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R Comtois

Publications and source records attributed to R Comtois.

49 records · Page 3Linked to original sources
PubMed1981

The pituitary-thyroid axis after hemithyroidectomy in euthyroid man.

The pathogenesis of euthyroid goiter is assumed to be TSH dependent, but most studies have not demonstrated elevation of serum TSH. To elucidate the early events involved in thyroid growth, we studied thyroid function in eight euthyroid patients subjected to hemithyroidectomy for solitary cold nodules preoperatively and 2, 15, 60, and 90 days and 36 months, postoperatively. Although within the euthyroid range, serum T4 decreased at 30 days and thereafter up to 90 days (P less than 0.01). Basal serum TSH rose significantly by the 30th day and remained elevated for the entire 90-day period (P less than 0.001). The serum TSH response to TRH was exaggerated from days 15-90 (P less than 0.001). Thirty-six months postoperatively, all parameters of thyroid function were similar to control values, with the exception of one patient who showed an exaggerated response of serum TSH to TRH. We conclude that 1) the dynamic phase of recuperation post hemithyroidectomy is TSH dependent, 2) the serum TSH increase occurs within normal limits and is a temporary event, and 3) 3 yr postoperatively, a new steady state is achieved with normal parameters of thyroid function. Thus, we believe that TSH plays a dominant role in the genesis of goiter.

Adult↗
PubMedDate not supplied

[Chronic fatigue: myth or reality?].

Chronic fatigue is one of the most common complaints. However, it can be a vexing problem in clinical practice. In contrast to serum cholesterol or blood pressure, fatigue may seem immeasurable. The management of fatigue is often complicated by the uncertainty surrounding of its cause and the frequent lack of specific therapy. Recently, criteria were established for the diagnosis of chronic fatigue syndrome. This working case definition does provide some guidance for the practicing physician.

Fatigue Syndrome, Chronic↗
PubMedDate not supplied

[Diagnostic value of the determination of blood urea in dehydrated patients with and without central diabetes insipidus].

Dehydrated patients usually present with an elevated serum urea level, owing in part to increased renal reabsorption of urea mediated by antidiuretic hormone (ADH). This study was carried out in order to examine whether, during dehydration, the variations in the serum urea level could discriminate patients with central diabetes insipidus (CDI) from those with dehydration due to other causes. We studied retrospectively 27 episodes of dehydration in 23 patients with CDI and 14 episodes in 14 patients without CDI. The mean serum urea level was 2.9 mmol/L in the CDI group and 15.4 mmol/L in the patients without CDI (p less than 0.001) while the mean serum sodium level was 155 mmol/L in both groups. During dehydration, patients with CDI decreased their serum urea level (4.0 +/- 2.3 vs 2.9 +/- 1.5 mmol/L, p less than 0.001). In addition, a positive correlation was found in the patients with CDI between the magnitude of diuresis and the percentage decrease in the serum urea level compared with the level before dehydration (r = 0.70, p less than 0.001). A striking increase in the clearance of urea (0.8 +/- 1 vs 2.1 +/- 1 ml/s, P less than 0.01), which exceeded the creatinine clearance (1.8 +/- 0.5 ml/s), was observed during dehydration in the six patients in whom clearance studies were done. Therefore, our results suggest that serum urea values can be used to distinguish patients dehydrated because of CDI from those with hypertonic dehydration but without ADH deficiency and that during dehydration the reabsorption of urea is mainly dependent on the renal action of ADH.

Adult↗
PubMedDate not supplied

[Treatment of the non-functioning hypophyseal adenoma].

Non-functioning pituitary adenoma is a lesion usually large enough to produce loss of vision and often loss of libido. Transsphenoidal microsurgery is the treatment of choice of these patients. Postoperative radiation therapy should be performed in patients with significant residual pituitary adenoma. Some studies have recently reported that somatostatin analogue may be useful as adjuvant medical therapy, at least in order to improve visual field defects.

Adenoma↗
PubMedDate not supplied

[The treatment of prolactinoma].

Prolactinoma is the most common type of secretory pituitary tumor. The clinical presentation varies with age and sex, and the size of the adenoma. The differential diagnosis with nonfunctioning adenoma and hyperprolactinemia is particularly important in selecting an appropriate therapy. The choice of therapy depends on a number of factors including the patient's preference. In cases of radiologically undetectable microprolactinomas, we prefer observation only. However, hypogonadic patients are treated with bromocriptine. Generally, it is our recommendation that almost all of the patients with micro--and macroprolactinomas undergo a primary medical therapy, provided they are willing to continue such therapy on a long term basis. We recommend transsphenoidal surgery for patients who refuse long term medical therapy and in rare cases of prolactinomas which are unresponsive to medical therapy. We also consider surgery as a valuable alternative to medical therapy in patients with microprolactinomas and prolactin below 200 micrograms/L.

Adolescent↗
PubMedDate not supplied

[The treatment of Cushing's disease].

The differential diagnosis of Cushing's disease remains difficult to establish. The selective transsphenoidal adenomectomy is the initial treatment of choice. In a group of 65 patients, 50 (77%) initially responded to surgery with correction of their hypercortisolism. Forty-three out of 51 (84%) patients with small pituitary tumors responded favourably to surgery, but recurrency occurred in 10% of the cases. Medical treatment with steroids inhibitors or antagonists is only an adjuvant treatment. In case of surgery failure or recurrency, bilateral adrenalectomy is usually performed. Conventional radiotherapy may be used after surgery in presence of macroadenomas or invasive adenomas. Correction of the hypercortisolism, after a second surgery, was achieved in 50% of the cases and was always associated with a panhypopituitarism.

Adenoma, Basophil↗
PubMedDate not supplied

[The treatment of acromegaly].

Acromegaly is a rare disease which can significantly reduce life expectancy. Clinical features are diverse and the patient may consult a variety of medical and surgical specialists before the diagnosis is suspected. However, the disease is easily confirmed by the appropriate laboratory tests, namely GH and IGF1 measurements. In most cases, acromegaly is secondary to a micro or macrosomatotrope pituitary adenoma. Those lesions are easily visualized by a pituitary CT Scan or Magnetic Resonance Imaging. Visual fields have to be evaluated by a neuro-ophthalmologist, and a thorough evaluation of other pituitary functions have to be performed. Selective removal of the adenoma by the transsphenoidal route is the treatment of choice for acromegaly. When performed by an experienced neurosurgeon, normalization of GH secretion can be expected in approximately 75% of cases. The surgical outcome is modulated by the volume, the extension of the tumor and the preoperative GH level. Octreotide, radiotherapy or bromocriptine are indicated whenever the patient remains with an elevated level of GH with persistency of symptoms.

Acromegaly↗