Post-partum recurrent sarcoidosis associated with type 1 diabetes mellitus.

Immunologic abnormalities observed in sarcoidosis may suggest a link between this affection and autoimmune endocrine diseases. Indeed a high frequency of autoimmune thyroïd diseases is observed in sarcoidosis. However association of type 1 insulin-dependent diabetes mellitus with sarcoidosis is rare. We report the case of a type 1 diabetic woman in whom clinical and biological signs of sarcoidosis appeared after her first pregnancy with a relapse in the post-partum period of a second pregnancy. Diagnosis of sarcoidosis was established on characteristic cutaneous, articular and pulmonary manifestations associated with elevated plasma levels of angiotensin converting enzyme. From this case, association between type 1 diabetes mellitus and sarcoidosis has been discussed as well as reciprocal relationship between sarcoidosis and pregnancy. Since familial history of sarcoidosis was present in this case, familial aspects of sarcoidosis have also been reviewed.

[Acromegaly in 2000]. / L'acromégalie en l'an 2000.

Acromegaly is a severe disease often diagnosed late. Morbidity and mortality are high, particularly due to cardiovascular and respiratory complications. Clinical diagnosis is often difficult to confirm, particularly in ectopic forms. In addition, recent reassessment of cure criteria have reduced the number of patients considered to be successfully cured. The therapeutic strategy for acromegaly is thus changing with the advent of somatostatin agonists. Medical treatment is proposed increasingly as the first intention treatment, particularly antitumoral therapy for macroadenomas with surgery or radiotherapy being used as second line treatment. The recent development of GH analogs offers new perspectives for the treatment of acromegaly.

[Diagnostic strategy in persistent hyperparathyroidism. Report of two cases and review of the literature]. / Stratégie diagnostique devant une hyperparathyroïdie persistante.

Ectopic adenoma is the main cause of surgery failure in the treatment of primary hyperparathyroidism (HPT). Localization of the abnormal glands is therefore necessary before a reoperation. We report two cases illustrating the interest of MRI and selective venous sampling of parathormone. In two patients with persistent hyperparathyroidism, ultrasound and sestamibi scanning failed to localize the ectopic glands. MRI suggested the presence of an adenoma in the mediastinum for the first patient and inside the thyroid for the second. In both cases, the localisation was confirmed by venous sampling and the reoperation was a success. We review the recent literature on this topic and we propose a diagnostic approach of persistent HPT.

[Malt lymphoma of the thyroid and Graves'disease]. / Lymphome thyroïdien de type MALT et maladie de Basedow.

Maltoma of the thyroid associated to Graves'disease is not such a frequently described association. We report a case of Maltoma of the thyroid gland in a patient with Grave's disease. The diagnosis was established by histological examination after total thyroidectomy. Slow enlargement of the thyroid gland despite a clinically successful antithyroid drug therapy could be considered as an advocating clinical manifestation. Associated anti-neoplastic chemotherapy and cervical irradiation resulted in good outcome with six years follow-up. A review is presented on treatment and prognosis of these tumors.

Triglycerides, apo C3 and Lp B:C3 and cardiovascular risk in type II diabetes.

AIMS/HYPOTHESIS: Cardiovascular complications and particularly coronary heart disease are the main causes of morbidity and mortality in Type II (non-insulin-dependent) diabetes mellitus. Some studies have shown that hypertriglyceridaemia in diabetes is an independent cardiovascular risk factor. In the ECTIM study high apolipoprotein C3 and lipoprotein B:C3 concentrations (lipoparticles playing a role in triglyceride metabolism) were associated with myocardial infarction in non-diabetic subjects. METHODS: We studied the relations between macroangiopathy and different cardiovascular risk factors and lipid variables in 188 Type II diabetic subjects. RESULTS: Multivariate analysis showed that triglycerides, apo C3 and Lp B:C3, sex, duration of diabetes, microalbuminuria and age were independently associated with macroangiopathy. The study group was divided into quartiles according to apo C3 and Lp B:C3 concentrations: the prevalence of macroangiopathy and coronary heart disease were increased in upper quartiles. CONCLUSION/INTERPRETATION: Triglycerides apo C3 and Lp B:C3 were independent cardiovascular risk markers in our group of Type II diabetic patients.