[Effects of glucocorticoids administration on memory. Cognitive impairment in Cushing's disease]. / Effets des glucocorticoïdes sur lá memoire. Troubles cognitifs dans la maladie de Cushing.

The case of a 85 years old woman is reported. She suffered from a partially reversible episodic memory dysfunction after i.m. injections of bethamethasone for acute lumbalgia. Cognitive impairments observed in Cushing's disease are reviewed as well as the deleterious effects of glucocorticoid treatments on episodic memory. They could be prevented by memantine.

[Neurosciences and the mind-brain connection: treatment of depression]. / Neurosciences et rapport pensée-cerveau: à propos des traitements de la dépression.

Neuroscientists claim that thoughts and intentions result only from brain activity. It is illustrated by the ability to control a robotic arm only by thought. However although they have a biological support, emotions, ideas and intentions are perceived at another level of reality than synapses and neurotransmitters. The reduction of mind to brain (called monism) represents a categorical error. Psychiatric praxis relies on a dualistic (complementary) position regarding e.g. depression treatment. Antidepressants and psychotherapy have distinct impacts on cerebral metabolism measured by fMRI and different ways to modify emotions. The combination of these two therapies is indicated in case of severe depression.

[Oxytocin: the hormone of love, trust and social bond. Clinical use in autism and social phobia]. / L'ocytocine: hormone de l'amour, de la confiance et du lien conjugal et social.

Oxytocin, an octapeptide synthesized in the hypothalamus, stimulates milk election and uterine contractions. In the brain this hormone acts as a neuropeptide. It could inhibit through the GABAergic system the activity of limbic amygdala, which is involved in the response to fear. Oxytocin could also induce the protective behaviour of the mother towards its offspring through the dopaminergic system. In mankind, oxytocin plays a role in trust, empathy, generosity, stress and sexuality. Clinical studies are testing potential benefits of oxytocin administration in autism, depression and social phobia. Results are still preliminary.

[Effects of folic acid on cerebrovascular and cancer risks]. / Effets de l'acide folique sur les risques cérébrovasculaires et oncologiques liés à l'homocystéine.

Homocysteine increase is associated with an elevated risk of cerebro-vascular (CV) disease as well as osteoporosis, dementia and depression. However, most secondary prevention trials did not show any CV benefit to decrease homocysteine levels through folate administration, with the possible exception of stroke. Reasons for these failures are analysed. Moreover, folate acid could decrease the risk of colon, breast and prostate cancers mainly in wine drinkers, whereas it increases the growth of preneoplasic cells of the latter cancers. In conclusion, folate acid does not benefit patients for secondary prevention of CV or malignant diseases but it still has to be proven that it could benefit patients for primary prevention.

[Estrogens and male sexuality: efficiency of antiestrogens in case of hypothalamic hypogonadism and late onset hypogonadism]. / Oestrogènes et sexualité masculine: effets des antioestrogènes en cas d'hypogonadisme hypothalamique.

Estrogen treatment in eugonadal men diminishes libido, whereas libido is preserved by estrogens in orchidectomized transsexuals as well as in cases of aromatase deficiency. Hypothalamic hypogonadism can be caused by stress, depression, anorexia or excessive exercise. It may result in erectile dysfunction and decreased libido. A 7 day trial of clomiphen (25 mg/day) can be used to test the responsiveness of the axis and may be continued for up to 6 months as a means to stimulation endogenous LH and testosterone secretion. Other antiestrogens such as raloxifen or anastrazol may have similar effects in obese men and in aging men with late onset hypogonadism (LOH).

[Is there an indication for dehydroepiandrosterone (DHEA) treatment in elderly women with Addison disease? Beneficial and adverse effects of DHEA]. / Y a-t-il une indication au traitement par la déhydroépiandrostérone (DHEA) chez les femmes âgées et les Addisoniens? Effets bénéfiques et indésirables de la DHEA.

DHEA is a cetosteroid secreted by the adrenal gland. Serum levels of DHEA decline by an average of 10% per decade whereas cortisol levels remain stable. The relative lack of DHEA secretion in elderly people has been called adrenopause. The daily administration of 50 mg of DHEA to women over 60 years old results in a two-fold increase in serum level of testosterone and androstenedione and in a 10% increase of estradiol in men. A 10 to 20% increase of IGF-1 is observed in both sexes. In women over 70 years old treated by 50 mg/day of DHEA for 6 months an improvement of bone turnover and of skin status was observed as well as an increase of overall well-being and of libido. These beneficial psychological effects have also been observed in younger men and women with adrenal insufficiency. In men 50 to 65 years old, 100 mg/day of DHEA for 6 months could slightly increase the lean body mass and the muscle strength. Moreover DHEA could increase immune function and NK cell activity. As there are no actual data about cardio-vascular and oncological risks of a prolonged treatment with DHEA, the administration of this steroid must still be considered experimental. Previous or present cancer of the breast or of the prostate is an absolute contraindication to DHEA treatment.

[Ten questions on the causes and consequences of obesity: stress hormones]. / Dix questions sur les causes et les conséquences de l'obésité: des hormones aux stress.

In Switzerland, 6% of men and 5% of women are obese (BMI > 30); 33% of men and 17% of women are overweight (BMI 25-30). Both genetic and environmental factors are responsible for obesity. There is an increased risk of C-V disease, diabetes and steato-hepatitis in abdominal obesity (abdominal circumference > 102 cm for men and > 88 cm for women). There is also an increased level of cortisol, which could be due to a difficulty to cope with psycho-social stress. Leptine and different hormones play a role in fat storage. Menopause and pregnancy are moderate risk factors for obesity. Weight gain may also result from different drugs, smoking cessation and stress. Eating disorders such as boulimia and binge eating must be diagnosed and treated. Beneficial health effect of weight loss is analysed.

[Ten questions on the treatment of obesity: from dieting to surgery]. / Dix questions sur les traitements de l'obésité: des régimes à la chirurgie.

Advantages and risk of weight reduction achieved by combining diets or unbalanced diets with restriction of carbohydrates or fat are discussed. Nutriments differ according to their density, their flavour, their satiating, and their thermogenic effect. Food is also a source of pleasure and a remedy to frustration. One of the problems of dieting is that most patients regain the weight they have lost due to a hypometabolism secondary to caloric restriction. Only physical exercise together with behavior therapy are able to slow down this weight regain. The indication of drug treatment with orlistat, sibutramine and fluoxetin and the indication to bariatric surgery are presented. The importance of the prevention of obesity by nutrition teaching in schools as well as the necessity of a long term treatment as in type II diabetes are underlined.

[What's new in hormone replacement therapy for postmenopausal women? I. Advantages of hormone replacement therapy (HRT)]. / Quoi de neuf dans le traitement hormonal substitutif de la ménopause? I. Avantages du traitement hormonal substitutif (THS).

Different cohort studies have shown that HRT decreases the risk of cardio-vascular (C-V) disease and the risk of bone fracture by 30 to 50%. The only controlled study (HERS study) did not show any benefit of HRT with estradiol and medroxyprogesterone (MPG) in secondary prevention. The beneficial effect of estrogens on coronary dilatation and on HDL cholesterol could be attenuated by some progestogens such as MPG but not by nomegestrol acetate. In this framework, the comparative metabolic effects of different progestogens and tibolone are described in this article. The effects of estrogens on mood and of androgens on libido are discussed. The preventive effect of estrogens on osteoporosis and on Alzheimer disease is compared to other nonhormonal treatments.

[What's new in hormone replacement therapy of postmenopausal women? II. Risks of hormone replacement therapy (HRT)]. / Quoi de neuf dans le traitement hormonal substitutif de la ménopause? II. Risques du traitement hormonal substitutif (THS).

A 50 year old woman has a 10% lifetime risk of developing a breast cancer. Depending on the duration of the treatment, HRT can increase this risk by 30 to 45%. The risk of endometrial cancer, which affects 2.3% of women, is increased even if sequential progestogens are given together with estrogens. The risk of venous thrombosis is increased 3 times. The occurrence of ictus is not modified by HRT. On the other hand estrogens may prevent the abdominal deposit of fat. The cancer risks associated with HRT must be balanced against their protective effects on cardio-vascular (C-V)diseases. In untreated women, mortality due to C-V disease is 39% whereas mortality due to breast cancer is 3% and only 0.3% for endometrial cancer. This article discusses also the possibility of HRT and of non hormonal treatments in patients with previous breast cancer.

[Cardiac decompensation after an adenectomy for primary hyperparathyroidism: hypocalcemic cardiopathy or cascade effect?]. / Décompensation cardiaque après adénectomie pour hyperparathyroïdie primaire: cardiopathie hypocalcémique ou effet de cascade?

A 42 year old woman presented with an auricular tachyarrhythmia as well as a congestive cardiac failure ascribed to a viral myocarditis, two months after an adenectomy for primary hyperparathyroidism. Serum calcium was low whereas parathormone serum was increased suggesting a "hungry bone syndrome". The left ventricular dysfunction persisted for a long period even after normalization of the serum calcium. The contributory role of hypocalcemia in unexplained or refractory heart failure is reviewed. The eventuality of a cascade effect is evoked.

[Etiology and treatment of sterility due to azoospermia]. / Etiologie et traitement de la stérilité due à une azoospermie.

Azoospermia can be classified according to the serum level of FSH into obstructive (OA) or non-obstructive (NOA) azoospermia. It can also be due to a lack of gonadotrophins. In the latter case the administration of FSH and HCG can normalize the sperm production. In the other cases ICSI must be performed. In OA sperm can be retrieved using percutaneous epididymal aspiration or testicular fine needle aspiration in case of failure of vasovasostomy or epididymovasostomy. In NOA or spermatogenic arrest, focal spermatogenesis can be observed in 40 to 50% of cases using repeated testis biopsies, allowing to perform ICSI. Although the risk of malformation in children born after ICSI is not increased there is an increased risk to transmit genetic abnormalities in case of NOA (such as the rate of sex chromosome, or microdeletions of the Y chromosome) and in case of congenital OA (mutations of the cystic fibrosis gene).

[Growth and collagen synthesis disorders in asthmatic children treated with inhaled steroids]. / Troubles de la croissance et de la synthèse du collagène chez des enfants asthmatiques traités par des stéroïdes en inhalation.

We report the case of an atopic patient aged 16 with a perannual asthma. He has been treated since the age of 4 with inhaled corticosteroïds. His growth was regular until he was 14 when beclomethasone was replaced by fluticasone (both administered by pressurized inhaler) due to adrenal suppression. Growth inhibiting effects of different inhaled corticosteroids are discussed focusing mainly on their effect on collagen synthesis.

[Attempted suicide with 400 thyroxine pills: what happened to the physician-patient relationship?]. / Tentamen avec 400 comprimés de thyroxine: que s'est-il passé dans la relation médecin-malade?

Patient aged 49 who developed hypothyroidism after receiving 1131 for relapsing Graves' disease after treatment with propylthiouracil followed by homeopathy. Substitution with thyroxine (0.05 mg/day) was prescribed. Depressed by the perspective of a life long treatment, the patient swallowed 400 pills (20 mg). The evolution was uncomplicated after betablockers administration at hospital. One year later she became euthyroid without further medication. The occurrence of transient hypothyroidism after curitherapy is discussed. The importance of mutual participation in the patient/physician relationship is underlined in the framework of divergent conceptions of medicine.

[Are the hormones of youth carcinogenic?]. / Les hormones de jouvence sont-elles cancérigènes?

The decrease of different hormones during aging could play some role in the decline of physical and mental functions of elderly people. Whereas estrogen secretion is almost abolished in menopause, there is a gradual decline of other hormones such as testosterone (T) in men as well as growth hormone (GH) or dehydropepian-drosteronesulfate (DHEAS). As "pause" means cessation in Greek, the term of "clise" (decline) seems to be more appropriate for the 3 latter hormones (e.g. androclise versus andropause). The administration of T and GH to elderly men can increase muscle mass, bone mineral content and decrease fat mass. Long term treatment with estrogens can decrease cardiovascular mortality of postmenopausal women. DHEA administration increases perceived well-being in both sexes. However treatments with T and DHEA risk to induce the growth of an occult prostate cancer and a long term treatments with estrogen can increase the risk of breast cancer. There is a strong association between circulating IGF-I levels and the relative risks of breast and prostate cancer. We hypothesize that the decrease of the latter hormones partially protects against the increasing occurrence of hormonosensitive cancers with aging. The administration of these hormones could oppose this process and increase the carcinogenic risk.

[Triggering role of emotional stress and childbirth. Unexpected occurrence of Graves' disease compared to 96 cases of Hashimoto thyroiditis and 97 cases of thyroid nodules]. / Rôle déclenchant des stress émotionnels et des accouchements. Dans la survenue de 98 cas de maladie de Basedow, comparés à 96 cas de thyroïdite de Hashimoto et 97 cas de nodules thyroïdiens.

98 patients with Graves' disease have been compared to 95 patients with Hashimoto's thyroiditis and to 97 patients with benign thyroid nodules (control group) in order to evaluate the triggering role of major stressors and pregnancy in the occurrence of autoimmune thyroid diseases. A stress factor has been encountered in 11% cases of Graves' disease and in 6% of Hashimoto's and thyroid nodes (chi 2 test, not different). Graves' disease occurred after a pregnancy in 25% of the women in child bearing age versus 10% of the cases of Hashimoto's (p < 0.05) and 13% of the thyroid nodes. The role of stressors, if any, in triggering Graves' disease seems to be weak and dubious compared to the role of pregnancy and post-partum. It is assumed that the decrease of immunosuppressive hormones occurring after stress or delivery could induce a rebound autoimmune reaction responsible for the thyroid disease. In Hashimoto's thyroiditis, stress and pregnancies do not seem to have any triggering role.

[Combined deficiency of thyroid stimulating hormone and growth hormone in a diabetic patient with Hashimoto thyroiditis]. / Déficits combinés en thyréostimuline et en hormone de croissance chez une diabétique atteinte de thyroïdite de Hashimoto.

We report the case of a 36-year-old female patient with insulin dependent diabetes who developed hypothyroidism of pituitary origin after giving birth. She had low levels of free T4 and TSH with no response to i.v. TRH. Antimicrosome antibodies were increased (1/25000), suggesting Hashimoto's thyroiditis. The other hormones were normal except for a low level of growth hormone and insulin growth factor 1. There were no antibodies against the pituitary. MRI of the pituitary was normal. We suspect a vascular origin for this partial pituitary deficiency.

Relationship between etiological factors and total motile sperm count in 350 infertile patients.

The prevalence of different etiologic factors has been evaluated in 350 male patients consulting the same physician in an urban, ambulatory setting for primary or secondary infertility of more than 1 year. Environmental factors such as alcohol or drugs represented 12% of the etiologies, acquired diseases such as varicocele and prostatitis 40%, congenital diseases and primary testicular failure 16.2%, idiopathic cases 19.4%, and abnormality of sperm transport 7.4%. The severity of sperm alterations in the different etiologic categories was evaluated by the total motile sperm count per ejaculate (TMS) (normal > 16). The TMS was less than 5 in classical causes of male infertility such as testicular failure, endocrinopathy, cancer, or antisperm antibodies. It was more than 10 in controversial causes of infertility such as varicocele, prostatis, chlamydial infections, and professional exposure to heat. After treatment, there was a nonsignificant increase of the TMS in the latter cases. In cases of azoospermia of pituitary origin, the TMS was normalized by a hormonal treatment. In some cases of azoospermia of possible obstructive origin, sperm appeared in the ejaculate after diclofenac treatment. The utility of andrological investigation and treatment is discussed.