Biomedical subjects

C Douillard

Publications and source records attributed to C Douillard.

6 recordsLinked to original sources

PubMed2002

Vitamin D deficiency and severe hyperparathyroidism.

The typical manifestations of severe hypercalcemia with osteitis fibrosa cystica have become exceedingly rare. We describe the case of a woman hospitalized for a tibial tumor with functional impotence, leading to a diagnosis of primary hyperparathyroidism (HPT I) associated with profound vitamin D deficiency. This 31-year-old woman was admitted, after two pregnancies complicated by the HELLP syndrome. Preoperative laboratory values were as follows: calcemia 4.05 mmol/l (2.2-2.6); urinary calcium 30 mmol/24 h (1.25-7.5); parathormone (PTH) 1 195 pg/ml (10-60); and 25 OH-vitamin D 13 nmol/l (22-120). Specific MIBI uptake by the tibial lesion oriented the diagnosis towards a brown tumor. After surgical excision of a parathyroid adenoma and the brown tumor (associated with tibial fracture), calcemia fell to 1.55 mmol/l and normalized after three months. Urinary calcium fell to 0.1 mmol/24 h and remained low during the 2 years following surgery. Vitamin D levels rapidly normalized on supplementation (87 nmol/l). PTH levels fell markedly after surgery but remained higher than normal till 2 years after surgery despite normalization of calcemia three months after. Bone repair, estimated by means of bone densitometry, improved from preoperative Z-score values of - 6.54, - 5.20 and - 3.50 in the left femoral neck, right femoral neck and lumbar spine, respectively, to - 0.20, - 1.55 and - 0.28, respectively, one year after surgery. In conclusion, this case illustrates: 1) the severe osseous expression of HPT probably related to vitamin D deficiency; 2) specific MIBI uptake by the bone lesion, orientating the diagnosis towards a brown tumor; 3) the consequences of vitamin D deficiency on postoperative outcome, with transient severe initial hypocalcemia related to bone calcium avidity; 4) a possible link between HPT and the HELLP syndrome.

Adult↗

PubMed2001

Lingual thyroid. A case report.

We describe an unusual clinical case in which a non functional cervical thyroid coexisted with a functional ectopic lingual thyroid. A twenty-year-old woman was referred for hypothyroidism treated with L-thyroxin related to a basilingual tumor diagnosed 8 years previously. Oropharyngeal examination showed a spherical basilingual tumor 2.5 cm in diameter. Laboratory findings during treatment with 50 microgram of L-thyroxin daily showed: TSH 6,280 microIU/ml (N: 4,4 to 3.6), FT3 4,2 pmol/l (N: 3.3 to 5.1), and FT4 15.4 pmol/l (N: 10,5 to 25,5). Antithyroid antibodies were absent. Cervical ultrasonography showed a small hypoechogenic, heterogeneous orthotopic thyroid gland confirmed by cervical computed tomography thyroid. An I(123) scan revealed uptake above the chin on the profile, and no significant uptake is the area of the normal thyroid. The lack of iodine uptake by the cervical thyroid remains unexplained. In conclusion, this report of an ectopic thyroid location in unusual because of the coexistence of non functional cervical thyroid and of a partially functional lingual thyroid tissue. The pathogenesis of this association remains unclear.

Adult↗

PubMed2000

Oxidative markers in diabetic ketoacidosis.

UNLABELLED: Oxidative stress has been implicated in the pathogenesis of the chronic complications of diabetes mellitus but little is known in diabetic ketoacidosis (DKA). The aim of this work was to determine whether lipid peroxidation, as assessed by measuring malondialdehyde (MDA, a prooxidant) and antioxidant status (TAS, an index of antioxidant defenses), is modified in DKA, and also whether any observed abnormalities were related to metabolic disturbances. METHODS: four groups of patients were studied, comprising 19 patients with DKA, massive ketonuria and plasma standard bicarbonate levels below 16 mmol/l (group 1); 20 patients with poorly controlled diabetes, glycated hemoglobin (HbA1c) above 8% and plasma bicarbonate levels above 16 mmol/l (group 2); 11 patients with well-controlled diabetes and HbA1c below 8% (group 3); and 10 non-diabetic, non-obese control subjects (group 4). Metabolic parameters, MDA levels and TAS were assessed in the plasma of the four groups of subjects. RESULTS: mean plasma MDA and TAS values were significantly different among the four groups (respectively p < 0.001 and p < 0.01). Mean plasma MDA value was significantly higher in group 1 than in group 3 (p < 0.02) and group 4 (p < 0.001) but was not different from that in group 2. Mean plasma MDA value in group 2 was significantly lower than that in group 4 (p = 0.002). Mean plasma TAS value in group 1 was significantly lower than in groups 3 (p < 0.002) and 4 (p < 0.05). Mean plasma TAS value was significantly lower in group 2 than in group 4 (p<0.05). Plasma MDA values in the diabetic patients (groups 1+2+3) were not related to any clinical characteristics (BMI, age, duration of the disease) or metabolic parameters (glycemia, HbA1c bicarbonates, blood urea nitrogen, phosphatemia, lipids), while plasma TAS values correlated negatively with glycemia, osmolality and HbA1c. A significant relationship was also found between TAS and HbA1c in group 1 (p < 0.05) and between MDA and HbA1c in group 3 (p < 0.05). Correlations were also found between TAS and phosphatemia in group 1 (p < 0.01) and between MDA and phosphatemia in group 2 (p < 0.01). A positive relationship between MDA and cholesterol levels was found in group 1 (p < 0.01). In conclusion, MDA values are increased and TAS values decreased in DKA and poorly controlled diabetes, and tend to correlate more with markers of diabetic imbalance than with markers of acute metabolic disturbances of DKA.

Adult↗

PubMed1999

[Relationship between corticotropin and arginine vasopressin in endocrine diseases].

VASOPRESSIN: The action of vasopressin (AVP) is not limited to regulating water excretion but also plays an essential role in regulating the corticotropic axis during stress. PHYSIOLOGY: Vasopressin is synthesized in the hypothalamus and stored in the posterior pituitary. It acts on 3 types of receptors (RV). RV1a are vascular receptors mediating the vasoconstrictor and glycogenolytic effects of the hormone. Anterior pituitary RV1b or V3 mediate stimulating effects on the corticotropic axis. Renal RV2 regulate water and urea excretion. Hypothetical extrarenal RV2 would be responsible for the vasodilator and procoagulant effects of the hormone. MODIFICATIONS IN ENDOCRINE DISEASES: Pituitary or adrenal hypocorticism syndromes include hyponatremia with secondary plasma hypoosmolality and reduced glomerular filtration due to the direct effect of glucocorticoids and also the effect of vasopressinism. Certain endogenous hypercorticisms appear to be related to an overexpression of RV: in ACTH-independent Cushingís syndrome, adrenal overexpression of eutopic RV1a, and in ACTH-dependent Cushingís syndrome, pituitary overexpression of eutopic RV1b or ectopic RV2. In addition, inappropriate secretion of antidiuretic hormone is frequent after transphenoidal surgery, particularly for corticotropic adenomas. DYNAMIC TESTS: The physiological response of ACTH and also AVP to corticotropin releasing hormone (CRH) in the petrous sinus, the unusual responses of certain corticotropic tumors to dDAVP, or certain forms of ACTH-independent hypercortisolism to lysine vasopressin (LVP) suggest excessive or ectopic expression of RV in corticotropic or adrenal cells: tumorgenesis of these cells could also depend, at least partially, on AVP.

Adrenocorticotropic Hormone↗

PubMed1999

Human pancreatic islet quality control: easy assessment of metabolic functions.

We describe simplified and rapid methods to assess islet function with the aim to develop better protocols for islet isolation and to determine islet characteristics before transplantation. These methods are also useful in the assessment of the potentially beneficial or deleterious effects of compounds added to the culture media in stimulation experiments. To this end, we took advantage of the multiscreen assay system produced by Millipore SA. This 96-well unit allowed the free-floating culture of islets on filter membranes, the rapid vacuuming and collection of conditioned media or reaction buffer and thus successive testing of the same number of islets, possibly at different culture times. We estimated islet viability by determination of the metabolic activity of cells, normal function of islets by their ability to metabolize glucose and to synthesize and secrete insulin and of nitrite release, a reflection of nitric oxide (NO) status of cells, which may be involved in a signaling pathway during glucose-stimulated insulin secretion or in cytokine inducible pathway. Assays may be performed either on selected islets or on aliquots of semi-purified preparations designated for grafting, allowing thus the rapid estimation of graft function of the entire preparation. This herein described system may be also extended to many other functional tests.

Automation↗

PubMed1999

[Bartter's syndromes].

Bartter syndromes are defined as a family of inherited recessive autosomal tubulopathies. They are characterized by hypochloremia, hypokalemia, metabolic alkalosis associated with potassium renal leakage and normal blood pressure despite increased plasma renin activity. Three forms of the disease are identified as followed: 1) Gitelman syndrome or hypocalciuria hypomagnesemia syndrome is a mild form often discovered in childhood or teenagers in reason of tetany. It is an homogeneous disorder related to mutations of the genes encoding the thiazide-sensitive Na-Cl cotransporter located in the distal convoluted tubule. 2) Antenatal Bartter syndrome with hypercalciuria and nephrocalcinosis or hyperprostaglandin E syndrome is a severe form, often revealed by hydramnios, prematurity and growth delay. It is related to mutations of two types of genes encoding for transporters of Henle's loop: the bumetanide-sensitive cotransporter Na-K-2Cl (NKCC2) [type I] or the inwardly-rectifying potassium channel (ROMK) [type II]. 3) the classical form or type III Bartter syndrome, often revealed by dehydration in the first year of life, is associated with hypomagnesemia in 20% of cases and normal or increased calciuria. This form is related to mutations of CLCNKB gene encoding for a chloride channel in Henle's loop. This classification, in part related to the demonstration of mutations in the genes encoding for tubular chloride or potassium channels, does not fit all cases, overlapping syndromes are frequent. Moreover some endocrinological (diabetes) and neurological (deafness) abnormalities are sometimes associated with Bartter syndromes. Both phenotypic and genetic approach must help to the diagnosis of these tubulopathies.

Bartter Syndrome↗