[Kidney full of stones, and an adrenal gland not quite normal]. / Des reins pleins de cailloux, et une surrénale pas tout à fait normale.

A 31-year-old patient was followed for cystinuria, justifying CT scans. In 2006, a tissue mass of 3cm of the right adrenal gland, homogeneous, measured at 3.5cm in 2007 was noted. Blood pressure was 90/61mmHg, without orthostatic hypotension. During the clinical interview, no discomfort, sweat attack, headache, or palpitation was reported by the patient. Hormonal assays did not favor a primary hyperaldosteronism, or a hypercortisolism. Adrenal androgens were normal. 24h normetanephrines urinary excretion and metanephrines to creatinine ratio were elevated. One year later, the patient remained asymptomatic and normotensive. Plasma levels of normetanephrine and metanephrine were increased and highly pathological. The tumor was 5cm long and fixed individually on MIBG scintigraphy and PET scan. Right adrenalectomy was performed. A pheochromocytoma was confirmed histologically. The peculiarity here was the absence of symptoms, especially arterial hypertension. This currently affects up to 47% of cases, particularly in the context of incidentaloma investigations and family screening. Indeed, 35 to 40% of pheochromocytomas are associated with a germline mutation, justifying a genetic analysis in this patient. Genetic analysis did not show any mutation associated with pheochromocytoma. At a 6-year interval pheochromocytoma did not reappeared while BP increased reaching hypertension threshold. The only documented recurrence was lithiasis.

[Physical activity level and home blood pressure measurement: Pilot study "Acti-HTA"]. / Niveau d'activité physique et contrôle ambulatoire de l'hypertension artérielle. Résultats de l'étude pilote « Acti-HTA ¼.

While physical activity (PA) is recommended for high blood pressure management, the level of PA practice of hypertensive patients remains unclear. We aimed to assess the association between the level of both PA and blood pressure of individuals consulting in 9 hypertension specialist centres. Eighty-five hypertensive patients were included (59 ± 14 years, 61% men, 12% smokers, 29% with diabetes). Following their consultation, they performed home blood pressure measurement (HBPM) over 7 days (2 in the morning+2 in the evening), they wrote in a dedicated form their daily activities to estimate the additional caloric expenditure using Acti-MET device (built from International physical Activity Questionnaire [IPAQ]). Thus, patients completed a self-administered questionnaire "score of Dijon" (distinguishing active subjects with a score>20/30, from sedentary<10/30). Subjects with normal HBPM value (<135/85 mm Hg) (55% of them) compared to those with high HBPM were older, had a non-significant trend towards higher weekly caloric expenditure (4959 ± 5045 kcal/week vs. 4048 ± 4199 kcal/week, P=0.3755) and score of Dijon (19.44 ± 5.81 vs. 18.00 ± 4.32, P=0.2094) with a higher proportion of "active" subjects (48.9% vs. 34.2%, P=0.1773). In conclusion, our results demonstrate a "tendency" to a higher level of reported PA for subjects whose hypertension was controlled. This encourages us to continue with a study that would include more subjects, which would assess PA level using an objective method such as wearing an accelerometer sensor.

[Pheochromocytoma: 25 years of experience. Report of 199 cases]. / Phéochromocytomes: 25 ans d'expérience. A propos de 199 cas.

The methods for diagnosing pheochromocytoma have progressed in 25 years, so changing the clinical, biological and tumoral presentations. The authors compare the features of 199 patients with pheochromocytoma operated between 1975 and 2001 by quartiles. The frequency and known duration of hypertension, plasma adrenaline, the tumour size and proportion of cases which were malignant from the outset, have decreased over the observation period (p < 0.01). The average age and proportion of familial cases or associated with diabetes or those of asymptomatic patients (with incidentaloma), has not changed significantly. The pheochromocytoma were adrenal (104 right, 60 left, 12 bilateral) or ectopic (23) and 13 were malignant from the outset. Over a median 5 year follow-up, 35 pheochromocytomas recurred either in the benign or malignant forms. Recurrences of tumours of the right adrenal were more common than those of the left adrenal gland (p = 0.03). In conclusion, pheochromocytomas are diagnosed earlier, at a stage when the tumours are smaller and less secreting. The higher incidence and recurrence rate of right adrenal pheochromocytoma remain unexplained.

[Consumption coagulopathy disclosing prostatic cancer]. / Coagulopathie de consommation révélatrice d'un cancer de la prostate.

Prostate cancer can be complicated by disseminated intravascular coagulation. The severity of this complication justifies rapid medical treatment. The authors describe the case of a man in his seventies presenting with disseminated purpuric lesions due to disseminated intravascular coagulation. Prostate cancer was documented concomitantly. The clinical course was rapidly unfavourable despite endocrine therapy and blood transfusions. The mechanism of disseminated intravascular coagulation in prostate cancer has not been clearly elucidated, but appears to be related to release of procoagulant substances during certain diagnostic or therapeutic procedures. The severity of the prognosis justifies rapid introduction of endocrine therapy, which is not immediately effective. It can help to achieve a period of remission if the haemorrhagic syndrome is controlled. Further studies may help to improve therapeutic management.