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￭ Sun-261 ￭
Feasibility of TSI bioassay as a predictor for Graves' disease recurrence
가톨릭대학교 서울성모병원 내과학교실
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전종식
Background/Aims: Recently introduced thyroid stimulating immunoglobulin (TSI) bioassay proved to be a good diagnostic marker for Graves’ disease (GD). However, the clinical value of TSI bioassay to predict the recurrence, compared to or combined to TSH receptor antibody (TRAb), was not evaluated yet in real clinical practice. Methods: This retrospective study eval-
uated clinical data of GD patients, from January 2005 to November 2013, who underwent TSI bioassay at least one time during follow-up after anti-thyroid drug (ATD) start. Recurrence rate of enrolled GD pa- tients was evaluated according to combinations of TRAb and TSI bio- assay positivity/negativity. Results: 44.8% of the patients who dis- continued the drug after confirming that the TSI bioassay had fallen be- low the cut-off value. Patients were divided into four groups depending on TRAb assay and TSI bioassay levels. Group 1 (N=43), both TRAb and TSI are negative; Group 2 (N=15), only TSI is negative; Group 3 (N=5), only TRAb negative; Group 4 (N=4), both TRAb and TSI are positive. Group 1 patients had higher recurrence rate compared to the Group 2 and 3 patients (46.5% vs 40%). TSI bioassay cut-off value at the time of relapse was analyzed using the ROC curve, the optimal TSI bioassay result was 86% specimen-to-reference ratio (SRR), then the re- currence rate was reanalyzed. In this case, recurrent rates of Group 2 and 4 were lower than that of cut-off value was 140% SRR at the time of ATD discontinuation.Conclusions: Our results suggested that TSI bio- assay might be more useful than TRAb assay to predict recurrent disease after ATD withdrawal. However, combinations of TRAb and TSI bio- assays could predict a recurrent disease better than single use of TRAb and TSI bioassays respectively, because the presence of the blocking an- tibody seems to have influence on the recurrence of GD. Also, applying the low cut-off value (86% SRR) is useful for predicting the recurrence when determining the drug stopping point.
￭ Sun-262 ￭
Two Cases of Cushing’s Syndrome in Pregnancy Diagnosed after Delivery
계명대학교 동산의료원
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임지민, 김한별, 김남경, 조난희, 한유진, 김혜순, 김미경
Introduction Cushing’s syndrome (CS) during pregnancy is extremely rare with approximately 220 cases reported in the literature since the first case re- ported in 1953. Women with CS rarely become pregnant since as many as 75 percent of all patients experience ovulatory dysfunction due to hyper- cortisolism on the reproductive axis. Here, we present two cases of CS in pregnancy, diagnosed after delivery, with a focus on its clinical features, diagnosis and treatment. Case Presentation Patient 1 is a 37-year-old female who was admitted for flank pain on both sides which continued for five months after giv- ing birth. At 35 weeks and one day of pregnancy, she had undergone a cesarean section (birth weight 1,720g) due to Pulmonary Artery Hypertension.Physical examination revealed a truncal obesity, striae cutis and buffalo hump. An endocrine evaluation revealed the features of ACTH-in- dependent hypercortisolism. A computed tomography (CT) scan identified a 35x28mm-sized hypo attenuating nodule in the right adrenal gland.
Subsequently, the patient underwent a laparoscopic right adrenalectomy and was given a hydrocortisone replacement therapy Patient 2 is a 30-year-old fe- male who was admitted for weight gain. The patient also reported easy bruisability and amenorrhea. She had spontaneous labor which resulted in a normal vaginal delivery of a low birth weight infant (birth weight 2,200g). Initial blood and laboratory examinations revealed the features of ACTH-dependent hypercortisolism. A pituitary MRI scan showed a 3x4x6mm sized microadenoma in the left side of pituitary gland. The ACTH-producing pituitary tumor was removed via endonasal TSA. Conclusion As reviewed in this paper, pregnant women with Cushing’s syndrome exhibited some of the most severe fetal prognoses, such as low birth weight, preterm labor, preeclampsia and fetal death. It is worth noting that the two cases of CS reviewed in this paper were di- agnosed after delivery. If had been diagnosed early in pregnancy, complications such as low birth weight or preeclampsia could have been prevented. Thus, early diagnosis and treatment of CS are imperative and require a high index of clinical suspicion.