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Biomedical subjects

P Vuillermet

Publications and source records attributed to P Vuillermet.

At least 19 recordsLinked to original sources
PubMed2003

An oestrogen-producing seminoma responsible for gynaecomastia.

In feminising testicular tumours, oestrogens can be either secreted by the tumour itself or produced by normal Leydig cells in response to paracrine and/or endocrine stimulation by hCG. Typical hormonal Leydig cell tumour patterns include: plasma oestradiol levels > 300 pmol/l on day 3 following an hCG injection, reduced plasma testosterone, and normal plasma hCG and gonadotrophin levels. Except for elevated plasma oestradiol levels, opposite results are observed in seminomas. We report a case of oestrogen-secreting seminoma mimicking a Leydig cell tumour. A 24-year-old Caucasian patient had complained of gynaecomastia for 6 months before admission. Hormonal pattern was typical of Leydig cell tumour. A 1.4 cm tumour was found in the left testis and confirmed on sonography. Considering the likely diagnosis of Leydig cell tumour, the patient was treated by tumourectomy. Surprisingly, pathological examination revealed a pure seminoma. Perifusion experiments showed that the tumour was able to secrete significant amounts of oestradiol. In addition, hCG induced a two-fold increase in oestradiol production from perifused tumour explants. Immunohistochemistry revealed that the tumour was composed of nests of seminoma cells intermingled with lymphoid infiltrates. Tumour cells also expressed aromatase, the hCG/LH receptor and the Leydig cell marker relaxin-like factor, but were betahCG-negative. These results demonstrate that a pure seminoma of the testis is able to synthesise and secrete oestrogens. They also illustrate that the body of proof favouring the diagnosis of feminising Leydig cell tumour of the testis is not rigorously specific.

Adult↗
PubMed1994

Effects of a slow-release formulation of the new somatostatin analogue lanreotide in TSH-secreting pituitary adenomas.

OBJECTIVE: Somatostatin analogues have been proposed for the treatment of thyrotrophinomas. However, this treatment requires several s.c. injections a day to be effective. The present study had the following aims: (i) appraisal of the efficacy of a single dose of two somatostatin analogues (lanreotide and octreotide) to acutely inhibit TSH secretion of TSH-secreting pituitary adenomas; (ii) assessment of the efficacy of a single injection of a slow release formulation of lanreotide (SR-L) in reducing TSH and thyroid hormone secretions in the same cases; and (iii) evaluation of the effects of SR-L used for 3-6 months on hormone secretion and tumour size. PATIENTS: Four patients with hyperthyroidism linked to a TSH-secreting pituitary adenoma found on pituitary magnetic resonance imaging (MRI) and subsequently proved by immunohistochemistry were studied. METHODS: In the first step of the study the patients received in a random order, vehicle, 150 micrograms octreotide and 500 micrograms lanreotide as a single s.c. injection. Measurements of plasma TSH, free T4 (fT4), free T3 (fT3) and free alpha subunit (fAS) levels were carried out before injection and then every other hour for 8 hours. In the second part of the study, after a basal blood sample (0800 h), each patient received 30 mg lanreotide as an i.m. injection of SR-L. Blood was sampled 2 hours later and then three times a week for 3 weeks in order to measure plasma TSH, fT4, fT3 and lanreotide levels using radioimmunoassays. The patients then received one SR-L injection twice or in one case three times a month for 3-6 months. Plasma TSH, fT4 and fT3 levels were measured monthly and a pituitary MRI was performed at the end of the treatment with SR-L. RESULTS: 500 micrograms lanreotide acutely reduced plasma TSH and fAS levels to the same extent as 150 micrograms octreotide. Two hours after a single i.m. injection of SR-L plasma lanreotide levels reached 7.8 +/- 0.6 micrograms/l and then progressively decreased, being 1.8 +/- 0.2 microgram/l on day 2 and 1.1 +/- 0.3 microgram/l on day 14 after the injection. Plasma TSH level decreased from basal value (mean +/- SEM 4.4 +/- 1.2 mlU/l) within 2 hours (2.5 +/- 0.8 mlU/l) and further declined to 0.8 +/- 0.2 ml/Ul on day 2 following the injection. Depending on the patient, plasma TSH levels were reduced for a period of 6-15 days. Plasma fT4, fT3 levels were normalized on day 2 and remained in the normal range for a period of time of 9-20 days. During long-term treatment, abdominal cramps and diarrhoea appeared, leading to interruption of the treatment in one patient. The treatment was well tolerated in the other three patients. Plasma TSH and thyroid hormone levels progressively decreased during the treatment. No change in adenoma volume was observed after 3-6 months of therapy. CONCLUSIONS: This study shows that (i) lanreotide is able to inhibit acutely TSH secretion in thyrotrophinomas and that a single s.c. injection of 500 micrograms lanreotide is as effective as 150 micrograms octreotide; (ii) SR-L appears to be able to reduce plasma TSH and to normalize fT4 and fT3 levels for 9-20 days in patients with thyrotrophinomas; (iii) this effect is maintained throughout the treatment using two or three SR-L injections monthly for months. These results suggest that SR-L could be used as a treatment of thyrotrophinomas and avoids the drawbacks of the modes of administration of other somatostatin analogues used in such cases.

Adenoma↗
PubMed1994

Does age play a role in clinical presentation of hypothyroidism?

OBJECTIVE: To determine if aging modifies the clinical presentation of hypothyroidism. DESIGN: Comparison of 24 clinical signs of hypothyroidism between elderly patients (> or = 70 years of age) and younger patients (< or = 55 years of age). SETTING: Prospective study of patients with chemically confirmed overt hypothyroidism. PATIENTS: Sixty seven elderly patients (79.3 +/- 6.7 years) and 54 younger patients (40.8 +/- 9 years) were included in the study. RESULTS: Neither mean duration of evolution nor mean thyroid-stimulating hormone (TSH) level were different between the 2 groups. Two signs were found in more than 50% of the elderly patients (fatigue and weakness). Four signs were significantly less frequent in elderly patients (chilliness, paresthesiae, weight gain, and cramps). Mean number of clinical signs in the elderly (6.6 +/- 4) was significantly smaller than in young patients (9.3 +/- 4.7) (P < 0.01). CONCLUSIONS: Our results suggest that the presentation of hypothyroidism is altered in the elderly in comparison with young patients in that there are (1) fewer signs or symptoms and (2) diminished frequency of some classical signs. Our results underline the importance of TSH measurement in the elderly.

Adult↗
PubMed1994

[Major hypercalcemia revealing sarcoidosis].

We reported a new case of sarcoidosis disclosed by a symptomatic severe hypercalcemia. Increase of 1,25-dihydroxyvitamin D is secondary to an extrarenal production by alveolar macrophages and sarcoid granuloma. Glucocorticoid administration produces a prompt and persistent decrease in serum and urinary levels of calcium.

Adrenal Cortex Hormones↗
PubMed1983

[Education of a hospitalized diabetic population].

During the second semester of 1981, all the diabetic patients who were hospitalized in the department (142 IDD and 75 NIDD) followed an educational program. Approximately half the patients were unable to follow the entire course, owing to visual, motor, intellectual or linguistic impairment. Few patients refused the course (8 cases). Evaluation of the theoretical knowledge at discharge showed poor results in 47% of IDD and 64% of NIDD, with patients in the latter group appearing to be less motivated. Advanced age, unemployment and alcoholism are detrimental factors. In contrast, among 71 IDD who followed only part of the course because of a handicap, 25 nevertheless acquired satisfactory knowledge, justifying an educational program with limited objectives. At follow-up at the outpatient clinic, insulin dependent patients exhibited better metabolic control, self-monitoring and acceptance of their disease; however, the patients who are seen at follow-up examinations are those who have the best theoretical knowledge. A comparative study of hospitalizations shows that admissions for hypoglycemia have decreased between 1978 and 1981, but education is not the only factor. The shortcomings and possible improvements are discussed.

Diabetes Mellitus↗
PubMed1981

[Multiple admission to hospital of diabetic patients (author's transl)].

Within an 8 years' period, 29 insulin-dependent diabetic patients were admitted to hospital on more than 5 occasions, which represents 177 admissions for a total of 3407 days. In almost 70% of the cases loss of control of diabetes was the only reason for admission, and in 33% there was no urgency. Diabetes was unquestionably severe in all patients and truly unstable in 6, but socio-economic reasons accounted for at least one admission in 17 patients and for all admissions in 8. The remaining 64 admissions for uncontrolled diabetes were mostly due to the patients' carelessness. Twelve patients totalling 97 admissions never attended the out-patient clinic. Such carelessness seems to have arisen partly from reactive depression and partly from personality disorders, but the physicians's responsibility cannot be dismissed. In order to reduce the number of unnecessary admissions, diabetologists should provide improved patients' training, pay more attention to their psycho-affective problems and demand regular out-patient attendance.

Adult↗
PubMed1978

[Renal dlabetes and chemical diabetes. Course in young subjects with normal weight (author's transl)].

Ninety-two young patients of normal weight with glycosuria were classified according to the results of glucose tolerance tests into renal diabetes (32 cases) and chemical diabetes (53 cases). After 5 years or more 17 of the patients with renal diabetes were located. In only one case had the development of chemical diabetes led to correction of the initial diagnosis to that of potential diabetes with a reduced renal glucose threshold. Family histories of diabetes were identical in both groups (renal and chemical diabetes) (35 %) and did not provide any means for distinguishing renal diabetes from diabetes mellitus with a reduced renal glucose threshold. Amongst the 34 subjects with chemical diabetes who were located, 3 had become frank diabetics (9 %). Chemical diabetes persisted in 14 patients (42 %) and 17 (50 %) could be considered to be normal. In addition to the three subjects with frank diabetes, only 9 patients (5 with chemical diabetes and 4 normal) continued to take oral therapy at the time of the final examination. However, 13 of these patients who were not taking any treatment had abandoned it relatively recently. Even if the effectiveness of oral therapy is not fully clear, it should be remembered that continued treatment renders the patient less neglectful as far as diet is concerned. Tests for microangiopathy in the three diabetic patients were negative.

Adult↗
PubMed1977

[Outcome in male sterility].

Of a total of 102 cases of male infertility seen over the past ten years, treatment resulted in normalisation of the sperm count in 26, with 12 normal pregnancies resulting. These results concerned cases of oligo-asthenospermia related to a varicocele, pyospermia, hormonal insufficiency or general and psychological disorders. Ten couples were able to have a child with the use of artificial insemination using fresh donor sperm. The abandonment of this technique, nor replaced by the use of frozen sperm provided by a sperm bank, results at the present time in a considerable reduction in the number of inseminations, associated with the overload of these banks. Nevertheless, half of all couples accept the principle of hetero-insemination. The number of couples adopting a child is very low (4% in this study) as a result not only of the difficulties of adoption but also refusal by the couple.

Adoption↗