Continuation of amiodarone therapy despite type II amiodarone-induced thyrotoxicosis.

Background: Amiodarone is a powerful antiarrhythmic drug; however, its use may be complicated by thyrotoxicosis. When this occurs, clinicians must balance the continuation of amiodarone for antiarrhythmic purposes, and the discontinuation of treatment in order to prevent aggravation of the thyrotoxicosis. We studied the consequences of continuation or cessation of amiodarone in patients with type II amiodarone-induced thyrotoxicosis.

Surgery versus medical follow-up in patients with asymptomatic primary hyperparathyroidism: a decision analysis.

Objectives: To examine the cost-effectiveness of strategies for management of primary asymptomatic hyperparathyroidism: surgical strategies and medical follow-up versus surgery.

Design: We used a Markov state-transition decision-analytic model for an hypothetical cohort of 55-year-old women to compare with a lifetime horizon costs and effectiveness of bilateral neck exploration (BNE), unilateral neck exploration (UNE), video-assisted parathyroidectomy (VAP) and lifelong medical follow-up shifting for either BNE or UNE in case of disease progression.

Methods: Data on localization tests, complications and treatment efficacies were derived from a systematic review of the literature.

[Iodine excess and thyroid dysfunction].

Hypothyroidism or hyperthyroidism may develop during iodine excess. Hypothyroidism occurs mostly in newborns or in elderly patients with underlying autoimmune thyroiditis and is treated by substitutive doses of thyroxine. Hyperthyroidism is of two types.

[Hyperthyroidism due to excess iodine].

TWO TYPES: Hyperthyroidism may develop in around 10% of patients in excess iodine. It may reveal an undetected pretoxic thyroid disease (type I) or have been induced by excess iodine in previously normal thyroid gland or in an euthyroid goiter (type II). IODINE EXCESSE REVEALING THYROTOXICOSIS: In the former situation, symptoms appear shortly after the iodine load, thyroid scintigraphy shows significant uptake and therapy includes discontinuation of iodine excess, antithyroid drugs, potassium perchlorate and, if necessary, thyroidectomy or a therapeutic dose of iodide 131.

Computerised intrapartum diagnosis of fetal hypoxia based on fetal heart rate monitoring and fetal pulse oximetry recordings utilising wavelet analysis and neural networks.

Objective: To develop a computerised system that will assist the early diagnosis of fetal hypoxia and to investigate the relationship between the fetal heart rate variability and the fetal pulse oximetry recordings.

Design: Retrospective off-line analysis of cardiotocogram and FSpO2 recordings.

Setting: The Maternity Unit of the 2nd Department of Obstetrics and Gynaecology, Aretaieion Hospital, University of Athens.

Mucin-like carcinoma-associated antigen (MCA) during normal pregnancy.

Objective: To assess the usefulness of Mucin-like carcinoma-associated antigen (MCA) in monitoring pregnant patients with breast cancer.

Study Design: Maternal serum (MS) and amniotic fluid (AF) antigen values were measured by an enzyme immunoassay in 30 pregnant women during the second trimester, in 28 during the third and in 26 at parturition. Sera only from 26 women in the first trimester and from 26 healthy, non-pregnant women (controls) were also analyzed.

[Pituitary metastases. 3 cases].

Objective: Review cases with hyothalamo-hypophyseal metastases which raise complex therapeutic situations.

Patients And Methods: Files of patients hospitalized from 1992 to 1996 at the Cochin Hospital Endocrinology unit were compared with data reported in the literature.

Results: We had patients with pituitary metastases from breast cancer and 69 cases have been reported in the literature: 72 patients, 57% men and 43% women, mean age 57.

[Hepatic ischemia and hypophyseal macroadenoma].

We report the first case of recurrent hepatitis secondary to a pituitary macroadenoma in a 55-year old man. Liver ischemia is thought to be the main consequence of episodes of acute adrenal insufficiency. Sudden acute adrenal insufficiency was due to enlargement of the sella content secondary to several microhemorrhages in the macroadenoma.

[Medical treatment of secretory hypophyseal adenomas].

The main indication for medical treatment of the secretory pituitary adenomas is macroprolactinoma. In this case, bromocriptine therapy obtains better results than surgery, by a life-long administration. New dopaminergic drugs with better tolerance and a longer half-life than bromocriptine will probably improve compliance to treatment.

[Thyroid hormone production and its regulation].

Thyroid gland fulfills two functions. On one hand, it synthesizes and builds up stocks of thyroid hormones in thyroglobulin molecules of the colloid in its follicles, such as they can maintain the hormonal secretion during several days and even weeks. To do this, it captures and concentrates plasma iodide through a specific membrane transporter and it oxidizes iodide through the action of thyroperoxidase and H2O2.

[Diabetes insipidus with a hypothalamo-hypophyseal morphologic anomaly during a pregnancy].

Background: Diabetes insipidus is uncommon in pregnancy. Despite physiological modifications in hydroelectrolytic balance during normal pregnancy, the capacity of the kidney to concentrate urine is preserved, partially due to lower vasopressin secretion.

Case Report: A young woman developed diabetes insipidus during the third trimester of normal pregnancy.

[POEMS syndrome with primary adrenocortical insufficiency].

Background: POEMS syndrome is a multisystem disorder. It usually presents as severe polyneuropathy and monoclonal gammapathy associated with endocrinopathies, organomegaly, skin hyperpigmentation.

Case Report: A patient with POEMS syndrome developed primary adrenocortical deficiency revelated by asthenia and hyperpigmentation.

[Failure of synthcen to diagnose corticotropin insufficiency].

It is commonly believed that a normal cortisol response to exogenous ACTH (synacthen test) reliably indicates, with the exception of states of acute ACTH deprivation, the integrity of hypothalamic-pituitary-adrenocortical function. Published evidence has shown that the synacthen test is not sensitive enough to reveal partial ACTH deficiency leading to a subnormal ACTH response to stress. We report a patient who maintained a normal response to exogenous ACTH stimulation despite symptomatic chronic ACTH deficiency in unstressed conditions.

[Differentiated thyroid carcinomas manifesting as toxic adenoma].

Background: Hot thyroid nodules are generally benign. We report two exceptional cases of thyroid carcinomas mimicking toxic adenomas.

Case Reports: A 35-year-old man and a 55-year-old woman had thyroid carcinoma behaving as an autonomously hyperfunctioning nodule.

[Assay of salivary cortisol. An interesting method for exploring the adrenal cortex].

AN INTERESTING METHOD FOR PATIENTS AND PHYSICIANS: Measurement of salivary cortisol has not modified the investigation of hospitalized patients but offers very original possibilities for exploring outpatients. REPEAT MEASUREMENTS AND STIMULATION TESTS: As for serum cortisol levels, repeat measurements or stimulation tests are required for reliable evaluation of salivary cortisol. SEVERAL APPLICATIONS: Salivary cortisol level can be an appropriate tool in screening for adrenal insufficiency, using the short ACTH injection test, evaluating hypercorticism through the circadian cycle of cortisol and overnight dexamethasone suppression test either at the physician's office or in the patient's home.

[Magnetic resonance imaging in Cushing disease. Prediction of surgical results].

Objectives: The purpose of the study is to determine if pituitary Magnetic Resonance Imaging (MRI) can predict the outcome of transsphenoidal surgery in patients with Cushing's disease.

Methods: Fifty four patients were divided in three groups according to MRI findings: those with a well circumscribed focal lesion clearly separated from the cavernous sinus (group 1, n = 24), those with adenomas in close contact with the cavernous sinus (group 2, n = 18), and those with no identified lesion (group 3, n = 12).

Results: The adenoma is found on the predicted side in 97,6% of the cases with positive MRI.

[Lymphocytic hypophysitis: a reality].

Lymphocytic hypophysitis is a rare entity; we report here three cases. This condition usually occurs in women during pregnancy or in the post-partum period. Pituitary enlargement is associated with complete or partial hypopituitarism.

[Riedel's thyroiditis and lymphoma. Diagnostic difficulties].

Two cases of Riedel's thyroiditis demonstrated the difficulties encountered in diagnosis. In the first case, subtotal thyroidectomy was performed due to compressive goiter. The intraoperative macroscopic aspect suggested Riedel's thyroiditis.

Overnight dexamethasone suppression test: comparison of plasma and salivary cortisol measurement for the screening of Cushing's syndrome.

The overnight 1-mg dexamethasone suppression test is a very good screening test for subjects suspected of having Cushing's syndrome. To simplify the procedure, we evaluated the 1-mg dexamethasone suppression test with measurement of salivary cortisol. We performed this test with plasma and salivary cortisol measurements in 27 patients with Cushing's syndrome and 64 normal controls.

Long-distance and long-term follow-up of a patient with intermittent Cushing's disease by salivary cortisol measurements.

Salivary cortisol is an excellent indicator of the plasma free cortisol concentration in normal and pathological situations. We took advantage of its ease of sampling, allowing multiple collections at home, to follow the course of a patient with Cushing's disease living in North Africa. This 48-year-old woman presented with a clinically moderate hypercortisolism caused by a large basophilic pituitary adenoma.

ADP and ATP activate distinct signaling pathways in human promonocytic U-937 cells differentiated with 1,25-dihydroxy-vitamin D3.

We investigated the effects of purinergic P2 agonists on cell adhesion, as well as the signaling pathways involved, in U-937 human promonocytic cells differentiated to a more mature monocytic phenotype with 1,25-(OH)2-vitamin D3. In cell adhesion studies, ATP was more potent than ADP, whereas ADP showed greater efficacy. The time course of the intracellular calcium concentration ([Ca2+]i) response to ATP was biphasic (a spike followed by a plateau), whereas ADP evoked a plateau after a time lag of several seconds.

Influence of radiotherapy on long-term relapse in clinically non-secreting pituitary adenomas. A retrospective study (1970-1988).

Objective: We wished to evaluate the influence of postoperative radiotherapy on the incidence of tumour regrowth in non-secreting pituitary adenomas.

Methods: The cases of 57 patients with clinically non-secreting pituitary adenomas were retained for a retrospective study of long-term disease-free survival out of a series of 66 patients treated between 1970 and 1988. Thirty-three patients were treated by surgery only (Group A), and twenty-four by surgery followed by external radiotherapy (Group B).