Ju Hee Lee

Objective: Data on hypothalamic–pituitary–adrenal axis (HPAA) recovery after adrenalectomy are limited by small samples, heterogeneous criteria, and no distinction between mild autonomous cortisol secretion (MACS) and adrenal Cushing syndrome (CS). We investigated HPAA recovery duration and associated factors separately in MACS and adrenal CS. Design: Retrospective, multicenter cohort. Methods: We analyzed 139 adults with MACS and 280 with adrenal CS who underwent unilateral adrenalectomy and required postoperative glucocorticoid replacement. HPAA recovery was defined as discontinuation of glucocorticoids. Associated factors were evaluated using Cox proportional hazards models and restricted mean survival time (RMST) regression. Results: The Kaplan–Meier-estimated median (95% confidence interval) time to recovery was 8.2 (6.5–9.7) months in MACS and 14.8 (13.2–16.3) months in adrenal CS. In MACS, older age [hazard ratio (HR) = 0.72 per 10 years; +94 days for >61 years, τ = 540 days] and cortisol after 1-mg overnight dexamethasone suppression test [post-overnight dexamethasone suppression test (ODST) cortisol] > 10.0 µg/dL (+113 days) were associated with delayed recovery, whereas higher dehydroepiandrosterone-sulfate ratio (HR = 1.50 per log-unit; −91 days for >0.61) and adrenocorticotropic hormone (ACTH) (HR = 1.61 per log-unit) were associated with faster recovery. In adrenal CS, older age (HR = 0.74 per 10 years; +198 days for >36 years, τ = 1095 days), higher glycated hemoglobin (HR = 0.81 per 1%), and post-ODST cortisol >7.9 µg/dL (+364 days) were associated with delayed recovery, whereas higher ACTH (HR = 1.27 per log-unit; −130 days for >5.1 pg/mL) was associated with faster recovery. Conclusions: Older age was consistently associated with delayed recovery, while biochemical markers contributed differentially by disease subtypes.

Genetic variation contributes to interindividual differences in blood pressure regulation and the long-term risk of hypertension. CYP11B2, which encodes aldosterone synthase, is a key component of the renin‒angiotensin‒aldosterone system; however, longitudinal evidence linking common genetic variants near CYP11B2 to incident hypertension remains limited. We investigated genetic variation at the CYP11B2 locus in 8,840 participants from the Korean Genome and Epidemiology Study, a population-based cohort with up to 16 years of follow-up data. Following gene-centric screening, we identified rs7831617, a common noncoding variant located downstream of CYP11B2, with genotype frequencies of 46.4% (GG), 43.6% (GT), and 9.8% (TT). Associations of rs7831617 with baseline blood pressure, plasma renin concentrations, prevalent hypertension, and incident hypertension were examined via multivariable regression and discrete-time survival analyses. In addition, metabolomic profiling was conducted in a subset of participants to explore genotype-dependent metabolic differences. The rs7831617 T allele was nominally associated with higher plasma renin concentrations and a lower risk of incident hypertension during follow-up (adjusted hazard ratio 0.93, 95% confidence interval 0.88-0.99), whereas no association was observed with prevalent hypertension at baseline. Metabolomic profiling revealed no global genotype-dependent metabolic shifts, with only six metabolites (glutamate, alanine, asparagine, PC ae C34:1, PC ae C42:4, and PC ae C44:5) showing nominal associations with genotype. Although several clinical and metabolomic phenotypes showed nominal associations with rs7831617, none remained significant after correction for multiple testing. These findings suggest a potential association of rs7831617, a common noncoding variant adjacent to CYP11B2, with lower blood pressure and a reduced long-term risk of hypertension.

Context: The 2025 clinical guideline for primary aldosteronism (PA) recommends a diagnostic and therapeutic pathway stratified by lateralization risk. The PA severity classification (PASC) integrates biochemical and clinical features and is intended to inform graded recommendations for adrenal venous sampling (AVS). Objective: We examined whether PASC is associated with AVS-defined lateralization and treatment outcomes. Design: A retrospective multicenter cohort study. Setting: Eight tertiary centers Patients: A total of 833 patients with PA who underwent AVS. PASC severity was classified as mild, moderate, or severe. Main Outcome Measures: We evaluated associations between severity, AVS-defined lateralization, and outcomes using the Primary Aldosteronism Surgical Outcome (PASO) and Primary Aldosteronism Medical Treatment Outcome (PAMO) criteria. Results: Among 833 patients, 52 (6.1%), 563 (67.6%) and 218 (26.2%) had mild, moderate, and severe PA, respectively. Higher severity was associated with a stepwise increase in AVS-defined lateralizing PA (19.2%, 48.0%, and 76.1%, respectively; P < .001). In unilateral PA treated surgically, PASO clinical outcomes differed by severity (P = .002), with complete clinical success in 40.2% (moderate) and 31.3% (severe), and a marked increase in partial clinical success in severe disease (55.1%). PASO biochemical outcomes were similar across severity groups (P = .389). In bilateral PA treated medically, PAMO clinical outcomes varied by severity (P = .005), with complete clinical response decreasing from mild to severe disease (36.8%, 27.0%, and 8.8%), whereas biochemical outcomes were comparable (P = .993). Conclusion: PASC-defined severity correlated with AVS-defined lateralization. Greater severity was associated with lower rates of complete clinical success/response despite preserved biochemical outcomes, supporting a severity-informed framework to complement AVS in PA management.

Technological advances in continuous glucose monitoring (CGM) have significantly transformed outpatient diabetes management. However, despite increasing clinical demand, CGM remains underutilized in hospitalized patients. In this perspective, we explore the rationale for inpatient CGM use, summarize key clinical findings supporting its accuracy and safety, and discuss current guideline recommendations. Drawing from recent literature and our institutional experience, we propose practical strategies for effective implementation of CGM in hospital settings, including appropriate patient selection and integration into clinical workflows. As healthcare systems move toward digital transformation, integration of CGM in inpatient care represents a timely and necessary advancement that could enhance glycemic control, reduce complications, and improve both patient and provider experience. Institutional and policy-level support will be essential to facilitate broader adoption.

Background We investigated the prevalence and clinical characteristics of type 2 diabetes mellitus in lean Korean adults. Methods We analyzed data from the Korea National Health and Nutrition Examination Survey 2001-2021 among adults aged >= 19 years. Trend analyses between 2001 and 2019-2021 (n = 89,720) and comparative analyses of multiple clinical characteristics between patients with type 2 diabetes with and without overweight/obesity were conducted (n = 2,284). Results Between 2001 and 2019-2021, the estimated prevalence of lean type 2 diabetes (body mass index [BMI] < 23 kg/m2) increased from 6.6 to 8.8%, representing a 33.3% increase. This was a similar extent of increase of type 2 diabetes associated with being overweight or obese (12.1-16.3%, + 34.7%). The increase in the prevalence of lean type 2 diabetes was more pronounced among females, while the increase among those who were overweight or obese was more pronounced among males than their counterparts. Although the overweight/obese type 2 diabetes group (T2DM group) showed more risk factors for cardiovascular disease, the lean T2DM group had lower insulin levels and reduced muscle mass and strength. Conclusions The prevalence of lean type 2 diabetes among Korean adults is increasing, at a rate similar to type 2 diabetes in overweight/obese individuals. Patients with lean type 2 diabetes showed decreased beta-cell function and sarcopenia. These findings emphasize the need for tailored management strategies for lean type 2 diabetes given its characteristics and rising prevalence.

Adaptive thermogenesis is a key homeostatic mechanism that primarily occurs in brown adipocytes and enables the maintenance of body temperature. Although this process involves coordinated responses in multiple tissues, including the browning of white adipocytes, the precise inter-organ crosstalk underlying adaptive thermogenesis is unclear. Here, we investigate the pivotal role of the GDNF family receptor alpha-like (GFRAL) neuronal axis in modulating compensatory thermogenic responses in brown and white adipose depots under stress conditions, specifically the mitochondrial unfolded protein response resulting from genetic modification and cold exposure. We employed a mouse model with targeted deletion of Crif1 in the mitoribosomes of brown adipocytes, and cold-exposed mice and immortalized adipocytes, to uncover the mechanism by which mitochondrial stress-induced growth differentiation factor 15 (GDF15) expression affects metabolism and facilitates adaptive thermogenesis. We found that Crif1 deletion resulted in browning of inguinal white adipose depots, increased energy expenditure, reduced food intake, and resistance to weight gain. Retrograde neuronal tracing established that GFRAL-positive neurons in the hindbrain and sympathetic preganglionic neurons in the spinal cord mediated the GDF15-associated browning of inguinal white adipose tissue. Intervention studies using antisense oligonucleotides to inhibit Gfral expression blunted the effect of Crif1 deletion on energy expenditure and food intake, further confirming the essential role the GFRAL axis plays in GDF15-driven thermogenic adaptation in white adipose tissue. Our findings suggest that the GFRAL neuronal axis is key in coordinating the adaptive thermogenic response across multiple tissues and adipose depots, thereby ensuring metabolic homeostasis during mitochondrial stress.

Park KH, et al. J Korean Med Sci. 2023 Aug;38(33):e259. https://doi.org/10.3346/jkms.2023.38.e259

Kang YE, et al. J Korean Med Sci. 2022 Nov;37(48):e338. https://doi.org/10.3346/jkms.2022.37.e338