Pituitary metastasis and sarcoidosis are two causes of pituitary stalk thickening. Their association has been described ago three decades. In this setting, we report a case of panhypopituitarism ...revealing pituitary metastasis from a small-cell lung carcinoma associated with sarcoidosis. A 49 year-old smoking patient with type 2 diabetes was admitted for acute adrenal failure with polyuria polydipsia syndrome and a pituitary tumor syndrome. Hormone explorations confirmed anterior pituitary insufficiency. Water restriction revealed central diabetes insipidus. The hypothalamic-pituitary MRI revealed a 1-cm sellar mass with nodular thickening of the stalk. The chest radiograph showed a heterogeneous opacity in the left lung. The thoraco-abdominal scan demonstrated a mass in the left lung highly suggestive of malignancy and many enlarged mediastinal nodes, hepatic nodules, and hypertrophy of the left adrenal. Bronchoscopy was performed three times and showed infiltration of the left bronchial tree but histological examination of the bronchial biopsies was negative for all samples. Ultrasound-guided biopsy of the liver was achieved and histology demonstrated sarcoidosis. The diagnosis of sarcoidosis was incompatible with the deterioration of the patient's general status. Subsequent radiographic explorations showed an increase in the size of the tumor mass and histological evaluation of a scan-guided trans-thoracic biopsy demonstrated small-cell carcinoma. Small-cell lung carcinoma is the most common cancer with pituitary metastasis. The proposed link between sarcoidosis and malignancy has remained controversial but has not been proven false.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Summary
Many studies have shown linkage between IDDM6 locus on 18q12–q21 chromosome and several autoimmune diseases, suggesting that it might harbour susceptibility genes common to autoimmunity. ...Using 12 families deriving from a large Tunisian multiplex family (the Akr family) from which 38 people were affected with autoimmune thyroid diseases (AITD), and 193 unrelated AITD patients, tested against 100 healthy subjects, we tried to replicate the positive results previously reported for the IDDM6. Akr members were genotyped with eight microsatellite markers harbouring the IDDM6 region. Multipoint non‐parametric linkage analysis have shown a clear peak values of NPL score around D18S41 marker (Z = 3.72, P = 0.0001). Family‐based association test (FBAT) and transmission disequilibrium test (TDT) have confirmed linkage results. In particular, a significant association with allele 3 of D18S41 and allele 2 of D18S57 markers was found. Case–control studies, using one intragenic microsatellite (locus CTG18.1) marker in the immunoglobulin transcription factor (ITF2) gene, a 5′ flanking AC repeat of the anti‐apoptotic BCL‐2 gene as well as two SNPs at positions +52 and +1955 from transcription start site of BCL‐2, showed no significant association between neither genes and AITD. Our study is the first replication of the 18q12–q21 chromosome region as a potential candidate to AITD genetic susceptibility. The Akr family has shown evidence for linkage between IDDM6 locus and AITD. Moreover, case–control study does not support the involvement of ITF2 and BCL2 genes in AITD pathogenesis.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK
23.
Obésité abdominale et gonarthrose Ghroubi, S.; Elleuch, H.; Guermazi, M. ...
Annales de réadaptation et de médecine physique,
11/2007, Volume:
50, Issue:
8
Journal Article
L'objectif de notre étude est d'étudier si le tour de taille (TT) est un indicateur plus fiable que l'indice de masse corporelle (IMC) de la présence d'une gonarthrose chez le sujet obèse.
Il s'agit ...d'une étude observationnelle ayant porté sur des patients obèses ne présentant pas d'autres facteurs de risque d'arthrose des genoux. Pour chaque patient nous avons précisé à côté des données démographiques, l'IMC, le TT, l'ancienneté de l'obésité et l'existence ou pas de douleurs du ou des deux genoux. Deux groupes ont été individualisés
: «
un groupe de sujets asymptomatiques
» (GA), et un «
groupe de sujets ayant des douleurs du ou des deux genoux
» (GDG). Pour le groupe des patients symptomatiques (GDG) nous avons précisé l'intensité de la douleur, le retentissement fonctionnel par l'indice de «
Lequesne
» et de «
Womac
». Tous les patients symptomatiques ont bénéficié de radiographies standard des deux genoux à la recherche de signes radiologiques d'arthrose. Ensuite le groupe GDG a été divisé en deux sous-groupes
: «
un groupe avec des signes radiologiques de gonarthrose
» (GDG-1) et un groupe sans signes radiologiques de gonarthrose (GDG-2). La comparabilité des deux groupes «
GA
» et «
GDG
» et des deux sous-groupes GDG-1 et GDG-2 a été vérifiée pour les critères d'âge, du sexe et de l'ancienneté de l'obésité. La comparaison des facteurs étudiés
: l'IMC le TT ainsi que l'existence d'un retentissement algofonctionnel, a été effectuée par le test de Student.
Cinquante-six patients ont été retenus pour l'étude, 82,5
% étaient de sexe féminin, l'obésité évoluait en moyenne depuis 13 ans
±
6,5. L'âge moyen était de 43,21
±
9,58 ans. L'IMC moyen était de 39,6
±
7,23 kg/m
2 et le TT moyen était de 113
±
14,3 cm. Trente-trois patients (59
%) étaient symptomatiques.
Nous avons noté qu'indépendamment de l'âge, du sexe, de l'ancienneté de l'obésité et de l'IMC, les patients symptomatiques (GDG) avaient un TT plus important par rapport au groupe de sujets asymptomatiques (GA)
: 117,27
±
14,71 versus 107
±
11,75 cm (
p
=
0,01). Dans le groupe de patients symptomatiques (GDG) et indépendamment des facteurs déjà cités les patients avec des signes radiologiques de gonarthrose (GDG-1) avaient un TT plus important par rapport au groupe de patient sans signes radiologiques de gonarthrose (GDG-2)
: 122
±
15,57 versus 108
±
6,88 cm (
p
=
0,01).
En plus les scores moyens de l'EVA douleur au repos et à l'effort, de l'indice de «
Womac
» et de l'indice de «
Lequesne
», étaient respectivement de 16
±
25,7 mm
; 75
±
18,3 mm
; 12,3
±
8,92 et 11,5
±
5,44 pour le groupe GDG-1 et de 7
±
18,4 mm
; 70 mm
±
19,2
; 5,7
±
3,05
; 6,9
±
3,79 pour le groupe GDG-2. La différence entre les deux sous-groupes n'était significative que pour les indices de «
Lequesne
» (
p
=
0,026) et de «
Womac
» (
p
=
0,015).
Indépendamment de l'IMC, le TT paraît être probablement un facteur prédictif de la présence de gonalgie et/ou d'une gonarthrose chez l'obèse ainsi que d'un retentissement fonctionnel plus important.
The objective of our study was to determine whether waist circumference (WC) is a more reliable indicator than body mass index (BMI) of the presence of knee osteoarthritis in obese subjects.
We performed an observational study of obese patients with no other risk factors for knee osteoarthritis. For each patient, we evaluated BMI, WC, duration of obesity and knee pain. Two groups were identified: “asymptomatic patients” (AG), without knee pain, and “symptomatic patients” (SG). For the SG, we measured pain intensity (visual analog scale VAS, 0-100 mm) and functional repercussions (using the Lequesne and WOMAC indexes). Patients with knee pain underwent standard radiographic procedures to search for signs of osteoarthritis, and the SG was divided into two subgroups: with radiological signs of osteoarthritis (SG-1) and without radiological signs of osteoarthritis (SG-2). The AG and SG groups and SG-1 and SG-2 groups were compared for age, sex, and duration of obesity. Comparisons of BMI, WC, and function involved the Student's
t-test.
We recruited 56 patients for the study (82.5% females; mean obesity duration (13
±
6.5 years; mean age 43.21
±
9.58 years). The mean BMI was 39.6
±
7.23 kg/m
2 and mean WC was 113
±
14.3 cm. We found 33 patients (59%) with knee pain. Independent of age, sex, duration of obesity and BMI, the SG showed more significant WC (117.27
±
14.71 cm vs. 107
±
11.75 cm for the AG,
P 0.01). In the same group and independent of the already mentioned factors, the patients with radiological signs of osteoarthritis showed significant WC 122
±
15.57 cm (SG-1) vs. 108
±
6.88 cm (SG-2) (
P 0.01). Moreover, the VAS score of pain at rest and during effort and the WOMAC and Lequesne scores were 16
±
25.7 mm, 75
±
18.3 mm, 12.3
±
8.92 and 11.5
±
5.44 (SG-1) and 7
±
18.4 mm, 70
±
19.2 mm, 5.7
±
3.05, and 6.9
±
3.79 (SG-2), respectively. The difference between SG-1 and SG-2 was significant only for the WOMAC (
P
=
0.015) and Lequesne (
P
=
0.026) scores.
Independent of BMI, WC appears to be a factor associated with the presence of knee pain and osteoarthritis in obese patients. Furthermore, a high WC is associated with significant functional repercussion.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Growth hormone (GH) together with cortisol are two important counter-regulatory hormones maintaining normal glycemia. Hyperinsulinemic hypoglycemia is a disorder of this counter-regulation described ...in neonates. We report here a rare case of reversible dissociated hypopituitarism secondary to an insulinoma in a 38-year-old man referred for investigation of hypoglycemic episodes. Hormonal investigations were in favour of dissociated anterior pituitary failure, with growth hormone and corticotroph deficiency. The hypothalamic-pituitary MRI was normal. The fasting test argued in favour of a hyperinsulinemic hypoglycemia. The abdominal scan and the endoscopic ultrasound showed a mass within the tail of the pancreas. Distal pancreatectomy was performed. Histology disclosed an insulinoma. On follow-up, no hypoglycemic episodes recurred and cortisol and GH response to induced hypoglycemia was normal. Our clinical case shows that hyperinsulinemia and hypoglycemia in patients with insulinoma can give rise to functional growth hormone and corticotrophin deficiency. The pathophysiological mechanism of this defective counter-regulation remains to be clarified; some studies suggest it could be related to hyperinsulinemia-induced decreased in CRF secretion and GHRH pulse.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
