[Rhabdomyolysis induced by fenofibrate monotherapy]. / Rhabdomyolyse induite par le fénofibrate en monothérapie.

INTRODUCTION: Rhabdomyolysis with fibrate have been reported when fibrate are associated with statin or during renal insufficiency or hypothyroidism. CASE RECORD: We describe one patient with diabetes mellitus treated by fenofibrate monotherapy since several years; 48 h after gliclazide therapy was introduced, rhabdomyolysis occurred. DISCUSSION: Responsibilities of deshydratation and / or drug interaction with gliclazide. are discussed.

[Pancreatic neuroendocrine tumors and von Hippel-Lindau disease]. / Tumeurs neuro-endocrines du pancréas et maladie de von Hippel-Lindau.

Pancreatic neuroendocrine tumors are rare in von Hippel-Lindau disease, most often asymptomatic, nonfunctioning, non secreting, and benign. We report a case of low grade malignant pancreatic, secreting and asymptomatic neuroendocrine tumors, occurring in a 27 year old woman in the setting von Hippel-Lindau disease with recurrent pheochromocytoma, retinal and medullary hemangioblastomas, paraganglioma of the carotid body and ovarian cystadenoma. Neuroendocrine pancreatic tumors of von Hippel-Lindau disease are often constituted by clear cells, in the contrary of other neuroendocrine tumors of the pancreas. Occurrence of a pancreatic neuroendocrine tumor, especially in association with pheochromocytoma, may be misdiagnosed with a type 2 multiple endocrine neoplasia syndrom instead of von Hippel-Lindau disease.

[Assessment of sub-clinical thyroid disfunction in aged hospitalized patients in Limousin]. / Evaluation des dysthyroïdies infra-cliniques chez des patients âgés hospitalisés en Limousin.

UNLABELLED: The aims of the study were to assess the prevalence of sub-clinical thyroid dysfunction in older patients and to analyze morphological and immunological thyroid abnormalities. SUBJECTS AND METHODS: The effect of aging on thyroid function morphology and immunology was studied in 102 french patients (70 women and 32 men) with a mean age of 81.7 +/- 7.3 years (65-101 years). All patients were hospitalized with different pathological conditions but without any thyroid disease. Patients with treatment or iodine substance which could modify thyroid function were excluded. Serum Free thyroxine (FT4) and TSH levels were detected by RIA. Morphological thyroid study was performed by clinical evaluation and ultrasonography. Two sub-groups of patients were distinguished according to immunological detection tests: In group A (n = 64) immunological parameter was performed by antithyroid microsomal antibodies and in group B (N = 38) by thyroid peroxidase antibodies. RESULTS: We found 4 hypothyroidisms (3.9%), 3 hyperthyroidisms (3%) and 4 marginal isolated high FT4 levels. Elevated levels of FT4 was observed in 3 patients and 1 care of low T4 was described. All patients with abnormal hormonal levels were female. Other patient had normal thyroid function: mean level FT4 was 11.2 +/- 2.2 pg/ml (N: 7-17) and mean level TSH was 1.6 +/- 0.8 mU/l (N: 0.2-4). These values are comparable to those observed in adult populations. Incidence of thyroid autoimmunity was very low (3.9%) in this series compared with previous data. From the morphological analysis, we found 32 morphological abnormalities (31.4%), without strong relation with thyroid dysfunction. Nodule prevalence was near 15% and goiter near 10%.

[Inhibition of steroidogenesis by ketoconazole. Therapeutic uses]. / Inhibition de la stéroïdogenèse par le kétoconazole. Applications thérapeutiques.

Ketoconazole, a broad-spectrum imidazole antimycotic agent, interferes with cytochrome P-450 enzyme systems in several organs (testis, ovary, adrenal gland, kidney, liver). It inhibits cholesterol synthesis by a dose-dependent transient braking of the 14 alpha-demethylase. Steroidogenesis is inhibited by its action on the C17-20 lyase, the cholesterol side-chain cleavage enzyme and the 17 alpha-hydroxylase. In gonads it inhibits aromatase and adrenocortical steroid biosynthesis is also inhibited at the 11 beta-hydroxylation and 18-hydroxylation steps. Its antiandrogenic effect may be useful in the management of metastatic prostate carcinoma and in testotoxicosis, its usefulness in the treatment of hirsutism is more questionable. Its anticortisolic effect may be useful in most Cushing's syndromes, where drug control of hypercortisolism is suitable for patients undergoing surgery, as well as those in whom more definitive treatment is delayed. Its usefulness as inhibitor of vitamin D or mineralocorticoids requires further investigation.

[Acute ischemia of an arm manifesting Buerger's disease. Predisposing role of anorexia nervosa]. / Ischéme aiguë d'un membre supérieur révélatrice d'une maladie de Buerger. Rôle favorisant d'une anorexie mentale.

Peripheral vasomotor disorders, notably acrocyanosis, are frequent in anorexia nervosa, but ischaemic accidents are unknown. We report the case of a 32-year-old woman with a 10-year history of anorexia nervosa, who developed acute ischaemia in one of her upper limbs. In this particular case several aetiological factors may be considered: Buerger's disease, of course, as the patient smoked and had an abnormal arteriography, but also hypercholesterolaemia, thrombocytosis and disorders of platelet aggregation.

[Treatment of prolactinoma]. / Traitement des adénomes à prolactine.

Prolactinomas rank first in frequency among hormone-secreting pituitary adenomas, but their management remains controversial. The authors present a review of the literature concerning the various therapeutic methods used and their results. As regards microadenomas, opinions are divided since the results obtained with bromocriptine and with selective adenomectomy are about the same. As regards macroadenomas, surgery exposes to more frequent complications and above all to recurrences. The majority of authors is in favour of bromocriptine first followed, if necessary, by surgical excision. Pregnancy may accelerate the development of prolactinomas. This risk is minimal with microadenomas and more real with macroadenomas, requiring more radical treatment before pregnancy and close monitoring.

Hyperthyroidism without elevated levels of thyroxine and triiodothyronine in a patient with pulmonary tuberculosis.

We have reported a case of toxic thyroid adenoma with low T3 and low T4 syndrome in a patient who received antituberculous drugs for active pulmonary tuberculosis. Search for thyroid-hormone-binding antibodies was negative. Thyroid lobectomy was done and histologic examination confirmed toxic thyroid adenoma; two months after operation the patient was clinically and biologically euthyroid. During the course of a severe nonthyroidal illness, normal thyroid hormone levels must be regarded as an indicator of hyperthyroidism. In addition, we believe that rifampin has a significant effect on thyroid function tests and results of thyroid physiology.

Autoimmune insulin syndrome.

Initially described in Japan, the autoimmune insulin syndrome is caused by the presence of anti-insulin antibodies in patients who have never received insulin. This syndrome accounts for spontaneous or reactive hypoglycaemia with very high levels of total immuno-reactive insulin. Discordance between the levels of immunoreactive insulin and C peptide indicate the possible presence of anti-insulin antibodies; this can avoid an incorrect diagnosis of insulinoma. These autoimmune hypoglycaemias often present a difficult diagnostic problem in distinguishing them from factitious hypoglycaemia. The course of the autoimmune insulin syndrome is usually favourable, with a spontaneous rapid diminution of the levels of anti-insulin antibodies. The reasons for the appearance of anti-insulin antibodies and the exact mechanisms of the hypoglycaemia remain uncertain. However, the frequent association of the autoimmune insulin syndrome with certain autoimmune diseases suggest a common immune dysfunction. Drugs containing a sulphydryl group have been implicated in the aetiology of this syndrome.

[Autoimmune hypoglycemia: the fault of pyritinol?]. / Hypoglycémie autoimmune: responsabilité du pyritinol?

Initially reported in Japan, autoimmune hypoglycemia is related to the presence of insulin-binding antibodies, even in patients who have never been treated with insulin. The authors report a case of spontaneous autoimmune hypoglycemia in a French woman receiving pyritinol. The difference between insulin and C peptide radioimmunoassay levels prompted a search for insulin antibodies. In vitro studies confirmed their presence and showed that they were immunoglobulins G with two binding sites without species specificity. The outcome of autoimmune hypoglycemia is usually favourable, with a rapid decrease of insulin antibodies but steroid therapy is needed when serious clinical manifestations are present. The differential diagnosis with factitious hypoglycemia may be difficult. The reasons for the appearance of the insulin antibodies and the exact mechanisms of hypoglycemia remain hypothetical. However, drugs with a sulfhydril group, such as pyritinol, could play a causative role in this syndrome.

[Sulfasalazine or salazosulfapyridine in the treatment of rheumatoid polyarthritis. An open study of 46 patients. Review of the literature]. / La sulfasalazine ou salazosulfapyridine dans le traitement de la polyarthrite rhumatoïde. Etude ouverte chez 46 malades. Revue de la littérature.

The SASP was studied in 46 patients with rheumatoid arthritis. The efficacy criteria which were selected (decrease of the sed rate by more than 50 p. cent during the first hour, morning stiffness under 20 minutes, Ritchie's index inferior to 10 and decreased cortisone and NSAID doses), explain that 25 p. cent of the patients are considered as satisfied after 12 months of trial. The patients selected, present severe forms of the disease or forms resistant to other treatments. The improvement appears significant after the first month. Half of the patients left the trial either because of ineffectiveness, or evolutive relapse (21.73 p. cent) or because of side-effects (28.26 p. cent). The most frequently observed disorders and intolerances are of digestive nature. No serious accident is to be deplored. Such results are in accordance with the data from the literature. The SASP must therefore be considered as the fundamental treatment of rheumatoid arthritis. The new galenic forms, dissolving in the gastro-intestinal tract, have enabled to markedly improve the digestive tolerance.

Bronchial leiomyoma: report of a case successfully treated by endoscopic neodymium-yttrium aluminum garnet laser.

A 40-year-old woman was admitted with dyspnea and episodes of bronchial infection. Leiomyoma of the right lateral basal bronchus was diagnosed and partially removed by a biopsy forceps, and neodymium-yttrium aluminum garnet laser therapy successfully destroyed the rest of this mass.

[Developmental adrenal tuberculosis. Value of x-ray computed tomography]. / Tuberculose surrénalienne évolutive. Intérêt de la tomodensitométrie.

Two cases of Addison's disease secondary to active adrenal tuberculosis are reported. Computed tomography showed hypertrophy of the adrenal gland, which was bilateral in one case and unilateral in the other. Repeat computed tomography scans during antituberculous chemotherapy demonstrated a progressive change of the adrenals toward atrophy and calcification, while the adrenal function remained impaired. The authors recall that adrenal tuberculosis may be unilateral first, then bilateral, and that the gland is initially hypertrophic before hormonal deficiency appears; later on, adrenal atrophy and calcification develop. Computed tomography seems to be useful in the aetiological diagnosis of Addison's disease. Moreover, it helps in determining whether or not antituberculous therapy is indicated, which is not always easy to decide in the absence of "active" focus. The finding, with or without positive tuberculin skin tests, of an adrenal hypertrophy unexplainable by any other pathology (e.g. metastasis, histoplasmosis) should call for antituberculous treatment, especially since it sometimes results in recovery of adrenal function.