Additional intranasal oxytocin to escitalopram improves depressive symptoms in resistant depression: an open trial.

The aim of this open trial was to assess the antidepressant/anxiolytic effects of oxytocin used as an adjunct to antidepressant in treatment-resistant depression. Fourteen patients, who have not responded to 40mg of escitalopram, received intranasal synthetic oxytocin during 4 weeks, in association with antidepressant. This is the first open trial study suggesting OT in association with escitalopram significantly reduced scores on Hamilton Depression Rating Scale.

Ascending aortic aneurysm in a patient with mixed gonadal dysgenesis.

Cardiovascular and endocrine complications in male or sexually-ambiguous patients carrying a 45,X/46,XY mosaicism are rarely discussed in the medical literature. However, young female patients with a diagnosis of Turner's disease usually benefit from regular cardiologic and endocrine follow-up, in accordance with current international guidelines. We report the case of a male patient, aged 23 years, with an ambiguous phenotype known to harbor a mixed gonadic 45,X/46,XY type dysgenesis. The patient was admitted to the cardiology ward for investigation and management of cardiac failure secondary to both a biscupid aortic valve and ascending aorta aneurysm. This case report, and the few others, which have been previously reported in the literature, emphasizes the importance of cardiologic and endocrine follow-up in male carriers of 45,X/46,XY mosaicism.

Oxytocin: From milk ejection to maladaptation in stress response and psychiatric disorders. A psychoneuroendocrine perspective.

Oxytocin (OT) is implicated in stress reduction as well as in social behavior. It inhibits the stress-induced activity of the hypothalamic-pituitary adrenal axis responsiveness. OT is involved in social affiliation, sexual and maternal-infant binding, anxiety, mood, feeding control and memory. Several lines of evidence suggest a role of OT in psychiatric disorders. Various psychiatric disorders are strongly influenced by social variables, such as panic attacks, depression and early childhood autism, and seem to exhibit a particularly close connection with the brain dynamics that underlie social emotions. This paper proposes an overview of OT in psychiatric disorders through the links with the stress response and prosocial behavior.

[Severe hyponatremia revealing Sheehan's syndrome]. / Une hyponatrémie sévère révélatrice d'un syndrome de Sheehan.

We describe the case of a young woman admitted for severe hyponatremia due to hypopituitarism caused by a Sheehan's syndrome. Sheehan's syndrome is a rare disorder. It develops after obstetrical hemorrhage that causes ischemic necrosis of the pituitary gland. In most cases, illness appears progressively and diagnosis is made after variable delay. Acute syndrome may develop immediately after delivery in some rare cases. Hyponatremia is a frequent manifestation and may be severe. It is principally caused by secondary adrenal failure.

ISA, ISSAM, EAU, EAA and ASA recommendations: investigation, treatment and monitoring of late-onset hypogonadism in males.

The new ISA, ISSAM, EAU, EAA and ASA recommendations on the investigation, treatment and monitoring of late-onset hypogonadism in males provide updated evidence-based information for clinicians who diagnose and treat patients with adult onset, age related testosterone deficiency.

[Secondary amenorrhea and cerebral ventriculomegaly]. / Aménorrhée secondaire et ventriculomégalie cérébrale.

Cerebral ventriculomegaly and hydrocephalus are not frequently associated with endocrine disorders of the gonadotropic axis. The mechanism of this association is not clarified. The most probable cause is however a partial hypothalamic dysfunction. The examination of the few reported cases is in favour of this explanation. We present the case of a young woman with a cerebral ventriculomegaly and suffering from secondary amenorrhea. Shunt was not necessary from the neurological point of view, the problem of secondary amenorrhea and anovulatory infertility was solved by clomiphen citrate therapy.

[Neurohypophyseal neuropeptides and unipolar depression: which future?]. / Peptides neurohypophysaires et dépression unipolaire: quel avenir?

Vasopressin (AVP) and oxytocin (OT) are two chemically similar neurohypophyseal neuropeptides which could be involved in mood disorders. Those two sister neuropeptides might be considered as ago-antagonist hormones. They act as neuromodulators of the stress response. AVP is known as an ACTH stimulating factor synergistic to CRH while OT could act as an antagonist of AVP on ACTH secretion. AVP seems to play an important role in the pathophysiology of major depression. Evidence suggests a role for OT as an endogenous antidepressant/anxiolytic hormone. OT release is also an important aspect of the pharmacological action of SSRIs. In addition, their receptors are of growing interest for psychiatric research. A selective AVP V1b receptor, SSR1419415, has been characterized and is endowed with anxiolytic- an and antidepressant-like properties. This paper proposes an overview of neurohypophyseal hormones in major depression.

[Rhabdomyolysis and hypothyroidism]. / Le cas clinique du mois. Rhabdomyolyse et hypothyroïdie.

We describe the case of a 29 year old patient who presented severe myalgias and asthenia for 3 months. First biological assessment revealed muscular lysis and raised transaminases. The following complementary screening showed major hypothyroidism with the presence of anti-microsomes antibodies, a carpian canal syndrome and a left ventricular systolic dysfunction. A diagnosis of hypothyroidic rhabdomyolysis consecutive to a Hashimoto disease was then mash. Patient was treated by hormonal thyroid substitution with a progressive improvement of muscular symptoms to complete recovery, and a concomitant normalization of cardiac and thyroid functions.

[Hormonal treatment in transsexual patients. Metabolic consequences]. / Le traitement hormonal des patients transsexuels et ses conséquences métaboliques.

Transsexualism is a sexual identity disorder distinguished by the extreme conviction of belonging to the opposite sex with a total disharmony in the original sex. Diagnosis is established when patients respond to three criteria (DSM-IV): 1) Desire to live and to be accepted as members of opposite sex; 2) Presence of sexual identity disorder for minimal two years; 3) Lack of mental disease or chromosomal anomalies. When diagnosis is confirmed, hormonal treatment can be started and so, improve the secondary sexual characters of selected sex. For patients F-M, treatment is composed of testosterone, most commonly esters of testosterone. For patients M-F, treatment consists of estrogens. These estrogens are frequently associated to an anti-androgen (cyproterone acetate) in the pre-reassignment phase. Avoiding the hepatic way, transdermal form is recommended. Hormonal treatments are not devoid of secondary effects: the most frequent one is venous thromboembolism. Considering contraindications and potential complications, each patient must be selected carefully. The endocrinological follow-up is essential and necessary.

Plasma oxytocin levels and anxiety in patients with major depression.

Cerebrospinal fluid and plasmatic levels of oxytocin (OT) have been found to change in mood disorders. In post-mortem studies, the numbers of OT-expressing neurons in the paraventricular nucleus have been reported to be increased. Moreover, OT is considered as an endogenous antistress hormone. It has also revealed antidepressive effects. OT may contribute to the dysregulation of the HPA system in major depression. The aim of the study was to assess a possible relationship between anxiety and plasma oxytocin (OT) levels in depressive patients. Severity of depression was estimated with the Hamilton Depression Rating Scale and anxiety by using the Spielberger State-Anxiety Inventory. Results showed a significant negative correlation between oxytocin and the scored symptoms depression (r=-0.58, p=0.003) and anxiety (r=-0.61, p=0.005).

[Oxytocin and maternal stress during the post-partum period]. / Ocytocine et stress de la mère au cours de la lactation en post-partum. L'ocytocine est-elle impliquée dans la confiance en soi de la mère allaitante? Revue de la littérature.

Oxytocin is required for lactation by promoting milk expulsion. Oxytocin has also been reported to exert a positive role in social attachment. The postpartum period has been shown to be crucial for maternal behavior initiation, and required self-trust reinforcement. However, this period is also remarkable for the high risk exposure of either psychic or physical stress. A negative impact on young mother is suspected, both in the short, medium or long term, which can even be deleterious for child-mother relationships. During lactation in female rats and sheep, oxytocin production has been proved to decrease stress-induced hormonal changes and later consequences. In human beings, only the first hour after breast-feeding seems to protect against physical or psychic stress. Oxytocin improves the stress-induced response by reducing the ACTH and cortisol secretion thus representing a potential therapeutic pathway in post-partum pathologies such as depression. Thus, this review of recent literature about oxytocin and stress during post-partum period, leads to the assumption that oxytocin, at the moment of installation of breastfeeding, acts not only on the physiological condition, but also on the psychic condition of the mother.

AVP- and OT-neurophysins response to apomorphine and clonidine in major depression.

A number of studies have reported abnormalities of neurohypophyseal secretions in major depressive disorder. The purpose of the present study was to test the influence of apomorphine and clonidine injections on plasma vasopressin (AVP)-neurophysins and oxytocin(OT)-neurophysins levels, as direct index of posterior pituitary activation in major depression. Apomorphine and clonidine tests were carried out in 25 medication-free depressive patients and 25 age and gender-matched healthy controls. Blood for neurophysins analysis was drawn by venipuncture at t0, t + 20, t + 40, t + 60 and t + 120. Baseline AVP-neurophysins concentrations were significantly lower in depressives (0.12 +/- 0.14 ng/ml) than in healthy subjects (0.24 +/- 2.15 ng/ml) (p < 0.04). The response to apomorphine test revealed a significant reduced response at 20 (p = 0.01), 40 (p = 0.007) and 60 (p = 0.02) and 120 (p = 0.02)min. Following clonidine test, post hoc tests also revealed a significant decrease at 0 (p = 0.04), 20 (p = 0.01), 40 (p = 0.007) and 60 (p = 0.02) and 120 (p = 0.006)min. Concerning OT-neurophysins, no significant differences were found between depressed and controls in response to clonidine or apomorphine injections. Following clonidine and apomorphine, major depressives exhibited a significantly lower peak GH response than controls. The study supports partially the hypothesis of a reduced vasopressinergic activity in depression. Moreover, we did not find any influence of acute apomorphine or clonidine injections on vasopressin-neurophysin or oxytocin-neurophysin in depressive patients.