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￭ S-439 ￭
Relationship between NK cell activity and glucose control in Type 2 Diabetes patients
연세대학교 강남세브란스병원 내분비내과
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김정혜, 박가희, 이상배, 유지홍, 김민진, 김유식, 남지선, 박종숙, 안철우, 김경래
Objective: NK cells are cytotoxic lymphocytes critical to innate immunity. Diabetes patients are prone to infection, and hyperglycemia has been shown to cause immune dysfunction. Not much is known about the NK cell activity in type 2 diabetes. The purpose of this study is to find out the difference in NK cell activity between type 2 diabetes patients and controls, and to investigate the association between NK cell activity and glucose control.
Methods: 49 subjects were enrolled in this study, with 23 type 2 diabetes patients and 26 normal glucose tolerant controls. Anthropometric and bio- chemical parameters including age, gender, body mass index (BMI), fasting glucose, c-peptide, insulin, HbA1c, cholesterol, triglyceride, HDL and LDL cholesterol were assessed. Homeostatic model assessment (HOMA) was calculated for insulin resistance. NK cell activity was measured using a newly developed NK Vueⓡ Kit (ATgen, Seoul), which is a method of detecting and comparing interferon-gamma level from NK cells. Results: NK cell ac- tivity was lower in type 2 diabetes patients compared to control subjects. There was a significant inverse linear relationship between NK cell activity and fasting plasma glucose after adjusting for age and gender (r＝-0.346, p＝0.045). Postprandial glucose and HbA1c showed a similar tendency with NK cell activity (r＝-0.313 and -0.241, and p＝0.072 and 0.17, respectively). Regression analysis showed HbA1c, fasting glucose and postprandial glu- cose to be independent predictors of NK cell activity (beta＝-0.303, -0.360, -0.356, and p＝0.034, 0.011, 0.033). There was no relationship between NK cell activity and HOMA-IR. Conclusion: NK cell activity was lower in type 2 diabetes compared to controls, and it was significantly related to degree of hyperglycemia. A further, larger population study is warranted to confirm the possible correlation.
￭ S-440 ￭
A rare case of PRL-GH-ACTH plurihormonal pituitary adenoma, adequately managed by medical therapy
성균관대학교 삼성서울병원 내분비대사내과
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박성운, 최민선, 이승은, 전지은, 이유빈, 김혜인, 김규리, 안지연, 박소영, 이문규, 허규연
Pituitary adenomas (PAs) are monoclonal cell-derived tumors, but can secrete more than one hormone. PAs with concomitant growth hormone (GH) and prolactin (PRL) secretion are quite common. However, PAs secreting PRL, GH and adrenocorticotropic hormone (ACTH) are very rare due to the difference of transcription factors regulating expression of those hormones. We report a case of giant prolactinoma co-secreting GH and ACTH. A 42-year-old male presented with headache, sudden blurred vision and an associated visual defects in both eyes due to giant pituitary mass. He demon- strated mild prognathism, thickening of soft tissues in hands and feet. He had mild central obesity and 10 kg of body weight gain for 2 years. However, he had no moon face, buffalo hump, purple striae or easy bruisability. PRL (1899 ng/mL) as well as others hormones including GH (29.52 ng/mL), IGH-1 (791 ng/mL), ACTH (156.3 pg/mL), and cortisol (27.4 g/dL) were abnormally high. Thyroid-stimulating hormone, follicle-stimulating hormone and luteinizing hormones were abnormally low. Besides prolactinoma, he was also diagnosed as acromegaly and Cushing’s disease, confirmed by 75 g oral glucose-induced GH suppression test and 1 and 8 mg dexamethasone suppression test, respectively. Sella MRI showed that 5 cm-sized mass lesion in the pituitary gland with the suprasellar extension and bilateral cavernous sinus involvement. Huge mass compressed optic chiasm, resulting in loss of vision. He was treated with carbegoline and lanreotide combination therapy. Pituitary mass were rapidly and markedly decreased and all of the pituitary hormones were normalized. His vision were improved 1 week after treatment and completely recovered 3 weeks after treatment. After 3 months of combination therapy, we maintained cabergoline monotherapy. Although most previous cases for plurihormonal pituitary adenoma were confirmed by immunohistochemical stain, we reported a very rare case of giant prolactinoma, diagnosed clinically as acromegaly and Cushing’s disease. In this case, cabergoline treatment without surgery, significantly reduced the mass size resulting in normalization of visual field and hormone levels in giant prolacti- noma with concomitant GH/ACTH secretion.
