Evaluation of the performance of ultrasonography and 99mTc-sestamibi scintigraphy for primary hyperparathyroidism surgery.

INTRODUCTION: Minimally invasive surgery has become the standard surgical attitude in primary hyperparathyroidism. It requires precise preoperative lesion localization. The aim of the present study was to evaluate the performance of ultrasonography and 99mTc-sestamibi scintigraphy in minimally invasive surgery for primary hyperparathyroidism. MATERIALS AND METHODS: A retrospective study included all patients managed surgically for primary hyperparathyroidism between January 2008 and November 2017 in the University Hospital of Brest (France). Two hundred and seventy-three patients underwent ultrasonography and 99mTc-sestamibi scintigraphy. Results determined intrinsic (sensitivity and specificity) and extrinsic (positive and negative predictive values) performance on per-patient and per-gland analysis. Demographic, preoperative, interventional and cure data were compared according to ultrasonography and scintigraphy results, distinguishing 3 patient groups: concordant n=156, discordant n=99, negative n=18. RESULTS: On per-gland analysis, sensitivity was 70% for ultrasound, 74% for 99mTc-sestamibi scintigraphy and 81% for associated ultrasound-scintigraphy; positive predictive values were 89%, 91% and 96%, respectively. Gland volume and concomitant thyroid pathology rates differed significantly (both p=0.003) between the 3 imaging results groups. CONCLUSION: The performance of associated ultrasound-99mTc-sestamibi-scintigraphy provided a positive predictive value of 96%. Combining the two techniques reduced surgical morbidity.

Which oral antidiabetic drug to combine with metformin to minimize the risk of hypoglycemia when initiating basal insulin?: A randomized controlled trial of a DPP4 inhibitor versus insulin secretagogues.

We conducted a pilot study to evaluate two therapeutic strategies at the time of insulin initiation in type 2 diabetic patients insufficiently controlled with metformin+insulin-secretagogues (IS, sulfonylureas or glinides). Patients were randomized to remain under the same dual therapy or to receive metformin+DPP4 inhibitors while starting insulin. Similar glycemic control was achieved in both groups. However less hypoglycemia was observed with DPP4 inhibitors despite higher doses of insulin.

[Cushing's disease: role of feeding]. / Maladie de Cushing: Rôle de l'alimentation.

We report a clinical case of a patient with corticotropin dependent Cushing disease. In this patient ingestion of mixed meals is followed by an increase of ACTH and cortisol. This effects seems secondary to ingestion of proteins, and it can be reproduced by intravenous injection of aminoacids. The pattern observed is similar to what is observed in normal subjects. Neurotransmitter substrate from protein meals or after intravenous injection of aminoacids may influence the factors controlling ACTH secretion in the studied patient.

[Polycystic ovary and diazoxide. In vivo study]. / Ovaires polykystiques et diazoxide. Etude in vivo.

The suppression of hyperinsulinism with diazoxide (300 mg/d during 30 days) in a young woman with PCOS and hirsutism, hyperinsulinism and insulinoresistance was followed by a modification of plasma androgens. Testosterone (T) and free testosterone (fT) were reduced after ten days and then increased but always remained below the baseline level. DHEAS had increased 200% by day 10, and 3 alpha-adiol G to three times its basal value by day 20. These modifications were constant during the treatment. fT decrease was secondary to reduction of hyperinsulinism which was followed by an increase of TeBG and a modest and transient reduction of androgen theca cells production. DHEAS increase was due to hyperinsulinism suppression which stimulated adrenal 17-20 lyase activity. 3 alpha-adiol G increase was concomittant, and can be considered as an index of adrenal androgen secretion.

[Evolution of levels of free thyroxine and thyrotropin in treated Cushing disease]. / Evolution de la thyroxine libre et de la thyréostimuline au cours de la maladie de Cushing traitée.

OBJECTIVE: Determine the frequency and changes in thyroid hormones in Cushing's disease. METHODS: Free thyroxin and thyrotropin levels were measured in 11 patients (age range 17 to 60 years) with Cushing's disease both before and after resection of the pituitary adenoma. RESULTS: Free thyroxin levels were low (8.3 to 11.7 pmol/l) in 7 patients. These patients had no clinical manifestations of hypothyroidism. In 4 patients, cure of the pituitary adenoma led to normalization of the thyroid hormones 10 days after operation (13 to 55 pmol/l); in the other cases surgical cure was unsuccessful and thyroxin levels remained low. Cortisol levels were finally normalized in these patients after irradiation of the pituitary, a second pituitary operation, or bilateral resection of the adrenal glands in 2 patients. Normal thyroxin levels were thus achieved. There was no correlation between serum cortisol and free thyroxin. CONCLUSION: Thyroid hormones should be assayed regularly in patients with Cushing's disease as a supplementary control of treatment effectiveness.

[Mid-term and long-term outcome in Leydig cell estrogen tumors]. / Devenir à moyen et à long terme des tumeurs estrogéniques à cellules de Leydig.

A study has been realized in six patients with estrogen secreting Leydig cell tumors from 18 to 120 months after hemicastration. Testicular contralateral volume is normalized, gynecomastia can be completely reduced, sex steroids are normalized while gonadotropins can be temporary increased. Spermogram which is abnormal can be normalized. These results confirm the heterogeneity of these tumors.