[Methadone-induced central adrenal insufficiency: a case report]. / Insuffisance surrénalienne centrale induite par la méthadone : à propos d'un cas.

Adrenal insufficiency secondary to opioid use remains inadequately acknowledged in medical literature. We present the case of a 33-year-old female patient diagnosed with central adrenal insufficiency (CAI), where methadone use was identified as the underlying cause after ruling out known etiologies. This article aims to enhance awareness among prescribing clinicians and medical professionals regarding the potential occurrence of AI in patients undergoing methadone treatment. This is especially pertinent given the widespread utilization of methadone in France for managing drug withdrawal.

Impact of storage temperature and time before analysis on electrolytes (Na+, K+, Ca2+), lactate, glucose, blood gases (pH, pO2, pCO2), tHb, O2Hb, COHb and MetHb results.

OBJECTIVES: The objective of our study is to evaluate the effect of storage temperature and time to analysis on arterial blood gas parameters in order to extend the CLSI recommendations. METHODS: Stability of 12 parameters (pH, pCO2, pO2, Na+, K+, Ca2+, glucose, lactate, hemoglobin, oxyhemoglobin, carboxyhemoglobin, methemoglobin) measured by GEM PREMIER™ 5000 blood gas analyzer was studied at room temperature and at +4 °C (52 patients). The storage times were 30, 45, 60, 90 and 120 min. Stability was evaluated on the difference from baseline, the difference from the analyte-specific measurement uncertainty applied to the baseline value, and the impact of the variation on the clinical interpretation. RESULTS: At room temperature, all parameters except the lactate remained stable for at least 60 min. A statistically significant difference was observed for pH at T45 and T60 and for pCO2 at T60 without modification of clinical interpretation. For lactate, clinical interpretation was modified from T45 and values were outside the range of acceptability defined by the measurement uncertainty. All parameters except pO2 remained stable for at least 120 min at +4 °C. CONCLUSIONS: A one-hour transport at room temperature is compatible with the performance of all the analyses studied except lactate. If the delay exceeds 30 min, the sample should be placed at +4 °C for lactate measurement. If the samples are stored in ice, it is important to note that the pO2 cannot be interpreted.

Hypophosphatemia related to a neuro-endocrine tumor of the pancreas: A case report.

BACKGROUND: Tumor-induced osteomalacia (TIO) is a paraneoplastic syndrome characterized by hypophosphatemia associated with elevated fibroblast growth factor 23 (FGF23). TIO is primarily caused by benign mesenchymal tumors of the soft tissue and skeleton. Rarely, it is associated with a solid tumor or hematological malignancy. To date, no case of osteomalacia related to pancreatic cancer has been reported in the literature. CASE REPORT: A 77-year-old woman was admitted to the rheumatology department (RD) of the Clermont-Ferrand University Hospital (France) for further evaluation of her hypophosphatemia. The patient reported bone pain, myalgia, and asthenia. Further laboratory tests revealed hyperphosphaturia, normocalcemia, low serum calcitriol, elevated serum alkaline phosphatase (ALP), and elevated plasma parathyroid hormone (PTH). A renal phosphate depletion disorder was suspected as an etiology for this hypophosphatemia. Finally, FGF23 levels were found to be significantly elevated, leading to a definitive diagnosis of pancreatic neuroendocrine tumor. CONCLUSION: This is the first report of hypophosphatemic osteomalacia related to pancreatic cancer. Therefore, in the setting of hypophosphatemia associated with renal phosphate wasting and low calcitriol level, plasma FGF23 measurement should be considered.

[Pre-analytical phase impact in the differences in natremia obtained by direct and indirect ion selective electrodes methods]. / Impact de la phase pré-analytique dans les différences de natrémies obtenues par techniques potentiométriques directe et indirecte.

Natremia is an important biological parameter providing information on the hydration state of patient's intracellular sector. Its measurement can be carried out either by multiparametric laboratory analyser (indirect potentiometry) or delocalized biology analyser (direct potentiometry). The main problem is that for a same patient, these two analysers can give quite different results, hence inducing interpretation problems for clinician. Two one-week study periods comparing the variations in blood sodium levels produced by these automatic analysers were carried out in two intensive care units of Clermont-Ferrand University Hospital. During the second study period, a protocol for collecting blood samples was applied in order to improve the pre-analytical conditions. Between the two weeks of studies, the median of the differences in natremia was significantly reduced, going from 4 mmol/L to 2 mmol/L (p < 0.001), as was the proportion of patients with large differences in sodium levels (strictly higher than 3 mmol/L) going from 51% to 24.8% (p < 0.001). The patients still presenting large variations in sodium had a median of proteins significantly lower than patients with deviations less than or equal to 3 mmol/L: 58.1 g/L against 62.25 g/L respectively (p < 0.001) leading to pseudo-hypernatremia (indirect potentiometry). Despite a significant reduction in differences linked to the application of good preanalytical practices, some patients nonetheless presented a major difference in natremia due to the difference of technique (variations in the lipidoprotein phase of the plasma of intensive care patients) and to the measurement uncertainties.