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Biomedical subjects

E Delgrange

Publications and source records attributed to E Delgrange.

At least 37 records · Page 2Linked to original sources
PubMed1998

Late development of resistance to bromocriptine in a patient with macroprolactinoma.

We report the case of a man with an invasive macroprolactinoma who developed resistance to bromocriptine to which he had previously responded satisfactorily for 5 years. Subsequently, hyperprolactinemia was controlled equally well with 600 microg quinagolide daily and later with 4.5 mg cabergoline weekly. This observation suggests that a loss of dopamine receptors at the tumoral cell surface might be the mechanism underlying acquired resistance to bromocriptine. In addition, no tumor growth was observed over a 10-year follow-up, which virtually excludes a malignant transformation of the prolactinoma. This case emphasizes the need for close supervision of patients with macroprolactinoma, even after the serum prolactin concentration has been normalized by bromocriptine. It furthermore illustrates the usefulness of quinagolide and cabergoline when resistance to bromocriptine develops after a prolonged period of adequate response to this drug.

Aminoquinolines↗
PubMed1997

Sex-related difference in the growth of prolactinomas: a clinical and proliferation marker study.

Prolactinomas in women commonly present as small intrasellar tumors, but are usually much larger in men. This discrepancy has generally been attributed to differences in the delay before diagnosis. However, studies comparing clinical and pathological correlates of growth of these tumors in both sexes are lacking. We conducted a retrospective study comparing 45 men and 51 women bearing prolactinoma to determine whether the predominance of large tumors in men was due to a delay in diagnosis or, rather, to a fundamental sex-related difference in tumor growth. Basal PRL levels (mean +/- SEM, 2789 +/- 573 ng/mL) and mean tumor diameter (26 +/- 2 mm) were significantly higher in men than in women (292 +/- 74 ng/mL and 10 +/- 1 mm, respectively; P < 0.001), but were not correlated to the age at diagnosis or the duration of symptoms. Giant tumors (n = 8) occurred in males only. The frequencies of bromocriptine-resistant tumors (30 vs.5%; P < 0.01) and invasive macroadenomas (52 vs.27%; P < 0.001) were significantly greater in men than those in women. Lastly, macroprolactinomas in males exhibited higher indexes of proliferating cells by Ki-67 immunoreactivity (2.6 +/- 1.1% of positive nuclei) than did similar tumors in female patients (0.4 +/- 0.2%; P = 0.08). We conclude that the predominance of large prolactinomas in men is due to a high frequency of rapidly growing tumors, which are often invasive and frequently bromocriptine resistant.

Adolescent↗
PubMed1996

An unusual case of bilateral virilizing adrenal adenoma co-secreting androgens and cortisol.

We report the case of a 68-year-old woman presenting with clinical and biochemical evidence of hyperandrogenism. Imaging studies revealed the presence of a bilateral adrenal tumor. Although there was a predominant secretion of androgens, autonomous production of cortisol was also evidenced on the basis of an inversion of the circadian rhythm of plasma cortisol and an absence of cortisol suppression by dexamethasone. The functional status of both tumors was demonstrated by an iodocholesterol scintigraphy and by an adrenal vein catheterization. Surgical excision of both adrenal tumors was performed and histological examination disclosed no criteria of malignancy. The patient still remains disease-free 3 years after surgery. To our knowledge, this is the second report of the bilateral occurrence of a virilizing adrenal tumor and the first in which the functional characteristics of the tumors are detailed.

Adenoma↗
PubMed1996

Effects of the dopamine agonist cabergoline in patients with prolactinoma intolerant or resistant to bromocriptine.

Cabergoline is a new long-acting crgoline derivative used to treat hyperprolactinaemia. Its effect was assessed in 10 patients (eight women and two men) with prolactinoma who were intolerant (group I: N = 7) or resistant (group II: N = 3) to bromocriptine. In group I, no side effect was observed on cabergoline therapy; two patients became pregnant and normoprolactinaemia was achieved in the live others. In group II, cabergoline was active and well-tolerated in two out of the three patients: one woman had three consecutive pregnancies: in another patient normoprolactinaemia was restored and the tumour shrank by 60%; in the third patient cabergoline was discontinued because of side effects and inefficacy. Thus, cabergoline appears to be an alternative of choice as treatment of hyperprolactinaemic patients who are intolerant or resistant to bromocriptine.

Adult↗
PubMed1994

Diagnostic approach to pulmonary lymphangioleiomyomatosis.

Pulmonary lymphangioleiomyomatosis is an interstitial lung disease with distinctive clinical, radiologic, physiological and pathological findings. We report an additional case of this rare condition, diagnosed on first medical evaluation by transbronchial lung biopsy and discuss the diagnostic approach.

Adult↗
PubMed1994

[Status of 3 years of hyperthyroidism treatment with iodine 131].

We analysed retrospectively the results obtained during 3 years in the treatment of thyrotoxicosis with 131-iodine. A group of 32 patients, including 21 Graves' diseases, 10 multinodular toxic goitres and 1 toxic adenoma has been collected. The therapeutic efficacy of one dose of radioiodine, assessed after 6 months was 100% in toxic multinodular goitres and 57% in Graves' diseases. No acute complications were observed. The best radiosensitivity of toxic multinodular goitres compared with diffuse goitres is probably due to the mechanisms themselves of thyrotoxicosis in these diseases. Results also suggest that multinodular toxic goitres in our country should be systematically treated with antithyroid drugs before radioiodine. In Graves' disease, no predictive factor of the early response to therapy could be definitely evidenced. Finally, clinicians should be aware of the advantages of such a treatment of thyrotoxicosis which is not very aggressive and at least definitive.

Adult↗
PubMedDate not supplied

Influence of age on the clinical presentation of prolactinomas in male patients.

OBJECTIVE: Secreting pituitary adenomas are usually not considered a disease of older people. However, in male patients, prolactin-secreting pituitary tumours occur at a similar frequency throughout the entire life span, giving the opportunity to study in this gender the influence of age on the clinical presentation and response to treatment of these tumours. METHODS: We conducted a retrospective study including 9 male patients aged >/=60 (range 60-73) years and 10 aged </=30 (range 17-30) years presenting with a prolactinoma in order to compare clinical presentation, results of pituitary function tests, and response to dopamine agonist therapy between older and younger patients. RESULTS: Four of the 9 elderly as well as the 10 younger patients came to medical attention for typical features of male prolactinomas including visual field defect in 5 (2 elderly), headaches in 2 (1 elderly), impotence in 3 (1 elderly), gynaecomastia and/or galactorrhoea in 2, and arrested puberty in 2. The remaining 5 older people presented for other various reasons: symptoms related to cortisol deficiency in 2, lethargy with clinical signs of hypopituitarism in 1, spontaneous multiple vertebral fractures in 1, and incidental discovery of a pituitary mass in 1. Basal prolactin levels (3,051+/-4,151 vs. 3,365 +/- 4,949 microg/l) and mean tumour diameter (30 +/- 16 vs. 25 +/- 13 mm) were similar in old and young patients. Cortisol deficiency was significantly more frequent in the elderly (n = 6) than in the young (n = 1) patients (p 0.02, Fisher's exact test). Secondary hypothyroidism was found in 2 elderly only, but not in young patients. Sixteen patients (8 elderly) received bromocriptine therapy for at least 6 months with a good tolerance. Normalization of the prolactin levels was achieved in 6 older (75%) and 4 younger patients (50%). CONCLUSIONS: The presentation of a prolactinoma in the elderly man is very heterogeneous and can be misleading. At the time of diagnosis, hypopituitarism is more frequent among older than younger patients despite a similar tumour size. We found dopamine agonists equally effective in the elderly.

Adolescent↗
PubMedDate not supplied

Minor alterations in thyroid-function tests associated with diabetes mellitus and obesity in outpatients without known thyroid illness.

Thyroid function tests might be affected by diabetes and obesity. To evaluate the influence of these parameters in routine conditions, 72 diabetic and 53 non-diabetic outpatients without known thyroid diseases or severe chronic illness were recruited over a 7-month period. For each patient, dosages of thyrotropin (TSH), total and free thyroxine (TT4 and FT4, respectively), total and free triiodothyronine (TT3 and FT3) and T3 resin uptake (T3RU) were performed by radioimmunoassays. The simultaneous influence of various parameters known to affect thyroid-function tests was evaluated by multivariate linear regression. The studied variables included gender, age, glucosteroids, estrogens, tobacco habits, iodine contacts, body mass index (BMI) and diabetes mellitus. Tobacco habits and iodine contacts did not influence any tests. As expected, estrogens induced an increase in TT4 and TT3 values (p < 0.001 and 0.020, respectively) associated with a decrease in T3RU (p < 0.001). Consequently, females had lower T3RU than males (p < 0.0001). Corticotherapy was associated with decreased TSH values (p = 0.022). TT3 and FT3 decreased with age (p < 0.001), whereas T3RU and FT4 increased (p = 0.020 and 0.004, respectively). In contrast to an increase in TSH (p = 0.006), TT4 and FT4 decreased at higher BMI levels (p = 0.018 and 0.004, respectively), which is consistent with subclinical hypothyroidism. In diabetic patients, TSH was lower than in nondiabetic subjects (p = 0.039). Thus, the present study indicates that besides known parameters such as age and drugs, thyroid-function tests can also be altered by diabetes mellitus and obesity.

Adolescent↗
PubMedDate not supplied

Hyperoxaluria: an underestimated cause of rapidly progressive renal failure.

Hyperoxaluria is rarely considered as a cause of rapidly progressive renal failure. A case is reported of a patient in whom rapidly renal failure developed after subtotal small bowel resection. A diagnosis of calcium oxalate deposits nephropathy was confirmed by renal biopsy. This cause of renal failure may be underestimated and should be systematically searched for in all patients with malabsorption.

Aged↗