Normal inhibin B levels suggest partial preservation of gonadal function in adult male patients with anorexia nervosa.

INTRODUCTION: The impact of undernutrition on endocrine and exocrine gonadatrope function is poorly known in male anorexia nervosa (AN) patients. AIM: The aim of this study was to compare the pituitary-gonadal function of male AN subjects with that of healthy controls, Kallmann syndrome (KS) patients, and female AN subjects. METHODS: Observational monocentric cross-sectional study performed in 31 male and 25 female subjects with restrictive-type AN, 22 male and 20 female controls, and nine male KS patients. MAIN OUTCOME MEASURES: Hormonal parameters are as follows: follicule stimulating hormone (FSH), luteinizing hormone (LH), sex hormone binding globulin, estradiol, testosterone, inhibin B, thyroid hormones, growth hormone (GH), insulin-like growth factor 1 (IGF-1), cortisol, adrenocorticotropic hormone (ACTH), dehydroepiandrosterone sulfate, and leptin. RESULTS: Similar abnormalities of free T3, GH, IGF-I, cortisol, and leptin were found in men as in AN women with equivalent undernutrition status when compared with corresponding controls. Low levels of LH, FSH were found in both male and female AN patients. In male AN, total testosterone was found lower than in controls but higher than in KS, while a lack of estradiol was noticed in AN women. Sex hormones variations were directly related to weight gain only in AN men. No relationship was found between sex hormones and leptin variation for both sexes. In AN men, inhibin B levels were similar to that of controls and did not correlate with testosterone levels. CONCLUSIONS: Significant differences of undernutrition impact on gonadal status were noticed between male and female AN subjects, including partial preservation of testosterone release and probable preservation of exocrine function, according to the normal inhibin B levels.

Seizure during Graves' disease.

Occurrence of seizure during Graves' disease is very rare. According to Lin et al. (1992), only 13 cases were published between 1956 and 1992. Since then, four other cases have been published, resulting in a total of 17 papers in 40 years (Li et al. 2000, Lee et al. 1997, Radetti et al. 1993). We report, in this paper, the case of a young girl treated for recurrent Graves' disease who presented a generalized seizure.

Insulin tolerance test predicts non response vs. sustained efficacy of Liraglutide on glycemic control in type 2 diabetes patients: A prospective real-world setting study.

AIMS: Less than half of type 2 diabetes patients treated with Glucagon-Like Peptide 1 (GLP-1) analogs displays good glycemic control, according to real life studies. Predictive markers of inefficacy/efficacy are therefore needed. The effectiveness of Liraglutide in terms of glycemic control and weight loss was then evaluated according to putative predictive parameters. METHODS: 80 type 2 diabetes patients treated with Liraglutide were included in this prospective study. An Insulin Tolerance test (ITT) was performed at baseline to calculate velocity of C-Peptide decrease (C-peptide T½). Several clinical and biological parameters including HbA1c and weight were assessed at baseline and after 12, 24, 52 and 104 weeks of treatment. RESULTS: HbA1c decrease over the follow-up period was highly associated with C-peptide T½. A mean fall of 0.7% of HbA1c (7.7 mmol/mol) was predicted with 82% sensitivity and 80% specificity by C-peptide T½. In patients with rapid response during ITT (C-peptide T½â€¯< 120 min), a HbA1c decrease of 1.5% (16.5 mmol/mol) was constantly found (p = .002) all over the follow-up. HbA1c remained unmodified for the rest of the patients (p = .34) compared to baseline. HbA1c evolution was not predicted by diabetes duration. Weight loss was predicted only by low baseline C-peptide plasma level. CONCLUSIONS: This study suggests ITT as an efficient test to discriminate non-response from long-term efficacy before initiating Liraglutide. ITT could therefore help avoiding "try and see" prescription pattern by using a more precise and patient-centered strategy in order to reduce inertia in adapting treatment and so reduce subsequent complications.

Pulsatile gonadotropin-releasing hormone therapy in persistent amenorrheic weight-recovered anorexia nervosa patients.

OBJECTIVE: To compare hormonal and clinical responses to GnRH pulsatile treatment in weight-recovered anorexia nervosa patients (Rec-AN) with persistent functional hypothalamic amenorrhea (HA) vs. in patients with secondary and primary HA. DESIGN: Retrospective, observational, ambulatory study. SETTING: University hospital. PATIENT(S): Forty-one women: 19 Rec-AN (body mass index >18.5 kg/m2 without menses recovery), 15 secondary HA without any eating disorders patients (SHA), and 7 primary HA patients (PHA). INTERVENTION(S): Gonadotropin-releasing hormone pulsatile therapy. MAIN OUTCOME MEASURE(S): Baseline E2, LH, and P plasma levels and their changes during induction cycles; ovulation, follicular recruitment, and pregnancies. RESULTS: The Rec-AN group displayed higher basal E2 and LH plasma levels after GnRH injection compared with SHA and PHA. Higher E2 and LH levels were observed during induction cycles in Rec-AN compared with SHA and PHA. Follicular recruitment was higher in Rec-AN. The ovulation rate was higher in Rec-AN compared with PHA but similar to SHA. CONCLUSION(S): This study showed increased gonadal status and higher E2 response to pulsatile GnRH therapy in persistent amenorrheic weight-recovered AN compared with HA from other causes. It suggests that their individual set-point of body weight allowing a fully functional gonadal axis is not reached yet. Specific factors of gonadal inertia in Rec-AN still remain unclear.

In vivo epinephrine-mediated regulation of gene expression in human skeletal muscle.

The stress hormone epinephrine produces major physiological effects on skeletal muscle. Here we determined skeletal muscle mRNA expression profiles before and during a 6-h epinephrine infusion performed in nine young men. Stringent statistical analysis of data obtained using 43000 cDNA element microarrays showed that 1206 and 474 genes were up- and down-regulated, respectively. Microarray data were validated using reverse transcription quantitative PCR. Gene classification was performed through data mining of Gene Ontology annotations, cluster analysis of regulated genes among 14 human tissues, and correlation analysis of mRNA and clinical parameter variations. Evidence of an autoregulatory control was provided by the regulation of key genes of the cAMP-dependent transcription pathway. Genes with known functional cAMP response elements were regulated by the hormone. The impact on metabolism was illustrated by coordinated regulations of genes involved in carbohydrate and protein metabolisms. Epinephrine had a profound effect on genes involved in immunity and inflammatory response, a previously unappreciated aspect of catecholamine action. Information on 526 mRNAs corresponded to genes of unknown function. These data define the molecular signatures of epinephrine action in human skeletal muscle. They may contribute to the understanding of skeletal muscle alterations observed in pathological conditions characterized by sympathetic nervous system overdrive.