[Acute adrenal insufficiency: an entity that should not be missed]. / Insuffisance surrénalienne aiguë†: une entité à ne pas manquer.

Acute adrenal insufficiency is a rare pathology which can be life threatening if not diagnosed and treated adequately. Clinical presentation is aspecific. Etiologies are classified as central or adrenal origins. Diagnosis of adrenal insufficiency is based on dosage of morning cortisol combined with a Synacthen test. When acute adrenal insufficiency is suspected, 100 mg of hydrocortisone should be administered as soon as possible, even before biological confirmation. This article, illustrated by a clinical case, will review the clinical presentation, diagnostic approach, and treatment of adrenal insufficiency.

L'insuffisance surrénalienne (IS) aiguë est une pathologie qui engage le pronostic vital si elle n'est pas diagnostiquée et traitée rapidement. Sa présentation clinique est aspécifique. Les étiologies sont classées en origines surrénaliennes ou centrales. Le diagnostic d'IS repose sur le dosage du cortisol matinal ainsi que sur un test au Synacthen. Lors d'une suspicion d'IS aiguë, le traitement par hydrocortisone 100 mg IV doit être administré dans les meilleurs délais sans attendre la confirmation biologique. Cet article, illustré par un cas clinique, a pour but de rappeler la présentation clinique, la démarche diagnostique et la prise en charge médicamenteuse de l'IS.

[Radiofrequency ablation of thyroid nodules†: an alternative to surgery or first-line treatment†?] / Ablation des nodules thyroïdiens par radiofréquence†: alternative à la chirurgie ou traitement de première ligne†?

Thyroid nodules are a very common problem whose prevalence increases with age. When treatment is considered, surgical excision is traditionally the first choice, except in the case of hyperfunctioning nodules, where treatment with radioactive iodine plays a major role. In recent years, there has been increasing experience in the thermal ablation of thyroid nodules by radiofrequency, with very encouraging results. This article aims to discuss the role of radiofrequency thermal ablation in the management of benign thyroid nodules by reviewing the indications, adverse effects and limitations of this method.

Les nodules thyroïdiens sont un problème très fréquent dont la prévalence augmente avec l'âge. Lorsqu'un traitement est envisagé, l'excision chirurgicale occupe jusqu'à présent la première place, sauf dans le cas des nodules hyperfonctionnels où la radiothérapie métabolique par iode 131 joue un rôle principal. Depuis quelques années, il existe une expérience croissante dans la thermoablation des nodules thyroïdiens par radiofréquence, avec des résultats très encourageants. Cet article a pour but de discuter la place de la thermoablation par radiofréquence dans la prise en charge des nodules thyroïdiens bénins en passant en revue les indications, les effets indésirables et les limitations de cette méthode.

Disease heterogeneity in IgG4-related hypophysitis: report of two histopathologically proven cases and review of the literature.

IgG4-related hypophysitis (IgG4-RH) is a rare disease, which can occur singularly or as manifestation of a systemic IgG4-related disease (IgG4-RD). Less than one hundred cases have been reported in the literature, very few of which were histopathologically documented. We analyzed the clinical, radiological, and histopathological features of two cases of IgG4-RH, the former observed in a 66-year-old man in the context of an IgG4-RD, and the latter affecting a 21-year-old woman, as an isolated lesion. In addition, we performed a comprehensive review of the previously published histopathologically documented cases of IgG4-RH. Pituitary samples from both patients showed dense lymphoplasmacytic infiltration, interstitial and storiform fibrosis, and high numbers of IgG4-positive plasma cells, consistent with IgG4-RH. From the literature review, we retrieved 18 papers reporting a total of 22 cases of histopathologically documented IgG4-RH. The revision of these cases, also including the two reported herein, showed an equal distribution of IgG4-RH in the two sexes, albeit significant clinico-pathological variation was found between cases arisen in female and male patients, respectively. In detail, IgG4-RH females were affected in their second-third decade of life, with a solitary pituitary lesion, low IgG4 serum level, and frequent association with autoimmune disorders. By contrast, IgG4-RH in men was a disease of the elderly, often in the context of a systemic IgG4-RD, with high IgG4 serum levels. Our study shows that IgG4-RH, as currently defined, is a clinically heterogenous disease, with different features in the two sexes. Indeed, cases diagnosed in young women, as our case 2, mostly do not present other evidence of IgG4-RD and might be better classified as lymphocytic hypophysitis with abundant IgG4+ plasma cells. For this reason, the histopathological examination of the pituitary lesion, particularly in female patients, may still be useful for a correct differential diagnosis with other variants of primary hypophysitis.

Effectiveness of a transition plan at discharge of patients hospitalized with heart failure: a before-and-after study.

AIMS: We evaluated the effectiveness of a multidisciplinary transition plan to reduce early readmission among heart failure patients. METHODS AND RESULTS: We conducted a before-and-after study in a tertiary internal medicine department, comparing 3 years of retrospective data (pre-intervention) and 13 months of prospective data (intervention period). Intervention was the introduction in 2013 of a transition plan performed by a multidisciplinary team. We included all consecutive patients hospitalized with symptomatic heart failure and discharged to home. The outcomes were the fraction of days spent in hospital because of readmission, based on the sum of all days spent in hospital, and the rate of readmission. The same measurements were used for those with potentially avoidable readmissions. Four hundred thirty-one patients were included and compared with 1441 patients in the pre-intervention period. Of the 431 patients, 138 received the transition plan while 293 were non-completers. Neither the fraction of days spent for readmissions nor the rate of readmission decreased during the intervention period. However, non-completers had a higher rate of the fraction of days spent for 30 day readmission (19.2% vs. 16.1%, P = 0.002) and for potentially avoidable readmission (9.8% vs. 13.2%, P = 0.001). The rate of potentially avoidable readmission decreased from 11.3% (before) to 9.9% (non-completers) and 8.7% (completers), reaching the adjusted expected range given by SQLape® (7.7-9.1%). CONCLUSIONS: A transition plan, requiring many resources, could decrease potentially avoidable readmission but shows no benefit on overall readmission. Future research should focus on potentially avoidable readmissions and other indicators such as patient satisfaction, adverse drug events, or adherence.

The Bethesda System for Reporting Thyroid Cytopathology Explained for Practitioners: Frequently Asked Questions.

BACKGROUND: The recent update of The Bethesda System for Reporting Thyroid Cytology (TBSRTC) is a very important development in the evaluation of thyroid nodules. Clinical experience and scientific literature both show that practitioners performing thyroid fine-needle aspiration are accustomed to basing the clinical management of patients on reports using TBSRTC. Specifically, clinicians are familiar with the percent risk of malignancy corresponding to each TBSRTC diagnostic category (DC), as well as with the respective recommendation for clinical management. However, most clinicians are much less familiar with the specific considerations that lie between a given DC, on the one end, and the respective risk of malignancy and associated management recommendation, on the other end. SUMMARY: A deeper understanding of the system can enlighten the clinician's thinking about the specific nodule under examination and can guide the decision-making process in a more meaningful way. Such an understanding can only be developed via close two-way communication between cytopathologists and clinicians. Through this type of interaction in the authors' tertiary medical center, recurring issues of particular importance for clinical practice were identified, which are reported here in the form of 16 frequently asked questions posed by the clinician to the cytopathologist. CONCLUSIONS: For each frequently asked question, an answer is provided based on the literature, the authors' experience, the new version of TBSRTC, and the new World Health Organization classification of tumors of endocrine organs.

[Diabetes mellitus secondary to an endocrine pathology : when to think about it ?] / Diabète sucré secondaire à une endocrinopathie : quand y penser ?

An endocrine disease can be associated with glucose intolerance or diabetes mellitus, and the latter can falsely be considered as type 2 diabetes. Glycemic imbalance can be a direct or indirect consequence of excessive hormone production. Endocrine diseases such as acromegaly, Cushing's syndrome and pheochromocytoma can increase glucose production and cause insulin resistance. Hyperthyroidism, hyperaldosteronism, glucagonoma and somatostatinoma lead to hyperglycemia by other physiopathological mechanisms detailed in this article. When a clinical picture suggests an endocrine disease, several analyses need to be done in order to avoid treatment escalation of diabetes.

Une endocrinopathie peut s'accompagner d'une intolérance au glucose ou d'un diabète, ce dernier pouvant être considéré à tort comme un diabète de type 2. Le déséquilibre glycémique peut être la conséquence directe ou indirecte d'un excès d'hormones. Certaines affections endocriniennes telles que l'acromégalie, le syndrome de Cushing et le phéochromocytome entraînent une augmentation de la néoglucogenèse et une résistance à l'insuline. L'hyperthyroïdie, l'hyperaldostéronisme, le glucagonome, le somatostatinome engendrent une hyperglycémie par d'autres mécanismes physiopathologiques détaillés dans cet article. Lors d'une présentation clinique évocatrice d'une endocrinopathie, il convient de la rechercher afin de ne pas intensifier le traitement du diabète sans prendre en charge la pathologie endocrinienne sous-jacente.

Prevalence and determinants of weight misperception in an urban Swiss population.

AIM: Weight misperception precludes effective management of pre-obesity and obesity, but little is known regarding its status in the Swiss population. Our study aimed to assess the prevalence and determinants of weight over- and underestimation in an adult urban Swiss population. METHODS: Cross-sectional study conducted between 2009 and 2012 in the city of Lausanne. Height and weight were measured using standardised procedures. Weight perception and other socio-demographic variables were collected through questionnaires. RESULTS: Data from 4284 participants (2261 women, 57.5 ± 10.4 years) were analysed. Overall, almost one-fifth (18%) of participants underestimated their weight, while only 7% overestimated it. One quarter of women and half of men with overweight underestimated their weight; the corresponding values for obese subjects were 7% and 10%. Multivariate analysis showed male gender (odds ratio [OR] 3.09, 95% confidence interval [CI] 2.54-3.76), increasing age or body mass index (p-value for trend <0.001), being born in Portugal (OR 2.10, 95% CI 1.42-3.10), low education (OR 1.90, 95% CI 1.47-2.47), and absence of diagnosis of pre-obesity or obesity by the doctor (OR 5.61, 95% CI 4.51-7.00) to be associated with weight underestimation. Overestimation was significantly higher in women (19.6%) than in men (8.5%). Weight overestimation was negatively associated with male gender (OR 0.29, 95% CI 0.22-0.39), increasing age (p-value for trend <0.001), being born in Portugal (OR 0.37, 95% CI 0.16-0.87) and positively associated with absence of diagnosis (OR 3.11, 95% CI 2.23-4.34). CONCLUSION: Almost one quarter of the Swiss population aged 40 to 80 has weight misperception, underestimation being over twice as frequent as overestimation. Adequate diagnosis of overweight or obesity might be the best deterrent against weight misperception.