Familial aggregation of LADA and juvenile type 1 diabetes in a French Caucasian family.

We describe here the unusual aggregation of diabetes cases in a family of 10 subjects. Among them, three adult siblings presented with LADA and one child presented with juvenile type 1 diabetes. Although the exact pathogenesis of LADA is unknown and questions the role of autoimmunity in beta cell failure, the familial aggregation of these two forms of diabetes underlines the existence of common roots, i.e. immune mechanisms and genetic susceptibility. This report clearly illustrates the differences in terms of autoimmunity (prevalence and titer of GAD and IA2 antibodies) and HLA class II genotype between patients with LADA and those with juvenile type 1 diabetes.

[Hyperthyroidism by autonomous metastasis of thyroid carcinoma (author's transl)]. / Hyperthyroïdie par métastases autonomes et extinctives d'un cancer thyroïdien

Nine years after surgical ablation of a trabeculo-vesicular carcinoma of the tyroid, a patient developped bone and liver metastasis. She had clinical signs of thyrotoxicosis, clear increase of blood T3 and sligh increase of T4. The TSH secretion was blocked. Exogenous TSH increased iodine uptake in the thyroid and not in the metastasis. After 2 doses of 120 mCi of 131I, she became hypothyroid, the liver was normal and the scan revealed the disappearance of uptake in thyroid and in metastasis. Such a clinical course was previously found in only 10 cases despite the frequent funcitonal differenciation of the metastasis of thyroid carcinomas.

[Metastatic thyroid carcinoma with hyperthyroidism (author's transl)]. / Hyperthyroïdie par métastases autonomes d'un cancer thyroïdien.

Eight years after subtotal thyroidectomy for thyroid carcinoma, a patient developped multiple metastasis in bones and liver with high radioiodine uptake. This patient had clinical and biological thyrotoxicosis with low iodine uptake in the cervical remaining thyroid tissue and TSH secretion was not stimulated by TRH. Administration of 240 millicuries of 131 I led to hypothyroidism, to clinical regression of liver metastasis and to disappearance of extra-cervical iodine uptake. Eleven similar case have been reported in the literature.

[Glucocorticoids and metabolism]. / Glucocorticoïdes et métabolismes

After a brief historical account, the physiological effect of glucocorticoid hormones are analysed. Their main point of impact is neoglucogenesis from proteins. To this is added their direct action on carbohydrates, their intervention in the use of lipids, and in the movement of water and salts. Cortisone penetrates into the cell, is fixed by a cortisone receptor in order to be transferred into the nucleus and to act on the transformation of ADN-ARN. Its relationships with cyclic AMP are discussed. The hormonal correlations of glucocorticoids are numerous. (insulin, catecholamine, glucagon, growth hormone, androgen). Synthetic cordicoids have biological actions which are close to those of glucocorticoids, but vary depending on their structure. These physiological and pharmacological notions imply certain precautions in the use of this type of hormone derivative.

Sideroblastic anaemia during fusidic acid treatment.

OBJECTIVES AND METHODS: To describe cases of fusidic acid-associated sideroblastic anaemia from the French Pharmacovigilance database. RESULTS: Six cases of sideroblastic anaemia associated with oral fusidic acid treatment were retrieved. Four females and two males (mean age 65.3 yr) developed severe anaemia (mean haemoglobin level: 6.9 g/dL) within 32-190 d (mean: 81 d) of treatment. Bone marrow aspirates showed dyserythropoiesis and ringed sideroblasts in all patients. Four patients required repeated blood transfusions. After fusidic acid discontinuation in five patients, complete recovery was obtained. In one patient, rechallenge with fusidic acid resulted in recurrence of anaemia that resolved after definitive discontinuation of the drug. CONCLUSION: Our data indicate that fusidic acid should be added to the list of drugs that can cause sideroblastic anaemia.