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J L Sadoul

Publications and source records attributed to J L Sadoul.

At least 19 recordsLinked to original sources
PubMed2002

Iatrogenic Cushing's syndrome in an HIV-infected patient treated with inhaled corticosteroids (fluticasone propionate) and low dose ritonavir enhanced PI containing regimen.

In HIV-infected patients, ritonavir, a potent cytochrome P450 inhibitor, is increasingly used to improve the pharmacokinetic profile of the associated protease inhibitor. HIV physicians are often faced with potential drug-drug interaction while treating associated diseases. We report the case of an HIV-infected patient with clinical features of Cushing's syndrome due to the interaction of low dose ritonavir with inhaled fluticasone propionate (FP). Safety of life-long CYP450 inhibition has still to be demonstrated.

Adult↗
PubMed2000

[Intravagal parathyroid ectopia].

AIM OF THE STUDY: The presence of an ectopic parathyroid gland is the commonest cause of persistent hyperparathyroidism (HPT). High cervical ectopic glands represent 0.21 to 9% of these cases. Only 3 cases of high intravagal sites have been described. The authors report two new cases of persistent HPT caused by an intravagal parathyroid gland. PATIENTS AND METHOD: In a series of 1,712 cases of HPT operated over the last 25 years (1,307 primary HPT and 405 secondary or tertiary HPT), two cases (0.12%) of persistent HPT were caused by a high intravagal parathyroid gland. One case corresponded to primary HPT and the other case corresponded to tertiary HPT. One patient underwent three operations and the other patient underwent four operations. CONCLUSION: Intravagal thyroid tissue may cause HPT. This very rare site must be considered among the other high cervical ectopic sites in the pre- and intraoperative assessment of hyperparathyroidism, particularly in cases of persistent or recurrent hyperparathyroidism.

Choristoma↗
PubMed2000

[Predictive malignancy factors in thyroid nodular disease].

Nodular thyroid pathology is frequent and remains a controversial issue when it comes to establishing an ideal endocrine surgical strategy. We studied clinical and complementary data predictive of malignancy using a large retrospective analysis of 366 cases operated for nodular pathology of the thyroid gland between January 1995 and December 1997 in our Head and Neck Surgery Unit of the Pasteur Hospital in Nice, France. The incidence of malignancy was 12.8% with the usual histologic findings (83% of well-differentiated tumors: 70% papillary, 13% vesicular, 9% medullar, 6% oncocytic and 2% anaplastic). Statistical analysis did not conclude on the predictive value of several items in terms of their relationship to high risk of malignancy (p > 0.05): size of nodules, signs of local compression, biological findings, presence of calcifications, mixed ultrasound aspect, no hypoechogenic halo, scintigraphic aspect. This retrospective work did however identify items predictive of malignancy when appearing in patients with nodular thyroid disease: male sex (odds ratio 2.4; 95%CI [1.17-4.88]; p=0.13), age (less than 40 yr or more than 70yr) (p=0.003), hard nodule consistency (odds ratio 7.40; 95%CI [3.99-13.52], p<0.001), invasion of lymphatic nodes noted prior to surgery (p=0.031), hyperechogenicity on ultrasound exam (p=0.013). We were able to confirm the highly negative predictive value (92%) of fine needle aspiration, emphasizing its value in endocrine thyroid nodular disease diagnosis.

Adolescent↗
PubMed1999

Fasting, postprandial, and post-methionine-load homocysteinaemia and methylenetetrahydrofolate reductase polymorphism in vascular disease.

Hyperhomocysteinaemia is an independent risk factor for cardiovascular disease. The C677T mutation of the methylenetetrahydrofolate reductase (MTHFR) is a common genetic cause of increased homocysteine (HCY) levels. Post-methionine-load HCY concentrations allow identification of certain cases of hyperhomocysteinaemia not demonstrated by fasting levels. This study investigated the relationship between MTHFR polymorphism and (1) fasting HCY levels (77 patients); (2) post-methionine HCY levels (54 patients); and (3) postprandial HCY concentrations (36 patients) in cardiovascular disease. As expected, mean fasting HCY value was higher in the +/+ patients. Moreover, patients who were homozygous for the mutation exhibited significantly increased mean post-methionine-load HCY; in contrast, literature results are conflicting. Mean postprandial HCY, which is not known to be increased in controls, was also increased in the (+/+) patients, although the difference did not reach statistical significance, probably owing to the small size of the sample. MTFHR polymorphism is known to be aggravated by a drop in circulating folate. Additional risk factors may be more prevalent in patients with cardiovascular disease.

Adolescent↗
PubMed1999

Apparent activities of 21-hydroxylase, 17alpha-hydroxylase and 17,20-lyase are impaired in adrenal incidentalomas.

OBJECTIVE: An increased response of 17-hydroxyprogesterone to ACTH stimulation has been observed in adrenal incidentaloma and linked to an impairment of either 21-hydroxylase or of 11beta-hydroxylase activity. To analyse this question further, we investigated the steroidogenic pathways in a series of 17 adrenal incidentalomas. DESIGN AND PATIENTS: 17 patients (7 women, 10 men; mean age, 62 +/- 12 years) with non-histologically analyzed adrenal incidentalomas were prospectively evaluated. METHODS: The following variables were investigated: 24-h urinary methanephrines and free cortisol excretion; plasma levels of ACTH and dehydroepiandrosterone; overnight dexamethasone suppression test; 1-24 ACTH stimulation test with measurement of: cortisol, 11-deoxycortisol, 17-hydroxyprogesterone, aldosterone, 11-deoxycorticosterone, progesterone, 17-hydroxypregnenolone, Delta4-androstenedione, dehydroepiandrosterone and 21-deoxycortisol. RESULTS: Discordant features of subclinical hypercorticism were noted in one case. No patient had dehydroepiandrosterone sulfate levels in the normal range for his or her age. Peak 17-hydroxyprogesterone and peak 21-deoxycortisol disclosed impairment of 21-hydroxylase in 11 and 10 cases respectively. An increased 11-deoxycortisol/cortisol ratio identified reduced activity of 11beta-hydroxylase in 11 patients. Eight patients displayed features of mild 17,20-lyase impairment, which was related to 21-hydroxylase dysfunction. Whereas only 2 patients showed no enzyme modification, 9 displayed alterations of at least two pathways. CONCLUSION: In our hands, a combination of enzyme dysfunction was frequently observed. Shared biochemical mechanisms could explain combined 17,20-lyase and 21-hydroxylase alterations, whereas coexistence of 21-hydroxylase (particularly when based on peak 21-deoxycortisol) and 11beta-hydroxylase is more puzzling.

17-alpha-Hydroxypregnenolone↗
PubMed1999

Assessment of cardiac arrhythmic risk in diabetic patients using QT dispersion abnormalities.

The purpose of this study was to assess the abnormalities and prevalence of QT dispersion in 154 diabetic patients (DP) who underwent a standard 12-lead ECG. QT interval was measured from the beginning of the QRS complex until the T wave returned to baseline. Atrial fibrillation, pacemakers and the impossibility of measuring 6 QT intervals per ECG were reasons for exclusion from the study. Diabetic patients were compared with 104 sex- and age-matched controls (C): mean age 50.7 +/- 2.3 years (DP) vs 48.4 +/- 10.1 (C) (ns); diabetes duration: 11.6 +/- 7.9 years. Seventy-eight percent of DP were non-insulin-dependent. Mean QT duration was 0.383 +/- 0.031 s (DP) vs 0.381 +/- 0.026 (C) (ns); QT dispersion (difference between the longest and shortest QT interval measurement) 0.033 +/- 0.015 s (DP) vs 0.024 +/- 0.011 (C) (p < 0.001); and QT variability 3.003 +/- 1.23% (DP) vs 2.295 +/- 0.936 (C) (p < 0.001); with a standard deviation of 0.012 +/- 0.005 s (DP) vs 0.009 +/- 0.004 (C) (ns). QT dispersion indices (dispersion, variability) were significantly increased in DP, even for short diabetes duration. Future studies should focus on QT dispersion to assess the usefulness of such indices in detecting DP at high risk of sudden death and ventricular arrhythmias.

Arrhythmias, Cardiac↗
PubMed1999

[Somatotrope pituitary adenomas. Contribution of presurgical treatment with somatostatin analogs].

Presurgical treatment of somatotrope pituitary adenomas with somatostatin analogs is warranted by the efficacy of both octreotide and lanreotide in the treatment of acromegaly. This efficacy is expressed in terms of symptom relief, reduced growth hormone secretion, lower IGF-1 levels, and reduced tumor volume. Excepting encased microadenomas and macroademonmas, all patients with acromegaly should be given somatostatin analogs preoperatively. In addition, in certain cases of microadenomas, it may be advisable to postpone surgery while giving this medical treatment. The following protocol can be used: subcutaneous octreotide to initiate treatment in order to progressively increase dosage and minimize secondary digestive tract side effects, followed by long-acting formulations for 3 months. Treatment is assessed on clinical secretory efficacy and radiology changes in tumor volume as well as tolerance, taking into account for the exceptional cases of pancreatic or hepatic disturbances. In our own personal experience, preoperative treatment almost always improve symptomatology, reduces hormone levels in 70% of the cases and reduces tumor volume in all patients, by more than 30% in 20% of patients. As demonstrated by the body of published work on presurgical use of somatostatin analogs, this treatment improves post-surgery outcome. This treatment is also cost-effective.

Adenoma↗
PubMed1997

[Preoperative localization in primary hyperparathyroidism: value of Tc-99m-MIBI scintigraphy].

In order to assess the value of scanning with 99mTc-MIBI before surgery in primary hyperparathyroidism (PHP), we performed this procedure in 30 patients with PHP. MIBI imaging findings were: 24 true positive results, three false positive, three false negative (sensitivity: 89%). The 24 true positive results comprised 21 solitary adenomas (one of which was ectopic), one cancer, and two parathyroid hyperplasias. Thus 99mTc-MIBI scanning seems to be useful for the preoperative localization, and for preparing the surgeon to unusual features that could generate surgical failure.

Adenoma↗
PubMed1995

[Genesis of thyroid nodules. Physiological and pathological mechanisms, clinical implications].

Thyroid nodules are the most frequently encountered thyroid diseases since they are displayed by clinical examination and ultrasound thyroid study in 3-5% and 50% of any patients, respectively. Thyroid nodules are more frequent in females and their prevalence increases with age, iodine deficiency and exposure to radiation. Thyrocytes proliferation is under the control of two classic factor (TSH and iodine) and a dozen of newly identified growth factors/regulators. Indeed, the hyperplastic phase, its angiogenic counterpart, and the following expression of thyrocytes' differentiation are the result of a complex intercellular cooperativity. Moreover, the innate thyrocytes heterogeneity, regarding their tendency to proliferate and differentiate, determines a more complexified control. This complex mechanism which allows a fine tuning of the thyroid function is nevertheless responsible for the various targets that will be affected by manifold etiopathogenetic factors. Thyroid nodules genesis may thus be envisioned as an amplification, secondary to genetic or/and epigenetic mechanisms, of the thyroid gland heterogeneity. Experimental data and their conceptual outcomes should be kept in mind in the diagnostic, therapeutic or preventive care of thyroid nodular diseases.

Female↗
PubMed1994

Mycobacterium avium intracellulare suppurative thyroiditis in a patient with Hashimoto's thyroiditis.

A case of suppurative thyroiditis occurring in a 72-year-old woman is reported. The clinical history of this woman, treated by tianeptine for mild exogenous affective disorder and by conventional insulin therapy for long-standing insulin-dependent diabetes, was remarkable for the pseudotumoral signs which led to the simultaneous diagnosis of hypothyroidism due to Hashimoto's thyroiditis and of mycobacterium avium intracellulare suppurative thyroiditis. To our knowledge, this is the second reported case of mycobacterium avium intracellulare thyroiditis. This case is also exemplary, given its occurrence in the absence of severe immunodepression, setting apart the mild impact on the immune system of affective disorder and of long duration's insulin-dependent diabetes.

Aged↗
PubMed1994

[Lithium therapy and hyperthyroidism: disease caused or facilitated by lithium? Review of the literature apropos of a case of hyperthyroidism preceded by transient hypothyroidism].

A case of hyperthyroidism occurring in a 68 year old man receiving lithium carbonate (1 g/day) for 5 years is reported. The clinical history of the patient, treated for bipolar affective disorder, was remarkable for transient hypothyroidism followed several months later by tremor, increased free thyroxine and triiodothyronine, and decreased TSH levels which led to lithium withdrawal. Two months later, clinical and biological signs were unchanged, Tc99m-scan displayed a homogeneous and increased isotope uptake. In this setting, high levels of autoantibodies against TSH-receptor, and grade I exophthalmos and slightly ocular muscle enlargement at CT-scan favored the diagnosis of Graves' disease (perhaps facilitated by lithium therapy). Carbimazole treatment was effective in controlling hyperthyroidism. Review of the literature disclosed 44 cases of hyperthyroidism occurring in lithium-treated patients. Most of these cases concerned specific thyroid diseases, particularly with an autoimmune mechanism. There is also evidence for an actual role of lithium in increasing intrathyroid iodide pool and for an impact of lithium on the immune system. Thus, the hypothesis that lithium may trigger the development of an autoimmune thyroid disease in predisposed patients deserves further investigation.

Aged↗
PubMed1993

High prevalence of thyroid autoantibodies in a prospective series of patients with chronic hepatitis C before interferon therapy.

After describing two cases of Hashimoto's thyroiditis associated with chronic hepatitis C, we set up a prospective study to assess the prevalence of thyroid autoantibodies (thyroglobulin and thyroid microsomal autoantibodies) in 72 chronic hepatitis C patients (43 men and 29 women; mean age = 51 +/- 2.1 yr) before interferon therapy admitted between January and December 1991 to our liver unit. Thyroid autoantibodies were systematically assayed in 60 chronic HBsAg-positive patients (34 men and 26 women; mean age = 50 +/- 2.2 yr), who served as controls. Antibody to hepatitis C virus was detected with a second-generation enzyme immunoassay and then confirmed with a recombinant immunoblot assay and a supplemental enzyme immunoassay using two beads. In chronic hepatitis C patients, no men had thyroid autoantibodies. Nine of 29 women (31%) had thyroid autoantibodies. Among them, six (20.7%) had high titers of thyroid autoantibodies, and two had hypothyroidism. In all nine of these women, hepatitis C virus viremia was detected on nested polymerase chain reaction (with primers located in the 5' untranslated region). One year later, titers of thyroid autoantibodies had increased in one patient. Three other patients progressed to hypothyroidism. We judged four of 29 patients (13.8%) to have Hashimoto's thyroiditis on the basis of their high titers of thyroid autoantibodies and biological features of hypothyroidism. In the control group, only one man had thyroid microsome autoantibodies, at a very low titer (1:100). The association between chronic hepatitis C and presence of thyroid autoantibodies is clearly confirmed (p = 0.021) by this study.

Autoantibodies↗