의료 인공지능의 발전방향

황보율 대한응급의학회 2022 대한응급의학회 학술대회초록집 Vol.2022 No.1

Association of the Parathyroid Adenoma Volume and the Biochemical Parameters in Primary Hyperparathyroidism

황보율,김정희,안지현,홍은실,온정헌,김은기,강아름,조선욱,박도준,박경수,김성연,조보연,신찬수 대한내분비학회 2011 Endocrinology and metabolism Vol.26 No.1

Background: The objective of this study is to demonstrate the relationship between the volume of a parathyroid adenoma and the preoperative biochemical parameters in patients undergoing surgery for primary hyperparathyroidism. Methods: The medical records of 68 patients who underwent a parathyroidectomy for a single parathyroid adenoma were retrospectively reviewed. The volume of the adenoma was estimated using its measured size and a mathematical formula. The correlation between the volume of the parathyroid adenoma and the preoperative laboratory data was assessed. Results: There were no correlations between the estimated volume of the adenoma and the serum calcium, alkaline phosphatase and parathyroid hormone levels. However, the volume of the adenoma was associated with the preoperative level of serum phosphorus. After excluding 5 adenomas with cystic degeneration, a positive correlation was noted between the adenoma volume and the preoperative levels of alkaline phosphatase and parathyroid hormone. Conclusion: The preoperative serum levels of calcium, alkaline phosphatase and parathyroid hormone are of limited use to predict the volume of the parathyroid adenoma in patients with a single parathyroid adenoma. We suggest that the absence of a correlation between the volume of the adenoma and the biochemical parameters can be attributed to the cystic degeneration of the adenomas.

Acute Hyperglycemia Associated with Anti-Cancer Medication

황보율,이은경 대한내분비학회 2017 Endocrinology and metabolism Vol.32 No.1

Hyperglycemia during chemotherapy occurs in approximately 10% to 30% of patients. Glucocorticoids and L-asparaginase are wellknown to cause acute hyperglycemia during chemotherapy. Long-term hyperglycemia is also frequently observed, especially in patientswith hematologic malignancies treated with L-asparaginase-based regimens and total body irradiation. Glucocorticoid-inducedhyperglycemia often develops because of increased insulin resistance, diminished insulin secretion, and exaggerated hepatic glucoseoutput. Screening strategies for this condition include random glucose testing, hemoglobin A1c testing, oral glucose loading, andfasting plasma glucose screens. The management of hyperglycemia starts with insulin or sulfonylurea, depending on the type, dose,and delivery of the glucocorticoid formulation. Mammalian target of rapamycin (mTOR) inhibitors are associated with a high incidenceof hyperglycemia, ranging from 13% to 50%. Immunotherapy, such as anti-programmed death 1 (PD-1) antibody treatment,induces hyperglycemia with a prevalence of 0.1%. The proposed mechanism of immunotherapy-induced hyperglycemia is an autoimmuneprocess (insulitis). Withdrawal of the PD-1 inhibitor is the primary treatment for severe hyperglycemia. The efficacy of glucocorticoidtherapy is not fully established and the decision to resume PD-1 inhibitor therapy depends on the severity of the hyperglycemia. Diabetic patients should achieve optimized glycemic control before initiating treatment, and glucose levels should bemonitored periodically in patients initiating mTOR inhibitor or PD-1 inhibitor therapy. With regard to hyperglycemia caused by anticancertherapy, frequent monitoring and proper management are important for promoting the efficacy of anti-cancer therapy and improvingpatients’ quality of life.

Genome-Wide Association Studies of Autoimmune Thyroid Diseases, Thyroid Function, and Thyroid Cancer

황보율,박영주 대한내분비학회 2018 Endocrinology and metabolism Vol.33 No.2

Thyroid diseases, including autoimmune thyroid diseases and thyroid cancer, are known to have high heritability. Family and twin studies have indicated that genetics plays a major role in the development of thyroid diseases. Thyroid function, represented by thyroid stimulating hormone (TSH) and free thyroxine (T4), is also known to be partly genetically determined. Before the era of genome-wide association studies (GWAS), the ability to identify genes responsible for susceptibility to thyroid disease was limited. Over the past decade, GWAS have been used to identify genes involved in many complex diseases, including various phenotypes of the thyroid gland. In GWAS of autoimmune thyroid diseases, many susceptibility loci associated with autoimmunity (human leukocyte antigen [HLA], protein tyrosine phosphatase, non-receptor type 22 [PTPN22], cytotoxic T-lymphocyte associated protein 4 [CTLA4], and interleukin 2 receptor subunit alpha [IL2RA]) or thyroid-specific genes (thyroid stimulating hormone receptor [TSHR] and forkhead box E1 [FOXE1]) have been identified. Regarding thyroid function, many susceptibility loci for levels of TSH and free T4 have been identified through genome-wide analyses. In GWAS of differentiated thyroid cancer, associations at FOXE1, MAP3K12 binding inhibitory protein 1 (MBIP)-NK2 homeobox 1 (NKX2-1), disrupted in renal carcinoma 3 (DIRC3), neuregulin 1 (NRG1), and pecanex-like 2 (PCNXL2) have been commonly identified in people of European and Korean ancestry, and many other susceptibility loci have been found in specific populations. Through GWAS of various thyroid-related phenotypes, many susceptibility loci have been found, providing insights into the pathogenesis of thyroid diseases and disease co-clustering within families and individuals

Prevalence and Clinical Characteristics of Recently Diagnosed Type 2 Diabetes Patients with Positive Anti-Glutamic Acid Decarboxylase Antibody

황보율,김진택,김은기,강아람,오태정,장학철,박경수,김성연,이홍규,조영민 대한당뇨병학회 2012 Diabetes and Metabolism Journal Vol.36 No.2

Background: Latent autoimmune diabetes in adults (LADA) refers to a specific type of diabetes characterized by adult onset, presence of islet auto-antibodies, insulin independence at the time of diagnosis, and rapid decline in β-cell function. The prevalence of LADA among patients with type 2 diabetes varies from 2% to 20% according to the study population. Since most studies on the prevalence of LADA performed in Korea were conducted in patients who had been tested for anti-glutamic acid decarboxylase antibody (GADAb), a selection bias could not be excluded. In this study, we examined the prevalence and clinical characteristics of LADA among adult patients recently diagnosed with type 2 diabetes. Methods: We included 462 patients who were diagnosed with type 2 diabetes within 5 years from the time this study was performed. We measured GADAb, fasting insulin level, fasting C-peptide level, fasting plasma glucose level, HbA1c, and serum lipid profiles and collected data on clinical characteristics. Results: The prevalence of LADA was 4.3% (20/462) among adult patients with newly diagnosed type 2 diabetes. Compared with the GADAb-negative patients, the GADAb-positive patients had lower fasting C-peptide levels (1.2±0.8 ng/mL vs. 2.0±1.2 ng/mL, P=0.004). Other metabolic features were not significantly different between the two groups. Conclusion: The prevalence of LADA is 4.3% among Korean adult patients with recently diagnosed type 2 diabetes. The Korean LADA patients exhibited decreased insulin secretory capacity as reflected by lower C-peptide levels. Background: Latent autoimmune diabetes in adults (LADA) refers to a specific type of diabetes characterized by adult onset, presence of islet auto-antibodies, insulin independence at the time of diagnosis, and rapid decline in β-cell function. The prevalence of LADA among patients with type 2 diabetes varies from 2% to 20% according to the study population. Since most studies on the prevalence of LADA performed in Korea were conducted in patients who had been tested for anti-glutamic acid decarboxylase antibody (GADAb), a selection bias could not be excluded. In this study, we examined the prevalence and clinical characteristics of LADA among adult patients recently diagnosed with type 2 diabetes. Methods: We included 462 patients who were diagnosed with type 2 diabetes within 5 years from the time this study was performed. We measured GADAb, fasting insulin level, fasting C-peptide level, fasting plasma glucose level, HbA1c, and serum lipid profiles and collected data on clinical characteristics. Results: The prevalence of LADA was 4.3% (20/462) among adult patients with newly diagnosed type 2 diabetes. Compared with the GADAb-negative patients, the GADAb-positive patients had lower fasting C-peptide levels (1.2±0.8 ng/mL vs. 2.0±1.2 ng/mL, P=0.004). Other metabolic features were not significantly different between the two groups. Conclusion: The prevalence of LADA is 4.3% among Korean adult patients with recently diagnosed type 2 diabetes. The Korean LADA patients exhibited decreased insulin secretory capacity as reflected by lower C-peptide levels.

Malignancy Rate in Sonographically Suspicious Thyroid Nodules of Less than a Centimeter in Size Does Not Decrease with Decreasing Size

황보율,안화영,이연희,이예진,김정희,온정헌,홍은실,김경원,정인경,최성희,임수,박도준,장학철,오병희,조보연,박영주 대한의학회 2011 Journal of Korean medical science Vol.26 No.2

We evaluated the malignancy and nondiagnostic rates using fine needle aspiration cytology (FNAC) results in thyroid nodules smaller than 1 cm according to the subdivided size. We retrospectively reviewed the medical records of all subjects underwent FNAC from 2003 to 2009 in our hospital, and 2,756 patients of subcentimeter thyroid nodules with one or more suspicious sonographic features and 7,105 with nodule sized 1 cm or more were included. The malignancy rate was higher in those subcentimeter nodules with suspicious sonographic findings than the nodule sized 1cm or more (19.7% vs 7.8%, P <0.001). We grouped the nodules based on size with mm interval and observed that the malignancy rate did not decrease but the nondiagnostic results increased its size decrement. When we divided the subjects arbitrarily into a 5 mm or smaller and a 6-9 mm sized group, nondiagnostic cytology findings were reported more frequently in the smaller group (24.3% vs 18.1%, P = 0.001), while the rate of “malignant” was similar (18.3% vs 15.5%, P = 0.123) and the rate of “suspicious for malignancy” was higher (6.8% vs 2.9%,P < 0.001). Therefore when we decide to perform FNAC or not in subcentimeter-sized nodules, we should consider sonographic findings and other clinical risk factors but not the nodular size itself.

부신 우연종에서 발견된 갈색세포종의 특성 분석

김예안,황보율,김민주,최형진,서제현,이예나,곽수헌,구유정,오태정,노은,배재현,김정희,박경수,김성연 대한내분비학회 2012 Endocrinology and metabolism Vol.27 No.2

Background: In approach to an adrenal incidentaloma, early exclusion of pheochromocytoma is clinically important, due to the risk of catecholamine crisis. The aims of this study are to investigate the characteristics of incidentally detected pheochromocytomas,compared with that of the other adrenal incidentalomas, and to compare these characteristics with those of symptomatic pheochromocytomas. Methods: In this retrospective study, we reviewed the medical records of 198 patients with adrenal incidentaloma from 2001 to 2010. We analyzed the clinical, laboratory and radiological data of pheochromocytomas, in comparison with those of the other adrenal incidentalomas. We also compared the characteristics of these incidentally detected pheochromocytomas with the medical records of 28 pathologically proven pheochromocytomas, diagnosed based on typical symptoms. Results: Among the 198 patients with adrenal incidentaloma, nineteen patients were diagnosed with pheochromocytoma. Pheochromocytomas showed larger size and higher Hounsfield unit at precontrast computed tomography (CT) than did non-pheochromocytomas. All pheochromocytomas were larger than 2.0 cm, and the Hounsfield units were 19 or higher in precontrast CT. When both criteria of size > 2.0 cm and Hounsfield unit > 19 were met, the sensitivity and specificity for the diagnosis of pheochromocytoma were 100% and 79.3%, respectively. Compared with patients with pheochromocytoma, diagnosed based on typical symptoms,patients with incidentally detected pheochromocytoma were older, presented less often with hypertension, and showed lower levels of 24-hour urine metanephrine. Conclusion: Adrenal incidentaloma with < 2.0 cm in size or ≤ 19 Hounsfield units in precontrast CT imaging was less likely to be a pheochromocytoma. Patients with incidentally discovered pheochromocytoma showed lower catecholamine metabolites, compared with those patients with symptomatic pheochromocytoma.

노인 인구에서 근감소증과 심혈관계 대사질환 위험인자와의 연관성 조사

김정희,황보율,홍은실,온정헌,김치헌,김혜원,안화영,윤지완,강선미,박영주,장학철,임수 대한노인병학회 2010 Annals of geriatric medicine and research Vol.14 No.3

Background: The aim of this study was to investigate sarcopenia and its association with cardiometabolic risk factors in a community-based elderly cohort in Korea. Methods: We recruited 287 men and 278 women aged 65 years or older and without physical disability. Appendicular skeletal muscle mass (ASM) was measured with dual energy X-ray absorptiometry. We used two definitions for sarcopenia-ASM divided by height2 (kg/m2) or by weight (%) <1 SD below the sex-specific mean for young adults. We compared RBP-4, adiponectin,hsCRP, lipid profiles, and insulin resistance between the sarcopenic and normal groups using ASM/Ht2 and ASM/Wt. Results: The prevalence of sarcopenia was 35.3% in men and 13.4% in women with sarcopenia defined by ASM/Ht2. However,it was 38.3% in men and 62.6% in women by ASM/Wt. In correlation analysis, body mass index was positively correlated with ASM/Ht2 and negatively correlated with ASM/Wt. The sarcopenic group, when defined as ASM/Ht2, showed lower RBP4, fasting plasma glucose, and HOMA-IR and higher adiponectin than the normal group but not significantly different lipid profiles. The sarcopenic group defined by ASM/Wt had higher RBP4, fasting plasma glucose, and HOMA-IR, and lower adiponectin than the normal group in both sexes. Only in the males did the sarcopenic group defined by ASM/Wt reveal higher total cholesterol, triglycerides, and LDL cholesterol, and lower HDL cholesterol than the normal group. Conclusion: In conclusion, the sarcopenic group defined by ASM/Wt was more closely associated with cardiometabolic risk factors than the normal group in a community-based elderly cohort. 연구배경: 우리나라에서 인구의 고령화 현상이 점차 심각해짐에 따라 신체장애를 동반하지 않은 활동적인 노인 혹은건강한 노화에 대한 관심이 높아지고 있다. 방법: 본 연구는 성남시 한 지역 65세 이상의 한국인 고령코호트를 대상으로 한 연구에서 근감소증의 지표 중에서이중 방사선 X-선 흡수법을 이용하여 측정한 사지 골격근량을 키의 제곱(ASM/Ht2) 또는 체중으로(ASM/Wt) 나눈 지표를 이용하여 각각 근감소증군과 정상군을 나누었다. 두 군사이의 RBP4, adiponecetin, hsCRP, 혈청 지질, 인슐린 저항성을 측정하여 비교하였다. 결과: ASM/Wt로 정의한 근감소증군에서만 정상군보다높은 RBP4, 낮은 adiponectin 수치를 보였으며 인슐린 저항성, 총 콜레스테롤, 중성지반, 저밀도 지질단백질 콜레스테롤 모두 높게 측정되었다. 결론: 근감소증 지표로 ASM/Ht2보다 ASM/Wt로 정의하였을 때 근감소증군에서 정상군보다 심혈관계 대사 질환에대한 위험이 더 높다는 것을 위험 인자의 분석을 통하여보여주었다.

설문지 조사를 이용한 시대별 갑상선암의 진단 동기 및 환경적 위험인자의 변화

김하나,황보율,공성혜,송영신,김민주,조선욱,이유진,이가희,박도준,이은경,박영주 대한갑상선학회 2017 International Journal of Thyroidology Vol.10 No.2

Background and Objectives: We analyzed the clinicopathologic differences of thyroid cancer by diagnosis periods, diagnostic motives, residence history and clinical risk factors in thyroid cancer patients. Materials and Methods: Total 1599 thyroid cancer patients who answered the questionnaires about family history of thyroid cancer, residence history including duration of residence and location were enrolled from two hospitals, Seoul National University Hospital and National Cancer Center in Korea. Demographics and environmental information were collected via questionnaires and clinical data were reviewed via electronic medical records. Results: More thyroid cancer has been diagnosed in 2011 to 2013 by screening test without specific symptom than before 1990. The size of cancer at diagnosis was significantly smaller and multifocal tumor was more frequently found in 2011 to 2013 than before 1990 as well. The tumors of obese or overweight patients tended to harbor extrathyroidal extension and lymph node metastasis than normal weight subjects with statistical significance. However, there were no differences in clinicopathologic characteristics according to residence and smoking history. Conclusion: In this study, there were some different clinicopathologic characteristics according to the diagnosis era, diagnostic motives, family history of thyroid cancer and body mass index.

티로신키나아제 억제제 치료 후 발생한 중증 저칼슘혈증및 갑상선기능저하증 1례

이은경,이영기,황보율,이유진 대한갑상선학회 2018 International Journal of Thyroidology Vol.11 No.2

After introducing tyrosine kinase inhibitors (TKIs) as promising treatments for radioactive iodine refractory advanced thyroid cancer patients, we more often meet patients with TKI-related hormone and electrolyte imbalances in clinics. Hypocalcemia associated with TKI is associated with an imbalance in calcium-vitamin D metabolism. TKI-related hypothyroidism is related to the metabolic rate of thyroid hormones. The two side effects usually occur in the early stages of TKI treatment, and if the imbalance is corrected appropriately, the effects are minor, but in severe cases, the TKI should be discontinued. The authors reported a case of severe hypocalcemia and thyroid dysfunction after TKI treatment. A 56-year-old man suffered from symptomatic hypocalcemia during TKI treatment, which was resolved after he stopped taking the TKI medication. Although calcium and vitamin D replacement have increased, hypocalcemia was recurred and TKI treatments have been permanently stopped due to serious weight loss in grade 3. After the interruption, his calcium levels normalized.