N. Germain

Insulin tolerance test predicts non response vs. sustained efficacy of Liraglutide on glycemic control in type 2 diabetes patients: A prospective real-world setting study

AIMSnLess than half of type 2 diabetes patients treated with Glucagon-Like Peptide 1 (GLP-1) analogs displays good glycemic control, according to real life studies. Predictive markers of inefficacy/efficacy are therefore needed. The effectiveness of Liraglutide in terms of glycemic control and weight loss was then evaluated according to putative predictive parameters.nnnMETHODSn80 type 2 diabetes patients treated with Liraglutide were included in this prospective study. An Insulin Tolerance test (ITT) was performed at baseline to calculate velocity of C-Peptide decrease (C-peptide T½). Several clinical and biological parameters including HbA1c and weight were assessed at baseline and after 12, 24, 52 and 104u202fweeks of treatment.nnnRESULTSnHbA1c decrease over the follow-up period was highly associated with C-peptide T½. A mean fall of 0.7% of HbA1c (7.7u202fmmol/mol) was predicted with 82% sensitivity and 80% specificity by C-peptide T½. In patients with rapid response during ITT (C-peptide T½u202f<u202f120u202fmin), a HbA1c decrease of 1.5% (16.5u202fmmol/mol) was constantly found (pu202f=u202f.002) all over the follow-up. HbA1c remained unmodified for the rest of the patients (pu202f=u202f.34) compared to baseline. HbA1c evolution was not predicted by diabetes duration. Weight loss was predicted only by low baseline C-peptide plasma level.nnnCONCLUSIONSnThis study suggests ITT as an efficient test to discriminate non-response from long-term efficacy before initiating Liraglutide. ITT could therefore help avoiding try and see prescription pattern by using a more precise and patient-centered strategy in order to reduce inertia in adapting treatment and so reduce subsequent complications.

Pulsatile gonadotropin-releasing hormone therapy in persistent amenorrheic weight-recovered anorexia nervosa patients

OBJECTIVEnTo compare hormonal and clinical responses to GnRH pulsatile treatment in weight-recovered anorexia nervosa patients (Rec-AN) with persistent functional hypothalamic amenorrhea (HA) vs. in patients with secondary and primary HA.nnnDESIGNnRetrospective, observational, ambulatory study.nnnSETTINGnUniversity hospital.nnnPATIENT(S)nForty-one women: 19 Rec-AN (body mass index >18.5xa0kg/m2 without menses recovery), 15 secondary HA without any eating disorders patients (SHA), and 7 primary HA patients (PHA).nnnINTERVENTION(S)nGonadotropin-releasing hormone pulsatile therapy.nnnMAIN OUTCOME MEASURE(S)nBaseline E2, LH, and P plasma levels and their changes during induction cycles; ovulation, follicular recruitment, and pregnancies.nnnRESULTSnThe Rec-AN group displayed higher basal E2 and LH plasma levels after GnRH injection compared with SHA and PHA. Higher E2 and LH levels were observed during induction cycles in Rec-AN compared with SHA and PHA. Follicular recruitment was higher in Rec-AN. The ovulation rate was higher in Rec-AN compared with PHA but similar to SHA.nnnCONCLUSION(S)nThis study showed increased gonadal status and higher E2 response to pulsatile GnRH therapy in persistent amenorrheic weight-recovered AN compared with HA from other causes. It suggests that their individual set-point of body weight allowing a fully functional gonadal axis is not reached yet. Specific factors of gonadal inertia in Rec-AN still remain unclear.

Differentiating constitutional thinness from anorexia nervosa in DSM 5 era

INTRODUCTIONnConstitutional thinness (CT) is an underweight state characterized by normal menstruations and no change in feeding behaviour. Thinness is the only resemblance between Anorexia Nervosa (AN) and CT. Removal of amenorrhea from the new DSM 5 definition of AN might result in misdiagnosis between these two populations. The objective of this study was to compare CT, AN and Control subjects in terms of biological, anthropometric, and psychological markers in order to better distinguish AN from CT subjects.nnnMATERIALS AND METHODSnBody composition, nutritional markers, pituitary hormones, bone markers and psychological scores were evaluated in three groups of young women: fifty-six CT, forty restrictive-type AN and fifty-four Control subjects. For every marker, a receiver Operator Characteristics (ROC) curve was calculated to evaluate the accuracy of differentiation between AN and CT groups.nnnRESULTSnFor most studied parameters, CT subjects were similar to Controls but dramatically different from AN subjects. DEBQ Restrained Eating subscale score was identified by ROC data analysis as the only psychological parameter tested to successfully differentiate AN from CT. Free-T3 and Leptin were shown to be powerful markers to differentiate AN and CT populations as they were highly specific and sensitive ones.nnnCONCLUSIONnThe exclusive use of psychological testing criteria is not always sufficient to differentiate AN and CT patients. Minimally, additional testing of Free T3 levels, which is cheap and widely accessible for general practitioners, should be completed to avoid misdiagnosis which could result in the implementation of ineffective treatment plans and social stigmatization for CT women.

À propos d’un cas : oncocytome de l’adénohypophyse

L’oncocytome de l’adenohypophyse est une tumeur rare de la region hypophysaire initialement rapportee en 2002. Il existe moins de 30xa0cas decrits dans la litterature. Nous rapportons le cas d’un patient de 48xa0ans se presentant aux urgences pour des cephalees d’apparition brutale pouvant faire evoquer un tableau d’apoplexie hypophysaire. Le champ visuel retrouve une hemianopsie bitemporale et l’IRM montre un adenome hypophysaire a developpement suprasellaire, mesurant 5xa0cm de grand axe, largement necrose. Le bilan biologique confirme le panhypopituitarisme suspecte cliniquement. Le 1er geste chirurgical a ete interrompu en raison d’une hemorragie importante empechant la visibilite. Les chirurgiens ont ete confrontes au meme probleme lors de la reprise chirurgicale et seule une exerese partielle a ete possible. L’anatomopathologie a conclu a un oncocytome a cellules fusiformes adenohypophysaire. L’etude immunohistochimique a montre un marquage typique de ces tumeurs par les anticorps Anti-PS100, Vimentine, EMA et TTF1. Un mois apres la chirurgie le champ visuel retrouve une quadranopsie bitemporale superieure. L’etude de l’evolution de ces tumeurs dans la litterature montre une recidive dans environ 45xa0% des cas ce qui nous amene a nous interroger sur la conduite a tenirxa0: reprise chirurgicale malgre le fort risque hemorragique, radiotherapie conventionnelle, surveillance rapprochee par l’imagerie. Cependant, une publication recente montre une absence de recidive apres 8xa0ans de surveillance. En conclusion, nous presentons une tumeur rare de l’hypophyse dont la problematique est celle du suivi.

Étude de la micro-architecture osseuse chez des patientes suivies pour un cancer thyroïdien différencié sous traitement hormonal freinateur de la TSH

Le traitement hormonal freinateur de la TSH (THF) utilise dans les cancers thyroidiens differencies (CTD) est responsable d’une action negative sur la densite minerale osseuse avec, dans de nombreuses etudes, une augmentation de l’osteoporose chez les patientes menopausees. Neanmoins, le lien entre THF et micro-architecture osseuse n’est pas connu. Cette etude pilote menee au CHU de Saint-Etienne est monocentrique, descriptive. La micro-architecture osseuse est decrite par un nouvel appareil de micro-tomographies haute resolution en trois dimensions de l’ordre de 100xa0μm (HR pQCT, SCANCO) dans un groupe de 30xa0femmes menopausees suivies pour des CTD evoluant depuis plus de 10xa0ans sous THF. Les resultats ont ete compares a un groupe temoin de 30xa0femmes menopausees comparables en âge. L’etude de la micro-architecture osseuse a egalement ete faite dans un groupe de 30xa0femmes, âgees de 20xa0a 45xa0ans, non menopausees, operees d’un CTD depuis moins d’un an. Les donnees analysees sontxa0: les marqueurs de remodelage osseux (cross laps et osteocalcine), le bilan phosphocalcique, la composition corporelle, la densite minerale osseuse du col femoral et vertebrale par absosbtometrie biphotonique, la VFA, la geometrie et densite osseuse totale, corticale et trabeculaire par HR-pQCT. Cette etude nous permet entre autre d’apprecier s’il existe ou non un lien entre l’importance du freinage par THF et l’atteinte potentielle de la micro-architecture osseuse dans ce groupe de patientes operees d’un CTD depuis plus de 10xa0ans.