[Lithium in the treatment of thyrotoxicosis (author's transl)].
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Biomedical subjects
Publications and source records attributed to M Linquette.
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T3 serum concentrations (RIA) was low in 25 cases and normal low in 10 among 57 patients with serious systemic illnesses. These 35 patients were in clinical euthyroid state and had a normal T4 serum concentration and F.T.I. T.S.H. serum concentration was normal in 28 cases of 31 low T3 syndrome observed.
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Serum thyroxine (T4), triiodothyronine (T3) and thyrotropin (T.S.H.) were measured in 32 hyperthyroid patients treated with carbimazole. A discrepancy between serum T4 AND T3 was present in 73 of 131 measurements: --normal T3 with increased T4 in 6 measurements; --increased T3 with normal T4 in 16 measurements: five times only there was a clinical hyperthyroidism; --normal T3 with decreased T4 in 49 measurements: three times only there was a clinical hypothyroidism. Serum T.S.H. level was increased in 13 of 19 measurements made in this group, state named "compensated hypothyroidism" according to Patel and Burger.
Two cases of phaeochromocytoma with hypokalaemia are reported. In the first, a carcinoma, hypokalaemia was potentially secondary to hyperreninaemia and hyperaldosteronism in association with probably paraneoplastic hypercorticism. The other was benign and the origin of isotopically demonstrated potassium deficiency was less clear, because hyperreninaemia, hyperaldosteronism and hypercortisolism were moderate.
A 21-year-old woman had sterility due to amenorrhoea-galactorrhoea with hyperprolactinaemia and hypoplastic ovaries. The sella turcica was asymmetrical but tomograms were suggestive of a congenital appearance. There was no suprasellar expansion. Treatment with bromocriptine and HMG resulted in pregnancy. Acute pituitary failure occurred at the 10th week, revealing an adenoma. The pregnancy proceeded to term after hypophysectomy. This complication, the first reported under the effects of bromocriptine, may serve as a reminder of the precautions to be taken during pregnancy in a hyperprolactinaemic woman.
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After being suspected in the presence of galactorrhoea, it is now easy to prove hyperprolactinism thanks to radioimmunoassay of prolactin. The repercussions of hyperprolactinism on gonad function are now well known, especially in women where they lead to anovulation then amenorrhoea, whereas in man there occurs hypoandrogenism with loss of libido. Hyperprolactinemia may occur in numerous circumstances and may be deduced logically from the mechanism of secretory regulation of this hormone. Among the latter, one cause dominates the others by its therapeutic consequences, I.e. the presence of an adenoma or microadenoma secreting prolactin discovered thanks to tomography of the sella turcica. The treatment of hyperprolactinism has advanced in recent years with the introduction of dopamineric drugs such as bromcriptin which permits one to normalise prolactinemia and thus restore gonad function. It's use requires however certain precautions and neurological and ophthalmic supervision when htere is a microadenoma.
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Total body water (T.B.W), extra-cellular fluid volume (E.C.F.), exchangeable sodium (NaE) and potassium (KE) were measured in one typical case of Bartter's syndrome with growth retardation. Intracellular potassium depletion was associated with a slight impaired carbohydrate tolerance and with decreased growth hormone response to arginine infusion and insulin-induced hypoglycemia. These observations demonstrate that impairement of growth hormone responses to stimulation occur in Bartter's syndrome with potassium depletion.
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