stage renal disease and related cardiovascular complications. Meanwhile, despite the current standard of care including optimized glucose control and the use of single-agent blockade of the renin-angiotensin-aldosterone system (RAAS), patients with T2DM remain at increased risk for death and complications from cardiorenal causes. The recent studies using sodium-glucose cotransporter 2 (SGLT2) inhibitors have shown not only glucose lowering effect, but also a reduction in blood pressure, weight loss, and a lowering cardiovascular risk. Regarding renal outcomes, the use of SGLT2 inhibitor slows the progression of kidney disease compared to placebo when added to standard care. However, concern has been raised that currently available SGLT2 inhibitors in Korea may be also associated with improved renal outcomes with long-term treatment. As a result, we aimed to evaluate the effect of long-term SGLT2 inhibitor treatment on renal function in the patients with T2DM using meta-analysis. (Korean J Med 2020;95:236-243)
뇌하수체 선종으로 감마나이프 치료 시행 후 발생한 뇌하수체 상피양 골육종 1예
박소영 ( So Young Park ),김유진 ( You Jin Kim ),이은정 ( Eun Jeong Lee ),최재신 ( Jae Shin Choi ),김재현 ( Jae Hyeon Kim ),진상만 ( Sang Man Jin ),허규연 ( Kyu Yeon Hur ) 대한내과학회 2017 대한내과학회지 Vol.92 No.2
본 증례는 수술 및 감마나이프 치료로 뇌하수체 선종을 치료하고 추적 관찰 중이던 환자에서 13년 후 뇌하수체 상피양 골육종이 확인된 증례이다. 고전적 방사선 치료와 관련된 이차성 종양의 발생에 대하여는 잘 알려져 있으나 상대적으로 저선량이 사용되는 정위적 방사선 치료에서는 이와 관련된 보고는 매우 드물다. 정위적 방사선 치료 후 발생하는 이차성 종양은 흔하지 않으나 임상 의사가 염두에 두어야 하는 부작용 중 하나이므로 증례보고하는 바이다. With the increasing use of stereotactic radiosurgery, recent reports have suggested that stereotactic radiosurgery may induce sec-ondary malignancies. While the risk of secondary malignancy after conventional radiotherapy is well known, its development after stereotactic radiosurgery has been reported in only a few cases. Here we present the case of a 56-year-old female with visual dis-turbance of sudden onset. She underwent trans-sphenoidal surgery for a pituitary adenoma 13 years earlier. Imaging studies re-vealed a newly developed pituitary mass invading the right carvenous sinus. Gross total resection of the tumor was performed using a trans-sphenoidal and pterygopalatine fossa approach. The histological diagnosis was pituitary epithelioid osteosarcoma. Clinicians should be aware of the rare occurrence of radiation-induced pituitary sarcoma as a potentially fatal late complication of stereotactic radiosurgery. (Korean J Med 2017;92:195-199)
박소영,강은석,김소헌,도미영,허규연,차봉수,임승길,이현철,안상훈,문영명,박영년 대한내분비학회 2004 Endocrinology and metabolism Vol.19 No.1
고칼슘혈증은 다양한 질환에서 발생하지만 가장 흔한 원인은 악성종양과 일차성 부갑상선 기능항진증으로 전체 고칼슘혈증의 90%를 차지한다. 그 외 고칼슘혈증의 원인으로 thiazide 계통의 이뇨제 사용, 개심술,만성신부전 시 투여되는 약제, 갑상선중독증, 리튬치료, 고정화, 만성육아종성질환 등이 원인이 될 수 있으며 우리나라의 경우는 결핵을 꼭 감별 진단해야 한다. 저자들은 전신 무력감, 식욕부진을 주소로 내원하여 고칼슘혈증이 발견된 환자에서 폐결핵 없이 간결핵에 동반된 고칼슘혈증을 진단하고, 결핵치료를 통하여 고칼슘혈증을 교정한 1예를 경험하였기에 보고하는 바이다. In this report, a 70-year-old female patient was detected with laboratory findings of hypercalcemia. The most common causes of hypercalcemia are primary hyperparathyroidism and malignant disease. Her laboratory tests did not show any evidence for neither primary hyperparathyroidism nor malignant diseases. Thus, granulomatous disease was suspected as the cause of the hypercalcemia. Liver MRI (magnetic resonance image) was performed on the subject, which suggested the presence of hepatic tuberculosis and sarcoidosis. Because the chest x-ray did not show a definite tuberculous lesion, we performed a laparoscopic liver biopsy for a final diagnosis. Findings from the biopsy specimen showed typical tuberculosis. After treatment with tuberculosis medication, hypercalcemia of the subject was resolved. Hypercalcemia is a well recognized as a possible complication of active pulmonary tuberculosis. But one should consider hepatic tuberculosis without pulmonary tuberculosis as a cause of hypercalcemia (J Kor Soc Endocrinol 19:64∼68, 2004).