Service dendocrinologie et maladies metaboliques

Le Touquet – Paris-Plage, France

Service dendocrinologie et maladies metaboliques

Le Touquet – Paris-Plage, France
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Duvillard L.,University of Burgundy | Duvillard L.,Laboratoire Of Biochimie Medicale | Florentin E.,University of Burgundy | Florentin E.,Laboratoire Of Biochimie Medicale | And 5 more authors.
Arteriosclerosis, Thrombosis, and Vascular Biology | Year: 2013

OBJECTIVE - : In vitro studies showed that insulin stimulates the production of apolipoprotein AI (apoAI). Thus, we hypothesized that chronic hyperinsulinemia could contribute to the increase in the production of high-density lipoprotein apoAI that is observed in metabolic syndrome. APPROACH AND RESULTS - : We performed an in vivo kinetic study with stable isotope in 7 patients with insulinoma who showed hyperinsulinemia but no insulin resistance, 8 patients with insulin resistance, and 16 controls. Insulinemia was 3.1× (P<0.01) higher in patients with insulinoma or insulin resistance than in controls in the fasting state and, respectively, 3.5× and 2.6× (P<0.05) higher in the fed state. The high-density lipoprotein apoAI pool size was smaller in patients with insulin resistance than in controls (49.3±5.4 versus 59.6±7.7 mg·kg; P<0.01), whereas both the high-density lipoprotein apoAI fractional catabolic rate and the high-density lipoprotein apoAI production rate were higher (0.30±0.07 versus 0.20±0.04 pool·d; P<0.0001 and 14.6±1.5 versus 11.5±1.9 mg·kg·d; P<0.01, respectively). In contrast, no significant difference was observed for these parameters between patients with insulinoma and controls. In patients with insulinoma, the apoAI pool size tended to be greater than in patients with insulin resistance (56.3±8.6 versus 49.3±5.4 mg·kg; P=0.078), whereas both the apoAI fractional catabolic rate and the production rate were lower (0.20±0.06 versus 0.30±0.07 pool·d; P<0.01 and 11.1±1.6 versus 14.6±1.5 mg·kg·d; P<0.01, respectively). The apoAI fractional catabolic rate was the only variable associated with the apoAI production rate in multivariate analysis and explained 80% of its variance. CONCLUSIONS - : Chronic endogenous hyperinsulinemia does not induce any increase in the apoAI production rate, which seems to be more dependent on the apoAI fractional catabolic rate. © 2013 American Heart Association, Inc.


Duvillard L.,University of Burgundy | Duvillard L.,Institute Federatif Of Recherche 100 | Florentin E.,University of Burgundy | Florentin E.,Institute Federatif Of Recherche 100 | And 5 more authors.
Journal of Clinical Endocrinology and Metabolism | Year: 2011

Objective: It is currently suggested that chronic hyperinsulinemia is a causal factor for the increased production rate of very-low-density lipoproteins (VLDL) associated with metabolic syndrome.However, the involvement of hyperinsulinemia independently of the other abnormalities also observed in metabolic syndrome has never been proven in humans. Design: We used patients with insulinoma showing hyperinsulinemia but no insulin resistance as a model and conducted an apolipoprotein B (apoB) kinetic study in seven patients with insulinoma, seven insulin-resistant (IR) obese patients, and 12 controls. Results: Insulinemia was higher in patients with insulinoma or IR than in controls both in the fasting state [2.4-fold (P = 0.039) and 3.1-fold (P = 0.003), respectively] and in the fed state [3.5-fold (P = 0.006) and 2.6-fold (P = 0.05), respectively]. Patients with insulinoma were not IR (steady state plasma glucose=80±46 mg/dl, a value lower than in IR subjects (231±75, P=0.0013). In the fed state, triglyceridemia and VLDL apoB pool size were higher in IR subjects compared with controls and patients with insulinoma [208 ± 56 vs. 89 ± 30 mg/dl (P < 0.0001) and 96 ± 42 mg/dl (P < 0.0001), respectively, for triglyceridemia and 3.56 ± 0.60 vs. 1.85 ± 0.88 mg/kg (P = 0.004) and 2.32±1.79 (P=0.052)mg/kg for VLDLapoBpool size].The production rate of VLDLapoBin subjects with insulinoma was not significantly different from that in controls (14.56 ± 7.43 vs. 16.40 ± 7.70 mg/kg · d) but was higher in IR subjects compared with these two groups [25.66 ± 12.84 mg/kg · d (P = 0.046 and 0.035, respectively)]. Conclusion: Chronic endogenous hyperinsulinemia is not directly responsible for any increase in the production rate of VLDL apoB in humans. Copyright © 2011 by The Endocrine Society.


Balavoine A.S.,Service dEndocrinologie et Maladies Metaboliques | Bataille P.,Center Hospitalier Of Boulogne Sur Mer | Vanhille P.,Center Hospitalier Of Valenciennes | Azar R.,Center Hospitalier Of Dunkerque | And 5 more authors.
European Journal of Endocrinology | Year: 2011

Introduction: Gitelman syndrome (GS) is a tubulopathy caused by SLC12A3 gene mutations, which lead to hypokalaemic alkalosis, secondary hyperaldosteronism, hypomagnesaemia and hypocalciuria. Aim: The aim of this study was to assess the prevalence of SLC12A3 gene mutations in adult hypokalaemic patients; to compare the phenotype of homozygous, heterozygous and non-mutated patients; and to determine the efficiency of treatment. Methods: Clinical, biological and genetic data were recorded in 26 patients. Results: Screening for the SLC12A3 gene detected two mutations in 15 patients (six homozygous and nine compound heterozygous), one mutation in six patients and no mutation in five patients. There was no statistical difference in clinical symptoms at diagnosis between the three groups. Systolic blood pressure tended to be lower in patients with two mutations (P=0.16). Hypertension was unexpectedly detected in four patients. Five patients with two mutated alleles and two with heterozygosity had severe manifestations of GS. Significant differences were observed between the three groups in blood potassium, chloride, magnesium, supine aldosterone, 24 h urine chloride and magnesium levels and in modification of the diet in renal disease. Mean blood potassium levels increased from 2.8±0.3, 3.5±0.5 and 3.2±0.3 before treatment to 3.2±0.5, 3.7±0.6 and 3.7±0.3 mmol/l with treatment in groups with two (P=0.003), one and no mutated alleles respectively. Conclusion: In adult patients referred for renal hypokalaemia, we confirmed the presence of mutations of the SLC12A3 gene in 80% of cases. GS was more severe in patients with two mutated alleles than in those with one or no mutated alleles. High blood pressure should not rule out the diagnosis, especially in older patients. © 2011 European Society of Endocrinology.


Dujardin F.,Service danatomie et cytologie pathologiques | Pages J.-C.,Service de biochimie et biologie moleculaire | Collin C.,Service de biochimie et biologie moleculaire | de Calan L.,Service de chirurgie digestive et endocrinienne | And 2 more authors.
Annales de Pathologie | Year: 2010

BRAF V600E mutation in papillary thyroid carcinoma (PTC): prevalence and detection in fine needle aspiration (FNA) specimens. Background and objective: The activating mutation of the BRAF gene, T1799A, is the most common and specific genetic alteration in PTC. In the present study, our aims were to confirm these data and investigate the feasibility of BRAF mutation detection in FNA specimens. Methods: In a retrospective study, we examined paraffin-embedded surgical samples of 57 PTC and 51 non-PTC thyroid tumors for the presence of BRAF mutation by dideoxy sequencing. We analyzed thyroid aspirates (drop and washed-out solution) and smears from 31 patients who underwent thyroidectomy, before intraoperative frozen sections, and 25 archival thyroid FNA smears. Results: The BRAF mutation was present in 58 % of PTC. Among non-PTC thyroid tumors, only one medullary thyroid carcinoma contained the BRAF mutation. BRAF mutation was correctly detected from the FNA-derived materials. Considering the search of BRAF mutation in preoperative FNA smears, the diagnosis of PTC would have been affirmed in 31 % (4/13) of indeterminate and suspicious FNA. Conclusion: BRAF mutation detection in FNA specimens is feasible and could be used as an adjunct tool for preoperative diagnosis of PTC classified as indeterminate and suspicious with conventional cytology (categories 3, 4 and 5 according to NCI/Bethesda 2008 terminology). © 2010 Elsevier Masson SAS.


PubMed | King Faisal Specialist Hospital And Research Center, Imperial College London, Al Afia Clinic, Shaukat Khanum Hospital and 4 more.
Type: | Journal: Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists | Year: 2016

Graves disease (GD) is commonly seen in endocrine clinical practice. The objective of this study was to evaluate the current diagnosis and management of patients with GD in the Middle East and North Africa (MENA).An electronic survey on management of GD, using an online questionnaire of a large pool of practicing physicians was performed. Responses from 352 eligible and willing physicians were included in this study. They were mostly endocrinologists (157) and internal medicine physicians (116).In addition to serum TSH and free T4 assays, most respondents would request serum anti-thyroid peroxidase antibody (TPOAb) and TSH-receptor autoantibody (TRAb) (50% and 46% respectively) whereas serum anti-thyroglobulin antibodies would be ordered by less respondents (36%). Thyroid ultrasound would be requested by a high number of respondents (63.7%), while only a small percentage would order isotopic thyroid studies. Antithyroid drug (ATD) therapy was the preferred first-line treatment (52.7%), followed by RAI treatment (36.8%), beta-blockers alone (6.9%), thyroidectomy (3.2%) and no therapy (1.3%). When RAI treatment was selected in the presence of mild Graves orbitopathy and/or associated risk factors for its occurrence/exacerbation, steroid prophylaxis was frequently used. The preferred ATD in pregnancy was propylthiouracil in the first trimester and carbimazole in the second and third trimesters. On most issues, choices of the MENA physicians fell between European and American practices.Hybrid practices are seen in the MENA region perhaps reflecting training and affiliations. Management approaches most suitable for patients in this region are needed.


PubMed | Service de gynecologie obstetrique et medecine de la reproduction, Service dendocrinologie et maladies metaboliques and Service de reanimation medicale et medecine interne
Type: Case Reports | Journal: Journal de gynecologie, obstetrique et biologie de la reproduction | Year: 2014

Three cases of ketosis decompensation occurring immediately in type I diabetic after corticotherapy for lung foetal maturation (LFM) are reported. Few of observations have been published. Increasing doses of insulin is mandatory under close monitoring of blood glucose levels, in particular according to the protocol proposed by Kaushal et al.: infusion of insulin adapted to the results of glucose levels, as a supplementation to the usual doses in each patient. Diabetes does not lead to hesitate prescribing a corticotherapy for LFM, but requires a strict control of needs in insulin to avoid a ketosis decompensation.


Buffet C.,Groupe Hospitalier la Pitie Salpetriere | Groussin L.,Service dEndocrinologie et Maladies Metaboliques
Revue du Praticien | Year: 2013

The diagnosis of thyroiditis encompasses a broad spectrum of thyroid disorders. Analysis of signs and symptoms, biochemical changes, neck ultrasound characteristics and radioactive iodine uptake values allows an accurate diagnosis. Recent studies of the whole genome have helped to identify many susceptibility genes for autoimmune thyroiditis. However, none of these genes contribute to a significant increase in risk of developing this thyroiditis. Clinical awareness of the characteristic presentations of exceptional thyroiditis (acute suppurative thyroiditis, Riedel's thyroiditis) is an important issue. Selenium administration seems to be beneficial for reducing the incidence of thyroiditis. Finally, certain drug-induced thyroiditis remains a therapeutic challenge for the physician.


Errajraji A.,Service dEndocrinologie et Maladies Metaboliques | Ouhdouch F.,Service dEndocrinologie et Maladies Metaboliques | El-Anssari N.,Service dEndocrinologie et Maladies Metaboliques
Medecine des Maladies Metaboliques | Year: 2010

Diabetes mellitus is a multifactorial chronic disease with a dramatic worldwide increase. To control hyperglycemia, several traditional remedies were tried and among them medicinal plants retain a large place. This prospective study objective was to evaluate their place and the various aspects of their use in diabetic patients living in south Morocco.356 type 2 diabetic patients (221 women, 135 men) were questioned through a questionnaire focusing on medicinal plant used, modalities and reasons for their use.185 (52%) patients declared using medicinal plant to control glycemia. Their use is significantly more frequent in women and in > 50-year old diabetics and those with a low educational level. Use of 38 plants was recorded, mainly Trigonella foenum, Artemisia abrotanum, Euphorbia resinifera, Salvia officinalis and Nigella sativa. Patients advocated several reasons to justify their use, but mainly a previous positive experience claimed by other diabetics. Most users are unaware of plant's toxicity as well as of their appropriate use (part to be used, mode to prepare them and quantity).Additional validated scientific data are clearly needed to improve knowledge on the mechanism of action and optimal use of medicinal plants before to be able to implement their use within the type 2 diabetes therapeutic armentarium. A particular attention has to be paid to sensibilize the general population as well as diabetic patients on the risks tied to an anarchical use of traditional/medicinal plants, particularly those with a known toxicity potential. © 2010 - Elsevier Masson SAS - Tous droits réservés.


The discovery of B-Raf activating mutations in thyroid carcinomas could open up new therapeutic solutions. In vitro studies and early clinical trials with B-Raf inhibitors has shown promising results. Specific mutated B-Raf inhibitors should now enter clinical trials for refractory thyroid carcinomas.


Deghima S.,Service dEndocrinologie et Maladies Metaboliques | Chentli F.,Service dEndocrinologie et Maladies Metaboliques
Revue Medicale de Liege | Year: 2012

Interferons are a large family of glycoproteins known as cytokines or substances released by lymphocytes that interfere with viral replication within host cells and activate the immune system. Nowadays, interferons are used as immunomodulators to treat many diseases, especially hepatitis. Among their side effects thyroidopathies are the most important. Their frequency varies from a study to another, and may reach 20%. Thyroid disorders may be an increase in thyroid antibodies or an abnormal function. Interferons can reveal or induce thyroid diseases whose mechanisms are still not understood. It seems that cytokines modify the immune system leading to an increase in stimulating or inhibiting antibodies production. A direct thyroid cells cytolysis is also possible. When stimulating antibodies are prevailing, hyperthyroidism is the resulting disease. This last situation is rarer than hypothyroidism resulting from an increase in inhibiting antibodies and/or thyroid cells cytolysis. When thyroid disease occurs under interferon therapy, overt hyper or hypothyroidism should be treated symptomatically without stopping interferons prescribed for a severe disease. However, after stopping interferons, control of thyroid function should be done to check if there is an ad integrum thyroid recovery.

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