[Two cases of non-functional gonadotroph adenoma pituitary apoplexy following GnRH-agonist treatment revealing gonadotroph adenoma and pseudopituitary apoplexy after GnRH administration]. / Deux cas de macroadénomes gonadotropes silencieux: apoplexie hypophysaire au décours d'une première injection d'agoniste de la LH-RH révélant un adénome gonadotrope. Pseudoapoplexie hypophysaire d'un adénome gonadotrope au décours d'un test de stimulation.

We report here two cases of pituitary apoplexy or pseudoapoplexy revealing a gonadotroph adenoma. A 69-year-old man, who had just started antiandrogen treatment (Gn-RH agonist) for prostatic cancer, was admitted to neurosurgery emergency because of increasing headache and visual impairment. The CT-scan disclosed the presence of a large pituitary mass with lateral invasion of the left cavernous sinus. Hormonel testing showed panhypopituitarism. A few days later, diabetes insipidus appeared. The patient first received corticosteroid therapy and underwent surgical adenomectomy. Immunostaining of the tumor tissue was positive for FSHbeta, confirming the diagnosis of gonadotroph adenoma. Three months after surgery, the endocrine evaluation showed pituitary insufficiency. An 81-year-old man complained of mnemonic disorders. The CT-scan revealed a pituitary mass without extension. The Ophthalmological examination showed left temporal upper quadranopsia. Endocrinological tests with administration of GN-HR triggered headache and vomiting. A second CT-scan was unchanged. Hormone testing revealed increased serum levels of FSH and decreased serum levels of LH. Surgical management of the primary tumor was undertaken due to the visual field alteration. Immunohistochemical studies confirmed the diagnosis of gonadotroph FSHbeta adenoma.

[Struma ovarii or malignant ovarian goiter. A case]. / Les struma ovarii ou goitres ovariens malins. Une observation.

BACKGROUND: We report a case of follicular struma ovarii observed in an ovary teratoma without metastatic dissemination. CASE REPORT: A right ovarian tumor was discovered at ultrasound examination in a 31-year-old woman complaining of low abdominal pain. The patient underwent laparoscopic exploration and a 4-cm cystic mass of the right ovary was removed. Microscopic examination showed a malignant struma ovarii of the follicular type with vascular space invasion; other teratomous elements were identified. Immunohistochemical staining for thyroglobulin confirmed the nature of the tumor. The patient was treated by complete right ovariectomy followed by total thyroidectomy and administration of radioactive iodine (99 mCi I-131). Repeat I-131 body scan performed at 6 months was normal. DISCUSSION: Struma ovarii is a rare type of ovarian teratoma, consisting mainly of thyroid tissue. The incidence of malignant struma ovarii is below 1% and fewer than two dozen cases with distant metastases have been reported. The major problem associated with struma ovarii has been the establishment of criteria for malignancy.

[Can free T3 determination be affected by the presence of type 1 diabetes mellitus?]. / Le dosage de la T3 libre est-il affecté par l'existence d'un diabète sucré de type 1?

Overall frequency of thyroid disease is increased in diabetic patients, especially in insulin-dependent diabetes. Free T3-assays are thus ordered more often in these populations. Attention has been drawn to the role of non-esterified fatty acids in the different techniques used to assay free T3. The aim of this work was to evaluate the clinical revelance in a population of uncontrolled insulin-dependent diabetes. The results demonstrated that elevated non-esterified fatty acid levels observed in type 1 diabetes in modifications of free T3 assays, don't modified the different technics of free T3.

[Lipid balance in an arteritic patient and therapeutic implications]. / Quel bilan lipidique chez un artéritique et quelles implications thérapeutiques.

The pathogenesis of atherosclerosis remains hypothetical, the current vogue of a lipidic origin being now only a working hypothesis. The management of an arteritic patient (for a treating clinician) is that of a case of global atherosclerosis. Screening for lipids: 1) is here of only moderate interest in the close scrutiny of currently recognized risk factors, and 2) should include initially a simple study of total plasma cholesterol (TC) and triglycerides (TG) on two occasions at one month's interval in a reliable laboratory. Therapeutic implications are a function of a global analysis of the patient and not just the values for even sophisticated assays of circulating lipids.

[Variations of the renin aldosterone system in Cushing's disease (author's transl)]. / Variations du système rénine angiotensine aldostérone dans la maladie de Cushing.

The renin aldosterone system was studied in 5 cases of Cushing's disease (bilateral benign hyperplasia) without medication. For a daily sodium intake of 120 mmol plasma angiotensinogen was abnormally increased, plasma renin activity (PRA) remained normal, but without significant diurnal variation. Plasma aldosterone (PA) was normal and its circadian rhythm was maintained. One hour active orthostatism and low sodium diet (20 mmol of sodium during 4 days) induced a normal PRA increase but an insufficient PA response. Positive significant correlations were found between PRA and PA and between plasma angiotensinogen and plasma cortisol. The mechanisms underlying this functional hypoaldosteronism were discussed.

Treatment of Cushing's disease by O,p'DDD. Survey of 62 cases.

In a study of nonsurgical therapy of Cushing's disease, 62 patients received O,p'-dichlorodiphenyldichloroethane (O,p'DDD), 16 of whom also received cobalt irradiation of the pituitary. After an initial treatment period averaging eight months, a remission of the disease was obtained in 38 of the 46 patients given O,p'DDD alone and in all patients who received drug combined with radiation. Although 60 per cent of these patients subsequently relapsed, additional courses of drug or radiation therapy were usually effective, and 63 per cent of the entire group of patients have so far been kept under control without adrenalectomy. (Forty patients have been followed for at least two years after the initial course of treatment.). O,p'DDD produced little gastrointestinal discomfort; an increased serum cholesterol was the main side effect. This drug allows long-term medical management of Cushings disease in most cases. Whether the combination of O'p'DDD with pituitary radiation is the best therapy has not been established.

Double blind clinical trial of mazindol on weight loss blood glucose, plasma insulin and serum lipids in overweight diabetic patients.

Mazindol, a drug with tricyclic structure unrelated to amphetamine and other anorectic drugs, has been used as an anorectic agent in a double blind clinical trial at a dose of 2 mg/day for 12 week (mazindol v. s. placebo), associated with a 1000 calorie diet on 46 obese diabetic patients. Thirty seven patients completed the trial with no significant difference between the two groups in the drop-out population; mazindol was well tolerated. In the mazindol-treated group the mean weight loss was 13.5 kg (22.3%) which was significantly greater (p less than 0.001) than in the placebo treated group where the mean weight loss was 4.2 kg (9.8%). Comparing the two groups after the 12 week trial, decrease in fasting blood glucose, serum insulin and triglycerides was not significant. In the mazindol-treated group a significant decrease of serum cholesterol, triglycerides and of the mean area under the curve of insulinemia during the OGTT has been observed. In the placebo treated group only serum triglycerides decreased significantly. The variations of plasma insulin and serum cholesterol were found to be correlated to the magnitude of weight loss. In conclusion mazindol is an effective drug for weight loss on the whole well tolerated but without specific properties on metabolism.

[Glucocorticoids and gluco-lipidic metabolism]. / Glucocorticoïdes et métabolisme glucido-lipidique.

Glucocorticoids increase the stocks of carbohydrate and the supra-hepatic flow of glucose. Their excess produces a centripetal redistribtution of adipose stocks and potentialises adipocyte lipolysis. Although their role of glucose and lipid metabolism is evident, the mechanisms and sites of action of glucocorticoids are multiple and not entirely clear. The actions of glucocorticoids become clear in cases of insulin deficiency, especially when the deficiency is marked, which is of great interest in current medical practice.