Effet secondaire inattendu de la métyrapone : à propos d’un cas

Introduction L’hypercorticisme est une pathologie rare et l’utilisation de la metyrapone est peu frequente. Le surdosage en metyrapone se traduit habituellement par des symptomes gastro-intestinaux et une insuffisance surrenalienne aigue. Observation Un diagnostic d’hypercorticisme est realise chez un homme de 28 ans. Un traitement par metyrapone 250 mg deux fois par jour a debute pour controler l’hypercorticisme. Le patient est hospitalise pour une intoxication medicamenteuse volontaire avec 100 comprimes de metyrapone. Un diagnostic d’insuffisance surrenalienne aigue est pose devant des douleurs abdominales, des vomissements, une asthenie et une hypotension. Il ne presente pas de myalgies…

Liraglutide reduces plasma PCSK9 in patients with type 2 diabetes not treated with statins

Dyslipidaemia in type 2 diabetes mellitus (T2DM), which increases cardiovascular risk, includes abnormal metabolism of low-density lipoproteins (LDL). Our group has recently shown that liraglutide increases LDL catabolism in patients with T2DM and that it reduces the expression of PCSK9 (a major inhibitor of LDL-receptor expression) in vitro and in mice. This prompted us to study the effect of liraglutide on plasma PCSK9 level in patients with T2DM.We studied prospectively 82 patients with T2DM (51 without statins, 31 with statins). Plasma PCSK9 and plasma lipids were measured before and six months after the initiation of a treatment with liraglutide at a dose of 1.2 mg/day.Plasma PCSK9 was…

A low-carbohydrate high-fat diet initiated promptly after diagnosis provides clinical remission in three patients with type 1 diabetes

Liraglutide Increases the Catabolism of Apolipoprotein B100–Containing Lipoproteins in Patients With Type 2 Diabetes and Reduces Proprotein Convertase Subtilisin/Kexin Type 9 Expression

OBJECTIVE Dyslipidemia observed in type 2 diabetes (T2D) is atherogenic. Important features of diabetic dyslipidemia are increased levels of triglyceride-rich lipoproteins and small dense LDL particles, which all have apolipoprotein B100 (apoB100) as a major apolipoprotein. This prompted us to study the effect of the GLP-1 agonist liraglutide on the metabolism of apoB100-containing lipoproteins. RESEARCH DESIGN AND METHODS We performed an in vivo kinetic study with stable isotopes (L-[1-13C]leucine) in 10 patients with T2D before and after 6 months of treatment with liraglutide (1.2 mg/day). We also evaluated in mice the effect of liraglutide on the expression of genes involved in apoB100-…

Fewer Type A personality traits in type 2 diabetes patients with diabetic foot ulcer.

Abstract Aim Type A personality—characterized by time urgency, strong drive, and a need for achievement and competitiveness—has been shown to be associated with reduced mortality in patients with diabetes. However, it is not known whether a Type A personality might protect against diabetic foot ulcer (DFU). This prompted our present analysis of the association between Type A personality and DFU. Methods The Bortner Scale questionnaire was used to assess Type A personality in 386 patients with type 2 diabetes (T2D), including 104 patients also presenting with, and 282 presenting without, DFU. Additional questionnaires were used to assess perceived stress and depression. Results Type A Bortne…

Frequent and severe hypoglycaemia detected with continuous glucose monitoring in older institutionalised patients with diabetes.

AbstractBackgroundLittle is known about the prevalence of hypoglycaemia in older people with diabetes. However, the HbA1c goal is ≥8% for institutionalised patients with treatments that can cause hypoglycaemia.PurposeWe aimed to assess the prevalence of hypoglycaemia with continuous glucose monitoring and to evaluate the link with HbA1C in older institutionalised patients with diabetes taking potentially hypoglycaemia-inducing drugs.DesignProspective, multicentre study carried out in six geriatric care centres in the Côte d’Or region of France between January 2019 and July 2020.Settings, subjects and methodsA FreeStyle Libre Pro® (FSLP) was worn for up to 14 days in blinded mode in 42 patie…

Glycemic Variability Assessment with a 14-Day Continuous Glucose Monitoring System: When and How Long to Measure MAGE (Mean Amplitude of Glucose Excursion) for Optimal Reliability?

Mean amplitude of glucose excursion (MAGE) is considered as the “gold standard” for assessing the short-term within-day glycemic variability (GV), which is an important component of overall glycemic control. A 14-day continuous glucose monitoring system is now widely used and allows easier assessment of GV. However, it is still unknown whether MAGE, usually calculated on a 48-hour period is identical whatever the time during the 14-day lifespan of the sensor and whether a longer time period might give additional information. We evaluated in 68 patients with type 1 diabetes, MAGE during three 2-day periods (day1-day3; day6-day8; day11-day13) and during periods of 3 days and 4 days. MAGE cal…

Effets de la corticothérapie systémique sur le métabolisme des HDL

Resume La prise exogene de glucocorticoides (GC) est responsable de nombreux effets secondaires, notamment metaboliques. Les effets sur le metabolisme lipidique ne se limitent pas aux triglycerides, mais concernent egalement les HDL. Meme si les donnees disponibles sont peu nombreuses, elles montrent que les GC entrainent une augmentation des taux plasmatiques de HDL-cholesterol et de la taille des particules HDL, independante de l’effet anti-inflammatoire des GC. Les mecanismes sous-jacents a ces augmentations restent actuellement meconnus. Alors que les patients traites par GC presentent une augmentation de la morbidite cardiovasculaire et que l’alteration de la fonctionnalite des HDL est…

Effets secondaires thyroïdiens sous immunothérapie anti-PD1 : évaluation des facteurs de survenue

Objectifs L’utilisation des immunotherapies anti-PD1 dans le traitement des cancers de la peau et du poumon, s’accompagne d’effets secondaires auto-immuns thyroidiens. L’objectif de cette etude etait de determiner leur frequence et d’identifier les facteurs favorisant leur survenue. Methodes Etude retrospective chez 196 patients traites pour un melanome malin ou un cancer bronchique non a petites cellules (CBNPC) par pembrolizumab ou par nivolumab, entre juillet 2014 et fevrier 2018. Quarante-quatre patients ont ete exclus de l’etude (34 pour antecedents de dysthyroidie et 18 par manque de donnees). Les dysthyroidies sous anti-PD1 ont ete differenciees des modifications de TSH par surcharge…

La prise de biotine à fortes doses : une cause d’hyperthyroïdie biologique factice

IntroductionMany hormone immunoassays use the biotin streptavidin interaction to immobilize immune complexes. The intake of high dose biotin can interfere with immunoassays using the biotin streptavidin interaction. The biotin-immunoassay interference generates falsely low or falsely high tests of hormones according to the type of immunoassay used.Case reportA 70-year-old patient, with progressive multiple sclerosis, was referred to our hospital for thyrotoxicosis. She was found to have markedly elevated thyroid hormones level (T3-T4) and decreased thyrotropin (TSH) level but she had no symptoms of hyperthyroidism. An ingestion of biotin, that is more and more frequent in patients with prog…

Effet secondaire inattendu de la métyrapone : à propos d’un cas

Thyroïdites : où en est-on en 2019 ?

Thyroiditis is a frequent and mostly benign disease that can sometimes disrupt the thyroid balance. Their diagnosis, as well as their aetiology, is a necessary step in the management of the patients. Painful thyroiditis includes acute thyroiditis of infectious origin and subacute thyroiditis. The first one can be treated by antibiotics or antifungals depending on the germ found. The second one will be treated with non-steroidal anti-inflammatory drugs or corticosteroids. In cases of Hashimoto's thyroiditis with overt hypothyroidism, replacement therapy with L-thyroxine will be adapted to the TSH level. As amiodarone treatment provides dysthyroidism, the thyroid status should be monitored re…