[Association of Basedow's disease and autoimmune thrombopenic purpura. No effect of hyperthyroidism on antiplatelet autoimmunity]. / Association maladie de Basedow et purpura thrombopénique auto-immun. Pas d'influence de l'hyperthyroïdie sur l'auto-immunité antiplaquettes.

The association between Graves' disease and autoimmune thrombocytopenic purpura is rare and yet more frequent than would be expected from a mere coincidence. The existence of an immunological disorder common to Graves' disease and autoimmune thrombocytopenic purpura and/or a direct responsibility of hyperthyroidism in the genesis of immunological disturbances resulting in autoimmune thrombocytopenic purpura are hypotheses put forward to try and explain why these two pathologies are associated. We report two cases in which the antiplatelet autoimmunity developed independently of the thyroid functional disorder, making it unlikely that hyperthyroidism played a direct role in the occurrence of the immunological disorders responsible for the autoimmune thrombocytopenic purpura. The physiopathology responsible for the Graves' disease-autoimmune thrombocytopenic purpura association remains imperfectly known. The existence of an immunological pathogenetic mechanism underlying both diseases seems to be likely; it probably acts through an antigenic determinant that is common to thyroid cells and platelets.

[Prognostic evolution of Graves' disease. Surgical treatment (author's transl)]. / Pronostic évolutif de la maladie de Basedow. Traitement chirurgical.

We report 80 cases of Graves' disease with goiter and homogeneous scintiscan. All the patients underwent surgery after treatment of hyperthyroidism by ATD then by iodine : bilateral subtotal lobectomy was performed in 89 % of cases. The patients have been followed up for 1 to 10 years after surgery, the actuarial rate of euthyroidism is stable at 77 % from the 3rd to the 10th year on. In the same way, 16 % of hypothyroidism and 9 % of recurrent hyperthyroidism do not change from respectively the first and the third year to the tenth after surgery. No correlation has been found between their appearance and the various clinical and biological parameters which has been studied.

[Twin pregnancy following bromocriptine in an acromegalic patient staying sterile after removal of a pituitary adenoma. Immunocytochemical study of the tumor (author's transl)]. / Grossesse gemellaire après bromocriptine chez une acromégale restée stérile après exérèse d'un adénome hypophysaire. Etude de la tumeur en immunofluorescence.

A pituitary adenoma was removed from a young woman who had acromegaly with galactorrhea-amenorrhea. Postoperatively, the dysmorphic acromegalic syndrome and galactorrhea decreased but amenorrhea, elevated serum GH and PRL concentrations remained. After Bromocriptine administration (5 mg daily) GH and PRL levels became normal, vaginal bleeding ensued within 3 months and a twin pregnancy was induced. An immunocytochemical study of the pituitary adenoma revealed the presence of two well defined, distinct cell types, each secreting one hormone with large preponderance of GH cells.

[Amiodarone and hyperthyroidism]. / Amiodarone et hyperthryroïdie.

22 cases of hyperthyroidism occurring during or following treatment with amiodarone are reported and compared with more than 15 cases in the literature. The specific clinical features of these cases of hyperthyroidism are presented and the problems in interpretation of the laboratory thyroid function tests are discussed. A study of the course of these cases reveals a number of prognostic factors. Finally, the authors describe the practical management of this form of hyperthyroidism.

[Plasma dopamine-beta-hydroxylase activity in pheochromocytoma (author's transl)]. / Activité dopamine-beta-hydroxylase plasmatique après ablation d'un phéochromocytome. Etude chez trois sujets.

In 3 patients with proved pheochromocytoma, circulating catecholamine concentrations, vanillylmandelic acid and total free catecholamine urinary excretion, dopamine-beta-hydroxylase activities in plasma were measured the day before surgery, during the removal of the tumour and postoperatively. Following the removal of the pheochromocytoma, all these parameters declined with a different rate, possibly related to the half-life proper to each molecule. The results showing a decrease in plasma D beta H activities after the removal of the tumors are in good accordance with most authors. The mechanism and the meaning of catecholamines release from non-innervated tumor-cells remain to be elucidated. By considering these three cases, it does not seem that the evolution of D beta H activity after removal of the tumor is dependent upon the fact that the pheochromocytoma releases preferentially either epinephrine or nephinephrine.

[A case of virilizing adrenal cortical adenoma whose steroid profile evokes a partial 21-hydroxylase deficiency (author's transl)]. / Un cas d'adénome corticosurrénalien virilisant présentant le profil hormonal d'un déficit partiel en 21-hydroxylase.

The C19 and C21 urinary steroids from a virilizing adrenal tumour with high levels of plasma 17 alpha-hydroxyprogesterone and its urinary metabolites have been identified and quantitated gas chromatography and mass spectrometry of sephadex fractions of the total urinary extract. A of the fifty-five identified steroids thirteen were compounds not found before in such a case. The actiology of the apparent 21-steroid hydroxtlase deficiency is discussed at the light of these analytical results and of the hormonogenesis enzymatic induction of the tumour biopsy.

[Endocrine abnormalities in HIV infections]. / Anomalies endocriniennes au cours de l'infection par le VIH.

The finding of endocrine gland lesions at pathological examination in AIDS and reports of several cases of endocrine disease in patients with this syndrome have prompted us to study endocrine functions in 63 patients (51 men, 12 women) with HIV-1 infection. According to the Center for Disease Control (CDC) classification system, 13 of these patients were stage CDC II, 27 stage CDC III and 23 stage CDC IV. We explored the adrenocortical function (ACTH, immediate tetracosactrin test) and the thyroid function (free T3 and T4 levels, TRH on TSH test) in all 63 patients. The hypothalamic-pituitary-gonadal axis (testosterone levels, LHRH test) and prolactin secretion (THR test) were explored in the 51 men. The results obtained showed early peripheral testicular insufficiency at stage CDC II and early pituitary gland abnormalities with hypersecretion of ACTH and prolactin also at stage CDC II. On the other hand, adrenocortical and pituitary abnormalities were not frequently found. The physiopathology of the endocrine abnormalities observed in HIV-1-infected patients remains unclear, but one may suspect that it involves interleukin-1 since this protein factor has recently been shown to stimulate the corticotropin-releasing hormone secretion and to act directly on the glycoprotein capsule of the virus (gp 120) whose structure is similar to that of some neurohormones.

[Effect of metoclopramide in a subject at risk for Huntington's chorea]. / Effet de la métoclopramide chez un sujet à risque de chorée de Huntington.

Because of vomiting, a 15 years old girl inserted one metoclopramide suppository. Her mother has Huntington's chorea. She had a transient choreiform syndrome. Could latent Huntington's chorea be revealed by this drug?

[Trouble of liver function in polymyalgia rheumatica (author's transl)]. / Atteinte hépatique au cours de la pseudo-polyarthrite rhizomélique.

The possible existence of liver function disease such as cholestasis during temporal arteritis or polymyalgia rheumatica has been recently discovered. Two cases are reported of cholestasis without jaundice during polymyalgia rheumatica. The altérations most frequently observed are the elevation of the alcalin phosphatases, 5' nucleotidases, gamma G.T. and the retention of BSP. The syndrome disappears by treatment as well as the rheumatologic disease. It seems to be interesting to diagnose polymyalgia rheumatica through this trouble of liver funcion.

Adrenal function in HIV infected patients.

UNLABELLED: Since anatomopathological lesions of the adrenal gland have been frequently observed at autopsy in AIDS, we investigated the glucocorticoid function in 63 patients (51 men, 12 women) infected by the human immunodeficiency virus (HIV) in order to determine the incidence and the nature of any adrenocortical abnormalities at various stages of HIV infection. The patients were classified according to the Centers for Disease Control (CDC) recommendations into group II (asymptomatic; N = 13), group III (lymphadenopathy; N = 27) and group IV (clinical manifestations; N = 23). Plasma ACTH and cortisol before and after an exogenous ACTH stimulation test were measured in patients as in 30 age-matched controls. Plasma renin activity and plasma aldosterone before and after ACTH stimulation were also measured in 31 patients (group II: 12; group III: 10; group IV: 9). Compared with controls patients from group II-III had higher levels of ACTH (39.11 +/- 17.01 vs 29.73 +/- 8.53 ng/l; p = 0.003) and basal cortisol (232 +/- 91.2 vs 184.3 +/- 30.9 micrograms/l; p = 0.03). No significant differences were noted between group IV patients and controls as to ACTH and basal and stimulated cortisol levels. Among the 63 patients, only one from group IV had a blunted cortisol response after ACTH stimulation test. Plasma renin activity, and basal and stimulated aldosterone levels in the 3 groups of patients were not different from control values. IN CONCLUSION: 1. Adrenal insufficiency does not seem very frequent in group IV patients and is likely to be a late complication in AIDS. 2. The increased ACTH and basal cortisol levels found in group II and group III patients argue for an early dysregulation of the adrenocortical axis in HIV infection. The exact physiopathological mechanism is not yet known, but an enhanced CRH production by interleukin 1 and/or a direct role of the HIV envelope glycoprotein (gp 120) may explain the high ACTH level in HIV patients.

Results of ultrasonically guided percutaneous ethanol injection into parathyroid adenomas in primary hyperparathyroidism.

Surgery is the usual treatment for primary hyperparathyroidism. However, some patients with high surgical risks are not suitable for surgery. For such patients, we propose, as an alternative treatment, ultrasonically guided percutaneous ethanol injection into parathyroid adenomas, in order to induce necrosis of the tumor. We report, here, the results of ultrasonically guided percutaneous ethanol injection into parathyroid adenomas, during a prolonged follow-up period up to 49 months, in a group of 13 patients (median age 79 years) with primary hyperparathyroidism and contraindications for surgery. In seven patients, complete normalization of plasma calcium, phosphorus and parathyroid hormone (PTH) levels was achieved after ethanol injections, with no recurrence of hypercalcemia during a median follow-up period of 28 months (total success). In these seven patients, plasma calcium, phosphorus and PTH levels were normalized 48 h after the successful ethanol injection. In four patients, a partial success was obtained with clinical improvement and normalization of plasma calcium levels but without complete normalization of plasma PTH levels. This partial success is due to incomplete necrosis of the adenoma, as has been confirmed in one patient by histopathological examination. The ethanol injection treatment failed in only two patients. This treatment was always well tolerated and no major side-effects were observed. In conclusion, our results give evidence that ultrasonically guided percutaneous ethanol injection into parathyroid adenomas can be a very useful alternative therapy in patients not suitable for surgery.

[Study of a virilizing adrenal cortical tumor. Analysis of urinary steroids by gas-liquid chromatography and mass spectrometry]. / Etude d'une tumeur corticosurrénalienne virilisante. Analyse de stéroïdes urinaires par chromatographie gaz-liquide et en couplage avec la spectrométrie de masse.

The C19 and C21 urinary steroids from a virilizing adrenal tumour with high levels of plasma 17alpha-progesterone and its urinary metabolites have been identified and quantitated by gas chromatography and mass spectrometry of sephadex fractions of the total urinary extract. Of the fifty five identified steroids thirteen were new compounds or known compounds not found before in such a case. The actiology of the apparent 21-steroid hydroxylase deficiency is discussed at the light of these analytical results and of the hormonogenesis enzymatic induction of the tumour biopsy.