Luteinizing hormone pulsatility in patients with major ovarian hyperandrogenism.

Hyperandrogenism and ovulatory dysfunction are common in women with either polycystic ovary (PCOS) or ovarian virilizing tumor. However, contrasting with the numerous studies that have extensively described gonadotropin secretory abnormalities, principally increased LH pulse amplitude and frequency, few studies have concerned gonadotropin secretion in patients with ovarian virilizing tumors; low gonadotropin levels have occasionally been reported, but never extensively studied. The goal of the present study was to further evaluate the pulsatility of LH secretion in women with ovarian virilizing tumor compared with that of PCOS patients. Eighteen women with major hyperandrogenism (plasma testosterone level >1.2 ng/ml) were studied (5 women with ovarian virilizing tumor, 13 women with PCOS, and 10 control women). Mean plasma LH level, LH pulse number and amplitude were dramatically low in patients with ovarian tumors when compared to both PCOS (p<0.001) and controls (p<0.001). In case of major hyperandrogenism, LH pulse pattern differs markedly between women with ovarian virilizing tumor or PCOS, suggesting different mechanisms of hypothalamic or pituitary feedback.

Allergy to insulin in a woman with gestational diabetes mellitus: transient efficiency of continuous subcutaneous insulin lispro infusion.

We report the case of a 31-year-old pregnant woman. She required insulin for the treatment of gestational diabetes from 27 weeks of amenorrhoea to delivery. An allergy to insulin was suspected because she presented with local symptoms at insulin injection sites and a decrease in efficiency of insulin. This diagnostic was confirmed by skin-prick tests. A treatment with subcutaneous continuous lispro insulin analogue infusion was initiated with an oral antihistaminic drug without local reaction. Seven weeks after the initiation of insulin pump, local reactions reappeared. The insulin analogue lispro is not always an alternative in insulin allergy. However, in the case we report, the lack of allergy during a few weeks allowed the birth of a normal infant.

Uncommon early-onset neuropathy in diabetic patients.

An acute neuropathy rarely occurs early in the course of diabetes mellitus. Five cases are described of adult patients who developed a peripheral neuropathy at the time or shortly after the onset or discovery of diabetes mellitus. Patient 1, an 80-year-old woman who developed a subacute tetraparesis with proximal and distal muscle weakness with normal cranial nerves, proved to have insulin-requiring diabetes mellitus. In the other patients, all men aged 23-34 years, symptomatic neuropathy occurred simultaneously (patient 2) or 1-6 months after the onset of insulin-dependent diabetes mellitus (IDDM) (patients 3-5). Patients 2 and 3 developed a symptomatic multifocal neuropathy; patients 4 and 5, a painful distal symmetrical sensory polyneuropathy (DSSP) shortly after beginning treatment with insulin. Nerve biopsy showed active axonal lesions in patients 2 and 5 and mixed axonal and demyelinating lesions in the others, with severe axon loss in patients 4 and 5. Vasculitic lesions were found in patient 2, who improved without additional treatment. Neurological examination remained unchanged after 2 years in patients 3-5. Although a coincidence cannot be excluded for patients 1-3, whose neuropathy was not of the pattern commonly found in diabetes, it is suggested that acute disequilibrium in the diabetic status may facilitate the occurrence of a variety of neuropathies. Alternatively, the autoimmune process which led to IDDM may also trigger an autoimmune neuropathy with vasculitis (patient 2) or demyelinative nerve lesions. Only the distal symmetrical sensory polyneuropathy with severe axonal lesions observed in patients 4 and 5 seems directly related to diabetes mellitus. In spite of their occurrence shortly after beginning insulin therapy, the role of treatment with insulin in the onset is uncertain.

[Electrolyte abnormalities in elderly people. Prevalence and relation to drug treatment. Multicenter study of 631 subjects aged 70 years and over]. / Anomalies électrolytiques chez les personnes âgées. Prévalence et relation avec le traitement médicamenteux. Etude multicentrique chez 631 sujets de 70 ans et plus.

In order to assess the responsibility of medicinal drugs for the disorders in electrolytes observed in elderly people, the prevalence of abnormal natraemia and kalaemia was prospectively established in 631 subjects aged 70 or more on the first day of hospitalization. Among 337 subjects not taking drugs likely to create problems (diuretics, angiotensin-converting enzyme inhibitors, anti-inflammatory agents) 3.6 percent had hyponatraemia (below 130 mmol/l) and 12.2 percent had hypokalaemia (below 3.5 mmol/l). Subjects with normal renal function who were taking angiotensin-converting enzyme inhibitors or non-steroidal anti-inflammatory agents showed no more electrolytic abnormalities than those who did not take them. Conversely, subjects on thiazides were more frequently hyponatraemic (11.8 percent) or hypokalaemic (16.2 percent; 20 percent in the absence of associated distal diuretics). These abnormalities were more frequent in women than in men (21.7 and 13 percent). This, together with the fact that 68 percent of subjects taking thiazides were women accounts for the marked female predominance of electrolytic abnormalities reported in the literature.

Thyrotoxicosis due to pituitary resistance to thyroid hormones. Successful control with D thyroxine: a study in three patients.

Selective pituitary resistance to thyroid hormone (PRTH) is responsible for thyrotoxicosis due to inappropriate secretion of TSH. The TSH suppressive action of D-thyroxine (DT4) has been previously documented in euthyroid and hypothyroid subjects. This prompted us to treat with DT4 three patients with PRTH uncontrolled by anti-thyroid drugs (ATD) alone or supplemented with bromocriptine, and whose follow-up had been complicated by atrial fibrillation in two patients. Because of 100% cross-reactivity between the D and L isomers of T4 and T3 in our RIAs, thyroglobulin (Tg) was used as an index of thyroid secretion. Under ATD, TSH and Tg levels were respectively: 35 mIU/l and 670.5 pmol/l (patient 1), 87 mIU/l and 453 pmol/l (patient 2) and 110 mIU/l and 906 pmol/l (patient 3). When DT4 was added (patient 1, 3 mg daily; patients 2 and 3, 2 mg daily) to the same dose of ATD, plasma TSH and Tg levels fell but were still over the upper limit of normal and thyrotoxicosis persisted as illustrated by a recurrence of atrial fibrillation in one patient. When ATD were withdrawn and DT4 given alone (2 mg daily) all symptoms subsided within 1 month while TSH and Tg levels fell within the normal range. TSH normalization was documented within 1 week in one patient.(ABSTRACT TRUNCATED AT 250 WORDS)

Ciclosporine and Graves' ophthalmopathy.

The pharmacological treatment of Graves' ophthalmopathy remains unsatisfactory due to the limited efficacy and severe side effects of the available drugs. Ciclosporine, an immunosuppressive drug has recently been used with the aim of controlling the autoimmune process considered to be responsible for the disease. This paper reviews the data obtained with ciclosporine in comparison with those previously reported with corticosteroids.

[Unusual concentrations of triiodothyronine in the serum due to anti-T3 autoantibodies]. / Concentrations insolites de la triiodothyronine du sérum dues à des autoanticorps anti-T3.

Abnormally high T3 serum concentrations incompatible with the patients' clinical thyroid status were observed in a case of Graves' disease and in a euthyroid patient with hyperlipaemia. T3 was in the form of immune complexes precipitable by polyethyleneglycol. Specific anti-T3 autoantibodies were detected in the serum gammaglobulin fraction. The T3 affinity constants of these autoantibodies were found to be as high as 1.10(10) and 7.2.10(10)l/mol respectively. The antibodies interfered with radioimmunological T3 determination, resulting in an apparent increase of T3. However, after extraction, true T3 serum levels remained higher than expected. These findings illustrate the importance of hormone concentrations, affinity constants of binding proteins and equilibrium between free and bound forms in the resulting hormonal effect.

[Red cell indices in the aged. 1 726 patients over the age of 70 (author's transl)]. / L'hémogramme du sujet âgé. 1 726 personnes de 70 ans ou plus.

Statistical analysis of red cell constants in 1 726 patients over the age of 70 shows that red cell counts, hemoglobin and hematocrits are slightly lower than those in young adults. However, the quality of the red cells is normal, because the MCV (mean cell volume) and MCHC (mean cell hemoglobin concentration) are normal.

[Frequency and etiology of anemia in patients over the age of 70 (author's transl)]. / Fréquence et étiologie des anémies chez les personnes âgées de plus de 70 ans. Etude de 1 726 sujets.

The study of 1 726 patients living in homes for the aged, or hospitalized shows that 20% of them have anemia. There is no increase in prevalence of the disease in females. A wide variety of mechanisms may cause anemia. However, chronic bleeding of essentially digestive origin is the most common. Several anemia-causing factors are particularly frequent in the aged: bleeding, inflammation, nutritional deficiencies, bone marrow failure. Diagnosis is complicated and may require examinations which are not always easily accepted by the aged.