1
|
Li L, Guo Y, Chen C, Wang Z, Liu Z. Mechanisms of hyponatremia and diabetes insipidus after acute spinal cord injury: a critical review. Chin Neurosurg J 2023; 9:32. [PMID: 37968769 PMCID: PMC10647149 DOI: 10.1186/s41016-023-00347-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 10/24/2023] [Indexed: 11/17/2023] Open
Abstract
The incidence of hyponatremia after spinal cord injury was reported to be between 25 and 80%. Hyponatremia can lead to a variety of clinical symptoms, from mild to severe and even life-threatening. Hyponatremia is often associated with diabetes insipidus, which refers to insufficient arginine vasopressin (AVP) secretion or defective renal response to AVP, with clinical manifestations of syndromes such as hypoosmolality, polydipsia, and polydipsia. Recent mechanistic studies on hyponatremia and diabetes insipidus after acute spinal cord injury have been performed in isolation, without integrating the above two symptoms into different pathological manifestations that occur in the same injury state and without considering the acute spinal cord injury patient's condition as a whole. The therapeutic principles of CSWS and SIADH are in opposition to one another. It is not easy to identify the mechanism of hyponatremia in clinical practice, which makes selecting the treatment difficult. According to the existing theories, treatments for hyponatremia and diabetes insipidus together are contraindicated, whether the mechanism of hyponatremia is thought to be CSWS or SIADH. In this paper, we review the mechanism of these two pathological manifestations and suggest that our current understanding of the mechanisms of hyponatremia and diabetes insipidus after high acute cervical SCI is insufficient, and it is likely that there are other undetected pathogenetic mechanisms.
Collapse
Affiliation(s)
- Lianhua Li
- Department of Orthopedics, the Fourth Medical Center of PLA General Hospital, Beijing, China.
| | - Yanhui Guo
- Department of Orthopedics, the Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Chen Chen
- Department of Orthopedics, the Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Zhonghe Wang
- Department of Orthopedics, the Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Zhi Liu
- Department of Orthopedics, the Fourth Medical Center of PLA General Hospital, Beijing, China
| |
Collapse
|
2
|
Ebrahimi F, Christ E. Why do patients with hypopituitarism still present an increased mortality? ANNALES D'ENDOCRINOLOGIE 2023; 84:285-290. [PMID: 36809815 DOI: 10.1016/j.ando.2023.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 02/21/2023]
Abstract
Hypopituitarism is defined as a lack or decreased secretion of one or several pituitary hormones. It can result from diseases of the pituitary gland or from pathologies of the superior regulatory center, i.e. the hypothalamus, thereby decreasing hypothalamic releasing hormones and consequently the pituitary hormones. It is still a rare disease with an estimated prevalence of 30-45 patients/100,000 and an incidence of 4-5/100,000/year. This review summarizes the currently available data with a focus on etiologies of hypopituitarism, evidence on mortality rates in patients with hypopituitarism, temporal trends in mortality , and associated diseases, pathophysiological mechanisms and risk factors that affect mortality risk in these patients.
Collapse
Affiliation(s)
- Fahim Ebrahimi
- Division of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland; University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital, Basel, Switzerland; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Emanuel Christ
- Division of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland.
| |
Collapse
|
3
|
|
4
|
Baba M, Alsbrook D, Williamson S, Soman S, Ramadan AR. Approach to the Management of Sodium Disorders in the Neuro Critical Care Unit. Curr Treat Options Neurol 2022. [DOI: 10.1007/s11940-022-00723-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
5
|
Haissaguerre M, Vantyghem MC. WHAT AN ENDOCRINOLOGIST SHOULD KNOW FOR PATIENTS RECEIVING LITHIUM THERAPY. ANNALES D'ENDOCRINOLOGIE 2022; 83:219-225. [DOI: 10.1016/j.ando.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/22/2021] [Accepted: 01/10/2022] [Indexed: 10/19/2022]
|
6
|
Abstract
Diabetes insipidus (DI) is a disorder characterized by a high hypotonic urinary output of more than 50ml per kg body weight per 24 hours, with associated polydipsia of more than 3 liters a day [1,2]. Central DI results from inadequate secretion and usually deficient synthesis of Arginine vasopressin (AVP) in the hypothalamus or pituitary gland. Besides central DI further underlying etiologies of DI can be due to other primary forms (renal origin) or secondary forms of polyuria (resulting from primary polydipsia). All these forms belong to the Polyuria Polydipsia Syndrom (PPS). In most cases central and nephrogenic DI are acquired, but there are also congenital forms caused by genetic mutations of the AVP gene (central DI) [3] or by mutations in the gene for the AVP V2R or the AQP2 water channel (nephrogenic DI) [4]. Primary polydipsia (PP) as secondary form of polyuria includes an excessive intake of large amounts of fluid leading to polyuria in the presence of intact AVP secretion and appropriate antidiuretic renal response. Differentiation between the three mentioned entities is difficult [5], especially in patients with Primary polydipsia or partial, mild forms of DI [1,6], but different tests for differential diagnosis, most recently based on measurement of copeptin, and a thorough medical history mostly lead to the correct diagnosis. This is important since treatment strategies vary and application of the wrong treatment can be dangerous [7]. Treatment of central DI consists of fluid management and drug therapy with the synthetic AVP analogue Desmopressin (DDAVP), that is used as nasal or oral preparation in most cases. Main side effect can be dilutional hyponatremia [8]. In this review we will focus on central diabetes insipidus and describe the prevalence, the clinical manifestations, the etiology as well as the differential diagnosis and management of central diabetes insipidus in the out- and inpatient setting.
Collapse
|
7
|
Lê HH, Lengelé JP, Henin M, Toffoli S, Mineur P. Diabetes insipidus and acute myeloid leukemia harboring monosomy 7: report of two cases and literature review. Acta Clin Belg 2021; 76:132-135. [PMID: 31452466 DOI: 10.1080/17843286.2019.1660024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Acute myeloid leukemia (AML) is unusually associated with diabetes insipidus (DI) in patients bearing monosomy 7 or chromosome 3 aberrations. To date, 84 cases have been reported worldwide. Physiopathological mechanisms linking these chromosomal abnormalities to DI are not yet understood. We report two patients with AML/DI and review the medical literature on those conditions.
Collapse
Affiliation(s)
- Huu Hanh Lê
- Medical School, University of Liège, Liège, Belgium
- Department of Nephrology, Grand Hôpital de Charleroi, Gilly, Belgium
- Department of Hematology, Grand Hôpital de Charleroi, Gilly, Belgium
| | | | - Marie Henin
- Department of Radiology, Grand Hôpital de Charleroi, Gilly, Belgium
| | - Sébastien Toffoli
- Centre for Human Genetics, Institute of Pathology and Genetics, Gosselies, Belgium
| | - Philippe Mineur
- Department of Hematology, Grand Hôpital de Charleroi, Gilly, Belgium
| |
Collapse
|
8
|
Concepción-Zavaleta MJ, Marreros DMM, Villasante EJG, Plasencia-Dueñas EA, Najarro SI, Rojas JC, Acurio CLA. Therapeutic challenge: Unusual coexistence of idiopathic central diabetes insipidus and diabetes mellitus in a male with vitiligo. CASPIAN JOURNAL OF INTERNAL MEDICINE 2021; 12:S363-S367. [PMID: 34760083 PMCID: PMC8559641 DOI: 10.22088/cjim.12.0.363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 12/14/2020] [Accepted: 12/21/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Idiopathic central diabetes insipidus (DI) is a rare endocrine disorder that results from total or partial deficiency of vasopressin secretion. It is idiopathic when the cause is unknown, but in many cases, is associated with autoimmune disorders. CASE PRESENTATION We present the case of a 44-year-old male with vitiligo and a family history of diabetes mellitus and thyroid disease. The patient presented with polydipsia and polyuria greater than 8 L/day. After water deprivation test, the patient was diagnosed with partial central diabetes insipidus. Contrast-enhanced pituitary magnetic resonance imaging showed decreased brightness of the neurohypophysis and normal thickness of the pituitary stalk. Because desmopressin was not initially available, the patient was managed with chlorpropamide, carbamazepine, and hydrochlorothiazide, and afterwards substituted. During his outpatient checkups, he presented many episodes of polyuria, the last after 13 years, with polyuria of up to 15 L associated with weight loss, and abnormal blood glucose levels; anti-GAD 65 and IA-2 antibodies were negative. He was subsequently diagnosed with diabetes mellitus and received metformin and insulin; this latter was suspended in subsequent check-ups due to hypoglycemic episodes. CONCLUSION We highlight the importance of treatment and adequate control of these pathologies, since they share similar clinical manifestations, can easily have electrolyte imbalance and represent a challenge for endocrinologists and internists.
Collapse
Affiliation(s)
| | | | | | | | | | - José Carrion Rojas
- Division of Endocrinology, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Perú
| | | |
Collapse
|
9
|
Farrell TP, Adams NC, Looby S. Neuroimaging of central diabetes insipidus. HANDBOOK OF CLINICAL NEUROLOGY 2021; 181:207-237. [PMID: 34238459 DOI: 10.1016/b978-0-12-820683-6.00016-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Central diabetes insipidus (CDI) occurs secondary to deficient synthesis or secretion of arginine vasopressin peptide from the hypothalamo-neurohypophyseal system (HNS). It is characterized by polydipsia and polyuria (urine output >30mL/kg/day in adults and >2l/m2/24h in children) of dilute urine (<250mOsm/L). It can result from any pathology affecting one or more components of the HNS including the hypothalamic osmoreceptors, supraoptic or paraventricular nuclei, and median eminence of the hypothalamus, infundibulum, stalk or the posterior pituitary gland. MRI is the imaging modality of choice for evaluation of the hypothalamic-pituitary axis (HPA), and a dedicated pituitary or sella protocol is essential. CT can provide complimentary diagnostic information and is also of value when MRI is contraindicated. The most common causes are benign or malignant neoplasia of the HPA (25%), surgery (20%), and head trauma (16%). No cause is identified in up to 30% of cases, classified as idiopathic CDI. Knowledge of the anatomy and physiology of the HNS is crucial when evaluating a patient with CDI. Establishing the etiology of CDI with MRI in combination with clinical and biochemical assessment facilitates appropriate targeted treatment. This chapter illustrates the wide variety of causes and imaging correlates of CDI on neuroimaging, discusses the optimal imaging protocols, and revises the detailed neuroanatomy required to interpret these studies.
Collapse
Affiliation(s)
- Terence Patrick Farrell
- Division of Neuroradiology, Thomas Jefferson University Hospital, Philadelphia, PA, United States
| | - Niamh Catherine Adams
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, United States.
| | - Seamus Looby
- Department of Neuroradiology, Beaumont Hospital, Dublin, Ireland
| |
Collapse
|
10
|
Astafyeva LI, Kadashev BA, Sidneva YG, Chernov IV, Kalinin PL. [Pituitary microadenomas - current diagnostic and treatment methods]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2020; 84:110-120. [PMID: 32412200 DOI: 10.17116/neiro202084021110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
According to previously accepted criteria, pituitary microadenoma is characterized by a diameter of less than 10 mm. Improvement and widespread use of MRI are accompanied by increased incidence of diagnosis of these neoplasms. Pituitary microadenomas is an extremely heterogeneous group of tumors with different biological behavior, endocrine secretion and clinical symptoms despite the common MR characteristics. Treatment is mainly determined by endocrine secretion. Endocrine-active microadenoma requires medication (in case of microprolactinoma) and surgical treatment (in case of microsomatotropinoma and ACTH-releasing tumor). Follow-up is advisable for endocrine-inactive microadenoma (microincidentaloma). Modern data on the incidence, clinical and endocrine features, diagnosis and treatment of various pituitary microadenomas are discussed in the article.
Collapse
Affiliation(s)
| | | | | | - I V Chernov
- Burdenko Neurosurgical Center, Moscow, Russia
| | - P L Kalinin
- Burdenko Neurosurgical Center, Moscow, Russia
| |
Collapse
|
11
|
Kaltsas GA, Kolomodi D, Randeva H, Grossman A. Nonneuroendocrine Neoplasms of the Pituitary Region. J Clin Endocrinol Metab 2019; 104:3108-3123. [PMID: 30779850 DOI: 10.1210/jc.2018-01871] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 02/14/2019] [Indexed: 12/18/2022]
Abstract
CONTEXT Although most sellar lesions are related to pituitary adenomas, the region gives rise to a variety of neoplasms that can be associated with substantial morbidity and/or mortality. DESIGN Information from reviews and guidelines of relevant societies dealing with such neoplasms, as well as articles that have provided new developments that made important contributions to their pathogenesis and treatment up to 2018, were obtained: public indexes such as PubMed/MEDLINE were used with the relevant search items. RESULTS Sellar neoplasms have a worse outcome than pituitary adenomas that is related not only to their natural history but also to side effects of therapies and evolving endocrine and/or hypothalamic deficiencies. Recent imaging advances have established the radiological fingerprint of some of these neoplasms, and several chromosomal aberrations have also been identified. Although established approaches along with new surgical and radiotherapeutic approaches remain the main treatment modalities, recent evidence has provided insight into their molecular pathogenesis involving, other than chemotherapy, treatments with targeted agents as in gliomas and craniopharyngiomas bearing BRAF mutations. Development of predictive markers of recurrences may also identify high-risk patients, including proliferative markers and expression of the progesterone receptor in meningiomas, and lead to less aggressive surgery. Owing to the rarity and complexity of these neoplasms, patients should be managed in dedicated centers. CONCLUSIONS The diagnosis and management of sellar neoplasms necessitate a multidisciplinary approach. Following evolving recent advances in their diagnosis and therapy, such a multidisciplinary approach needs to be extended to establish evidence-based diagnostic and management plans.
Collapse
Affiliation(s)
- Gregory A Kaltsas
- First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
- WISDEM Centre, University Hospital of Coventry and Warwickshire, Coventry, United Kingdom
| | - Dionysia Kolomodi
- First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Harpal Randeva
- WISDEM Centre, University Hospital of Coventry and Warwickshire, Coventry, United Kingdom
| | - Ashley Grossman
- Centre for Endocrinology, Barts and the London School of Medicine, Queen Mary University of London, London, United Kingdom
| |
Collapse
|
12
|
Pérez MA, Millán HA, Naranjo JA, Flórez Romero A. Adipsic diabetes insipidus secondary to craniopharyngioma resection. BMJ Case Rep 2019; 12:12/1/e225903. [PMID: 30709829 DOI: 10.1136/bcr-2018-225903] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Adipsic diabetes insipidus is an infrequent disease which may be associated with craniopharyngioma. It may be secondary to the tumour's extension, as well as to resection of the mass. We present the case of a 24-year-old woman with a history of delayed puberty and hypothyroidism, but no prior study reports. She consulted due to a headache with warning signs associated with altered visual acuity. Brain MRI was performed which showed signs of a non-adenomatous lesion with suprasellar and hypothalamic extension. Following transcranial surgery, she developed diabetes insipidus criteria, with absence of thirst documented during the hospitalisation. The histopathological findings confirmed the diagnosis of craniopharyngioma. The patient was treated with desmopressin and received recommendations regarding rehydration according to the quantification of losses, with electrolyte stabilisation.
Collapse
Affiliation(s)
- María Alejandra Pérez
- Internal Medicine, Fundación Cardioinfantil, Bogotá, Colombia.,Internal medicine, Fundación Cardioinfantil, Bogotá, Colombia
| | | | | | | |
Collapse
|
13
|
Qin C, Li J, Tang K. The Paraventricular Nucleus of the Hypothalamus: Development, Function, and Human Diseases. Endocrinology 2018; 159:3458-3472. [PMID: 30052854 DOI: 10.1210/en.2018-00453] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 07/16/2018] [Indexed: 02/08/2023]
Abstract
The paraventricular nucleus of the hypothalamus (PVH), located in the ventral diencephalon adjacent to the third ventricle, is a highly conserved brain region present in species from zebrafish to humans. The PVH is composed of three main types of neurons, magnocellular, parvocellular, and long-projecting neurons, which play imperative roles in the regulation of energy balance and various endocrinological activities. In this review, we focus mainly on recent findings about the early development of the hypothalamus and the PVH, the functions of the PVH in the modulation of energy homeostasis and in the hypothalamus-pituitary system, and human diseases associated with the PVH, such as obesity, short stature, hypertension, and diabetes insipidus. Thus, the investigations of the PVH will benefit not only understanding of the development of the central nervous system but also the etiology of and therapy for human diseases.
Collapse
Affiliation(s)
- Cheng Qin
- Queen Mary School, Medical Department, Nanchang University, Nanchang, Jiangxi, China
- Institute of Life Science, Nanchang University, Nanchang, Jiangxi, China
| | - Jiaheng Li
- Queen Mary School, Medical Department, Nanchang University, Nanchang, Jiangxi, China
- Institute of Life Science, Nanchang University, Nanchang, Jiangxi, China
| | - Ke Tang
- Institute of Life Science, Nanchang University, Nanchang, Jiangxi, China
- Precise Genome Engineering Center, School of Life Sciences, Guangzhou University, Guangzhou, Guangdong, China
| |
Collapse
|
14
|
Butcher JT, Mintz JD, Larion S, Qiu S, Ruan L, Fulton DJ, Stepp DW. Increased Muscle Mass Protects Against Hypertension and Renal Injury in Obesity. J Am Heart Assoc 2018; 7:e009358. [PMID: 30369309 PMCID: PMC6201396 DOI: 10.1161/jaha.118.009358] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 06/20/2018] [Indexed: 01/06/2023]
Abstract
Background Obesity compromises cardiometabolic function and is associated with hypertension and chronic kidney disease. Exercise ameliorates these conditions, even without weight loss. Although the mechanisms of exercise's benefits remain unclear, augmented lean body mass is a suspected mechanism. Myostatin is a potent negative regulator of skeletal muscle mass that is upregulated in obesity and downregulated with exercise. The current study tested the hypothesis that deletion of myostatin would increase muscle mass and reduce blood pressure and kidney injury in obesity. Methods and Results Myostatin knockout mice were crossed to db/db mice, and metabolic and cardiovascular functions were examined. Deletion of myostatin increased skeletal muscle mass by ≈50% to 60% without concomitant weight loss or reduction in fat mass. Increased blood pressure in obesity was prevented by the deletion of myostatin, but did not confer additional benefit against salt loading. Kidney injury was evident because of increased albuminuria, which was abolished in obese mice lacking myostatin. Glycosuria, total urine volume, and whole kidney NOX-4 levels were increased in obesity and prevented by myostatin deletion, arguing that increased muscle mass provides a multipronged defense against renal dysfunction in obese mice. Conclusions These experimental observations suggest that loss of muscle mass is a novel risk factor in obesity-derived cardiovascular dysfunction. Interventions that increase muscle mass, either through exercise or pharmacologically, may help limit cardiovascular disease in obese individuals.
Collapse
Affiliation(s)
- Joshua T. Butcher
- Vascular Biology CenterMedical College of Georgia at Augusta UniversityAugustaGA
| | - James D. Mintz
- Vascular Biology CenterMedical College of Georgia at Augusta UniversityAugustaGA
| | - Sebastian Larion
- Vascular Biology CenterMedical College of Georgia at Augusta UniversityAugustaGA
| | - Shuiqing Qiu
- Vascular Biology CenterMedical College of Georgia at Augusta UniversityAugustaGA
| | - Ling Ruan
- Vascular Biology CenterMedical College of Georgia at Augusta UniversityAugustaGA
| | - David J. Fulton
- Vascular Biology CenterMedical College of Georgia at Augusta UniversityAugustaGA
- Department of PharmacologyMedical College of Georgia at Augusta UniversityAugustaGA
| | - David W. Stepp
- Vascular Biology CenterMedical College of Georgia at Augusta UniversityAugustaGA
- Department of PhysiologyMedical College of Georgia at Augusta UniversityAugustaGA
| |
Collapse
|
15
|
Neuroimaging of central diabetes insipidus—when, how and findings. Neuroradiology 2018; 60:995-1012. [DOI: 10.1007/s00234-018-2072-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 07/30/2018] [Indexed: 12/19/2022]
|
16
|
Montefusco L, Harari S, Elia D, Rossi A, Specchia C, Torre O, Adda G, Arosio M. Endocrine and metabolic assessment in adults with Langerhans cell histiocytosis. Eur J Intern Med 2018; 51:61-67. [PMID: 29198444 DOI: 10.1016/j.ejim.2017.11.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 11/26/2017] [Accepted: 11/27/2017] [Indexed: 12/22/2022]
Abstract
CONTEXT Diabetes insipidus (DI) is one of most common complications of Langerhans cell histiocytosis (LCH) but prevalence of anterior pituitary deficiencies and metabolic alterations have not been clearly defined yet. OBJECTIVES Evaluate prevalence of endocrine and metabolic manifestations in a cohort of patients affected by Pulmonary LCH. METHODS Observational cross-sectional study on 18 adults (7 M/11 F, 42±12years) studied for complete basal and dynamic endocrine lab tests and glucose metabolism. RESULTS Hypothalamic-pituitary endocrine alterations were found in 9 patients: 9 had DI, 5 Growth Hormone Deficiency (GHD), 5 central hypogonadism, 3 central hypothyroidism and 1 central hypoadrenalism. Hyperprolactinemia and hypothalamic syndrome were found in 2 patients each. All these central endocrine alterations were always associated to DI. Five of the 10 MRI performed showed abnormalities. Prevalence of obesity and glucose alterations (either DM or IFG/IGT) were respectively 39% and 33%, higher than expected basing on epidemiological data on general Italian population. Multi-system-LCH without risk-organ involvement (LCH MS-RO-) seems to have slightly higher prevalence of insulin resistance, glucose alterations and metabolic syndrome than LCH with isolated lung involvement (LCH SS lung+). A papillary BRAFV600E positive thyroid carcinoma was diagnosed in one patient. CONCLUSIONS The presence of anterior pituitary deficiencies should be systematically sought in all LCH patients with DI both at diagnosis and during the follow-up by basal and dynamic hormonal assessment. Patients with pulmonary LCH, particularly those with MS disease, have a worse metabolic profile than general population. Occurrence of papillary thyroid carcinoma has been reported.
Collapse
Affiliation(s)
- L Montefusco
- U.O. di Malattie Endocrine e Diabetologia, Ospedale San Giuseppe Multimedica, Milan, Italy; MultiMedica IRCCS, Milan, Italy
| | - S Harari
- MultiMedica IRCCS, Milan, Italy; U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria - Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe Multimedica, Milan, Italy.
| | - D Elia
- MultiMedica IRCCS, Milan, Italy; U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria - Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe Multimedica, Milan, Italy
| | - A Rossi
- U.O. di Malattie Endocrine e Diabetologia, Ospedale San Giuseppe Multimedica, Milan, Italy; MultiMedica IRCCS, Milan, Italy
| | - C Specchia
- MultiMedica IRCCS, Milan, Italy; Dipartimento di Medicina Molecolare e Traslazionale, Università di Brescia, Italy
| | - O Torre
- MultiMedica IRCCS, Milan, Italy; U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria - Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe Multimedica, Milan, Italy
| | - G Adda
- U.O. di Malattie Endocrine e Diabetologia, Ospedale San Giuseppe Multimedica, Milan, Italy; MultiMedica IRCCS, Milan, Italy
| | - M Arosio
- U.O. di Endocrinologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Dipartimento di Scienze Cliniche e di Comunità, Università di Milano, Milan, Italy
| |
Collapse
|
17
|
Tack LJ, T’Sjoen G, Lapauw B. Exacerbation of pre-existing diabetes insipidus during pregnancy, mechanisms and management. Acta Clin Belg 2017; 72:213-216. [PMID: 27654225 DOI: 10.1080/17843286.2016.1235244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
During pregnancy, physiological changes in osmotic homeostasis cause water retention. If excessive, this can cause gestational diabetes insipidus (DI), particularly in patients with already impaired vasopressin secretion. We present the case of a 34-year-old patient with pre-existing hypopituitarism who experienced a transient exacerbation of her DI during a twin pregnancy. In contrast to typical gestational DI, polyuria and polydipsia occurred during the first trimester and remained stable thereafter. This case highlights a challenging clinical entity of which pathophysiology, diagnostic approach and treatment will be discussed.
Collapse
Affiliation(s)
- Lloyd J.W. Tack
- Division of Pediatric Endocrinology, Department of Pediatrics, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Guy T’Sjoen
- Division of Endocrinology, Department Internal Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Bruno Lapauw
- Division of Endocrinology, Department Internal Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium
| |
Collapse
|
18
|
Bauman WA, Wecht JM, Biering-Sørensen F. International spinal cord injury endocrine and metabolic extended data set. Spinal Cord 2017; 55:466-477. [DOI: 10.1038/sc.2016.164] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 10/21/2016] [Indexed: 01/27/2023]
|
19
|
Water metabolism dysfunction via renin-angiotensin system activation caused by liver damage in mice treated with microcystin-RR. Toxicol Lett 2017; 273:86-96. [PMID: 28330766 DOI: 10.1016/j.toxlet.2017.03.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 03/10/2017] [Accepted: 03/17/2017] [Indexed: 01/12/2023]
Abstract
Microcystins (MCs) are a group of monocyclic heptapeptide toxins that have been shown to act as potent hepatotoxins. However, the observed symptoms of water metabolism disruption induced by microcystin-RR (MC-RR) or MCs have rarely been reported, and a relatively clear mechanism has not been identified. In the present study, male mice were divided into 4 groups (A: 140μg/kg, B: 70μg/kg,C: 35μg/kg, and D: 0μg/kg) and administered MC-RR daily for a month. On day 8 of treatment, an increase in water intake and urine output was observed in the high-dose group compared with the control, and the symptoms worsened with the repeated administration of the toxin until day 30. In addition, the urine specific gravity decreased and serum enzymes that can reflect hepatic damage increased in the high-dose group compared with the control (P<0.05). The mRNA level of angiotensinogen (AGT) in hepatocytes was upregulated to approximately 150% of the control (P<0.05), and the serum renin-angiotensin system (RAS) was activated in the high-dose group; however, signs of renal injury were not observed throughout the experiment. After the toxin treatment was completed, the high levels of the RAS and vasopressin in group A returned to normal levels within 1 week. As expected, the symptoms of polyuria and polydipsia also disappeared. Therefore, we propose that water metabolism dysfunction occurs via RAS activation caused by liver damage because the increased serum RAS levels in the experiment were consistent with the increased urine output and water intake in the mice during the observation period. In addition, we found for the first time that a RAS blocker could alleviate the observed polyuria and polydipsia and inactivate the high level of the RAS induced by MC-RR in a dose-dependent manner, which further supported our hypothesis.
Collapse
|
20
|
Fleseriu M, Hashim IA, Karavitaki N, Melmed S, Murad MH, Salvatori R, Samuels MH. Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2016; 101:3888-3921. [PMID: 27736313 DOI: 10.1210/jc.2016-2118] [Citation(s) in RCA: 474] [Impact Index Per Article: 59.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To formulate clinical practice guidelines for hormonal replacement in hypopituitarism in adults. PARTICIPANTS The participants include an Endocrine Society-appointed Task Force of six experts, a methodologist, and a medical writer. The American Association for Clinical Chemistry, the Pituitary Society, and the European Society of Endocrinology co-sponsored this guideline. EVIDENCE The Task Force developed this evidence-based guideline using the Grading of Recommendations, Assessment, Development, and Evaluation system to describe the strength of recommendations and the quality of evidence. The Task Force commissioned two systematic reviews and used the best available evidence from other published systematic reviews and individual studies. CONSENSUS PROCESS One group meeting, several conference calls, and e-mail communications enabled consensus. Committees and members of the Endocrine Society, the American Association for Clinical Chemistry, the Pituitary Society, and the European Society of Endocrinology reviewed and commented on preliminary drafts of these guidelines. CONCLUSIONS Using an evidence-based approach, this guideline addresses important clinical issues regarding the evaluation and management of hypopituitarism in adults, including appropriate biochemical assessments, specific therapeutic decisions to decrease the risk of co-morbidities due to hormonal over-replacement or under-replacement, and managing hypopituitarism during pregnancy, pituitary surgery, and other types of surgeries.
Collapse
Affiliation(s)
- Maria Fleseriu
- Oregon Health & Science University, Northwest Pituitary Center (M.F.), and Departments of Neurological Surgery and Medicine (Division of Endocrinology, Diabetes, and Clinical Nutrition), Portland, Oregon 97239; Department of Pathology (I.A.H.), University of Texas Southwestern Medical Center, Dallas, Texas 75390; Institute of Metabolism and Systems Research (N.K.), College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom; Centre for Endocrinology, Diabetes, and Metabolism (N.K.), Birmingham Health Partners, Birmingham B15 2TH, United Kingdom, Pituitary Center (S.M.), Cedars-Sinai Medical Center, Los Angeles, California 90048; Mayo Clinic Evidence-Based Practice Center, (M.H.M), Rochester, Minnesota 55905; Department of Medicine, Division of Endocrinology and Metabolism (R.S.), Pituitary Center, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287; and Division of Endocrinology, Diabetes, and Clinical Nutrition (M.H.S.), Oregon Health & Science University, Portland, Oregon 97239
| | - Ibrahim A Hashim
- Oregon Health & Science University, Northwest Pituitary Center (M.F.), and Departments of Neurological Surgery and Medicine (Division of Endocrinology, Diabetes, and Clinical Nutrition), Portland, Oregon 97239; Department of Pathology (I.A.H.), University of Texas Southwestern Medical Center, Dallas, Texas 75390; Institute of Metabolism and Systems Research (N.K.), College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom; Centre for Endocrinology, Diabetes, and Metabolism (N.K.), Birmingham Health Partners, Birmingham B15 2TH, United Kingdom, Pituitary Center (S.M.), Cedars-Sinai Medical Center, Los Angeles, California 90048; Mayo Clinic Evidence-Based Practice Center, (M.H.M), Rochester, Minnesota 55905; Department of Medicine, Division of Endocrinology and Metabolism (R.S.), Pituitary Center, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287; and Division of Endocrinology, Diabetes, and Clinical Nutrition (M.H.S.), Oregon Health & Science University, Portland, Oregon 97239
| | - Niki Karavitaki
- Oregon Health & Science University, Northwest Pituitary Center (M.F.), and Departments of Neurological Surgery and Medicine (Division of Endocrinology, Diabetes, and Clinical Nutrition), Portland, Oregon 97239; Department of Pathology (I.A.H.), University of Texas Southwestern Medical Center, Dallas, Texas 75390; Institute of Metabolism and Systems Research (N.K.), College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom; Centre for Endocrinology, Diabetes, and Metabolism (N.K.), Birmingham Health Partners, Birmingham B15 2TH, United Kingdom, Pituitary Center (S.M.), Cedars-Sinai Medical Center, Los Angeles, California 90048; Mayo Clinic Evidence-Based Practice Center, (M.H.M), Rochester, Minnesota 55905; Department of Medicine, Division of Endocrinology and Metabolism (R.S.), Pituitary Center, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287; and Division of Endocrinology, Diabetes, and Clinical Nutrition (M.H.S.), Oregon Health & Science University, Portland, Oregon 97239
| | - Shlomo Melmed
- Oregon Health & Science University, Northwest Pituitary Center (M.F.), and Departments of Neurological Surgery and Medicine (Division of Endocrinology, Diabetes, and Clinical Nutrition), Portland, Oregon 97239; Department of Pathology (I.A.H.), University of Texas Southwestern Medical Center, Dallas, Texas 75390; Institute of Metabolism and Systems Research (N.K.), College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom; Centre for Endocrinology, Diabetes, and Metabolism (N.K.), Birmingham Health Partners, Birmingham B15 2TH, United Kingdom, Pituitary Center (S.M.), Cedars-Sinai Medical Center, Los Angeles, California 90048; Mayo Clinic Evidence-Based Practice Center, (M.H.M), Rochester, Minnesota 55905; Department of Medicine, Division of Endocrinology and Metabolism (R.S.), Pituitary Center, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287; and Division of Endocrinology, Diabetes, and Clinical Nutrition (M.H.S.), Oregon Health & Science University, Portland, Oregon 97239
| | - M Hassan Murad
- Oregon Health & Science University, Northwest Pituitary Center (M.F.), and Departments of Neurological Surgery and Medicine (Division of Endocrinology, Diabetes, and Clinical Nutrition), Portland, Oregon 97239; Department of Pathology (I.A.H.), University of Texas Southwestern Medical Center, Dallas, Texas 75390; Institute of Metabolism and Systems Research (N.K.), College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom; Centre for Endocrinology, Diabetes, and Metabolism (N.K.), Birmingham Health Partners, Birmingham B15 2TH, United Kingdom, Pituitary Center (S.M.), Cedars-Sinai Medical Center, Los Angeles, California 90048; Mayo Clinic Evidence-Based Practice Center, (M.H.M), Rochester, Minnesota 55905; Department of Medicine, Division of Endocrinology and Metabolism (R.S.), Pituitary Center, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287; and Division of Endocrinology, Diabetes, and Clinical Nutrition (M.H.S.), Oregon Health & Science University, Portland, Oregon 97239
| | - Roberto Salvatori
- Oregon Health & Science University, Northwest Pituitary Center (M.F.), and Departments of Neurological Surgery and Medicine (Division of Endocrinology, Diabetes, and Clinical Nutrition), Portland, Oregon 97239; Department of Pathology (I.A.H.), University of Texas Southwestern Medical Center, Dallas, Texas 75390; Institute of Metabolism and Systems Research (N.K.), College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom; Centre for Endocrinology, Diabetes, and Metabolism (N.K.), Birmingham Health Partners, Birmingham B15 2TH, United Kingdom, Pituitary Center (S.M.), Cedars-Sinai Medical Center, Los Angeles, California 90048; Mayo Clinic Evidence-Based Practice Center, (M.H.M), Rochester, Minnesota 55905; Department of Medicine, Division of Endocrinology and Metabolism (R.S.), Pituitary Center, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287; and Division of Endocrinology, Diabetes, and Clinical Nutrition (M.H.S.), Oregon Health & Science University, Portland, Oregon 97239
| | - Mary H Samuels
- Oregon Health & Science University, Northwest Pituitary Center (M.F.), and Departments of Neurological Surgery and Medicine (Division of Endocrinology, Diabetes, and Clinical Nutrition), Portland, Oregon 97239; Department of Pathology (I.A.H.), University of Texas Southwestern Medical Center, Dallas, Texas 75390; Institute of Metabolism and Systems Research (N.K.), College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom; Centre for Endocrinology, Diabetes, and Metabolism (N.K.), Birmingham Health Partners, Birmingham B15 2TH, United Kingdom, Pituitary Center (S.M.), Cedars-Sinai Medical Center, Los Angeles, California 90048; Mayo Clinic Evidence-Based Practice Center, (M.H.M), Rochester, Minnesota 55905; Department of Medicine, Division of Endocrinology and Metabolism (R.S.), Pituitary Center, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287; and Division of Endocrinology, Diabetes, and Clinical Nutrition (M.H.S.), Oregon Health & Science University, Portland, Oregon 97239
| |
Collapse
|
21
|
Guo S, Wang C, Zhang J, Tian Y, Wu Q. Diagnosis and management of tumor-like hypophysitis: A retrospective case series. Oncol Lett 2015; 11:1315-1320. [PMID: 26893737 PMCID: PMC4734295 DOI: 10.3892/ol.2015.4046] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 11/03/2015] [Indexed: 01/08/2023] Open
Abstract
Tumor-like hypophysitis is an uncommon sellar condition that presents as inflammatory lesions on the structures of the pituitary gland. The diagnosis and management of hypophysitis poses a significant challenge, as its clinical manifestation and appearance in imaging studies are difficult to distinguish from that of pituitary tumors. The present retrospective study summarizes two rare cases of primary granulomatous hypophysitis, two cases of lymphocytic hypophysitis, and three cases in which a pathological diagnosis was not determined due to the use of hormone replacement therapy only. The mean age of the patients studied was 45.71±22.16 years, and the patients comprised two males and five females. The clinical signs of hypophysitis included headache, fever, gradual decrease in visual acuity, nausea and vomiting. Enhanced magnetic resonance imaging revealed sellar and pituitary stalk lesions, with iso- or hypodense signals on T1-weighted images. Transsphenoidal surgery was performed in three cases. It was challenging to diagnose hypophysitis due to the lack of any significant specific clinical signs. A transsphenoidal biopsy with fast-frozen pathology is able to diagnose hypophysitis. Glucocorticoid therapy may be a potential treatment for hypophysitis, as complete removal of pituitary masses may disable pituitary function.
Collapse
Affiliation(s)
- Songxue Guo
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, P.R. China; Department of Burns, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, P.R. China
| | - Chaohui Wang
- Department of Neurosurgery, Ruian People's Hospital, Wenzhou, Zhejiang 325200, P.R. China
| | - Jianmin Zhang
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, P.R. China
| | - Yong Tian
- Department of Neurosurgery, Second Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310005, P.R. China
| | - Qun Wu
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, P.R. China
| |
Collapse
|
22
|
Wong T, Laing C, Ekong R, Povey S, Unwin RJ. Persistent severe polyuria after renal transplant. Clin Kidney J 2015; 9:180-3. [PMID: 26985366 PMCID: PMC4792610 DOI: 10.1093/ckj/sfv100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 09/14/2015] [Indexed: 12/20/2022] Open
Abstract
Polydipsia and polyuria are common symptoms in patients with diabetes insipidus (DI), which can be due to inadequate vasopressin production (cranial DI) or vasopressin insensitivity (nephrogenic DI). Clinical diagnosis of the subtypes of DI can be tricky. We present a 44-year-old man with a strong family history of DI who had been diagnosed with autosomal dominant nephrogenic DI from infancy. At the age of 40, he had progressed to end-stage renal failure. When he experienced unresolving severe polyuria after renal transplant, further investigations revealed that he was misdiagnosed and that he had a novel mutation causing autosomal dominant cranial DI.
Collapse
Affiliation(s)
| | - Chris Laing
- UCL Centre for Nephrology , Royal Free Hospital , London , UK
| | - Rosemary Ekong
- Department of Genetics, Evolution and Environment , UCL , London , UK
| | - Sue Povey
- Department of Genetics, Evolution and Environment , UCL , London , UK
| | - Robert J Unwin
- Division of Medicine , University College London , London , UK
| |
Collapse
|
23
|
Galland F, Vantyghem MC, Cazabat L, Boulin A, Cotton F, Bonneville JF, Jouanneau E, Vidal-Trécan G, Chanson P. Management of nonfunctioning pituitary incidentaloma. ANNALES D'ENDOCRINOLOGIE 2015; 76:191-200. [PMID: 26054868 DOI: 10.1016/j.ando.2015.04.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 04/29/2015] [Indexed: 11/27/2022]
Abstract
Prevalence of pituitary incidentaloma is variable: between 1.4% and 27% at autopsy, and between 3.7% and 37% on imaging. Pituitary microincidentalomas (serendipitously discovered adenoma <1cm in diameter) may increase in size, but only 5% exceed 10mm. Pituitary macroincidentalomas (serendipitously discovered adenoma>1cm in diameter) show increased size in 20-24% and 34-40% of cases at respectively 4 and 8years' follow-up. Radiologic differential diagnosis requires MRI centered on the pituitary gland. Initial assessment of nonfunctioning (NF) microincidentaloma is firstly clinical, the endocrinologist looking for signs of hypersecretion (signs of hyperprolactinemia, acromegaly or Cushing's syndrome), followed up by systematic prolactin and IGF-1 assay. Initial assessment of NF macroincidentaloma is clinical, the endocrinologist looking for signs of hormonal hypersecretion or hypopituitarism, followed up by hormonal assay to screen for hypersecretion or hormonal deficiency and by ophthalmologic assessment (visual acuity and visual field) if and only if the lesion is near the optic chiasm (OC). NF microincidentaloma of less than 5mm requires no surveillance; those of≥5mm are not operated on but rather monitored on MRI at 6months and then 2years. Macroincidentaloma remote from the OC is monitored on MRI at 1year, with hormonal exploration (for anterior pituitary deficiency), then every 2years. When macroincidentaloma located near the OC is managed by surveillance rather than surgery, MRI is recommended at 6months, with hormonal and visual exploration, then annual MRI and hormonal and visual assessment every 6months. Surgery is indicated in the following cases: evolutive NF microincidentaloma, NF macroincidentaloma associated with hypopituitarism or showing progression, incidentaloma compressing the OC, possible malignancy, non-compliant patient, pregnancy desired in the short-term, or context at risk of apoplexy.
Collapse
Affiliation(s)
- Françoise Galland
- Service d'Endocrinologie, Diabétologie, Nutrition, CHU de Rennes Hôpital Sud, 16, boulevard de Bulgarie, 35000 Rennes, France
| | | | - Laure Cazabat
- Département d'Endocrinologie, CHU Ambroise-Paré, AP-HP, Boulogne, France
| | - Anne Boulin
- Département d'Endocrinologie, CHU Ambroise-Paré, AP-HP, Boulogne, France
| | - François Cotton
- Département de Biochimie Clinique, Hôpital Erasme, Université Libre de Bruxelles, route de Lennik, 808, 1070 Brussels, Belgium
| | | | - Emmanuel Jouanneau
- Département de Neurochirurgie B, Pierre-Wertheimer - Hospices Civils de Lyon, Lyon, France
| | - Gwénaelle Vidal-Trécan
- Département d'Épidemiologie et Évaluation des Politiques de Santé, Université Paris Descartes, Paris Sorbonne Cité, Paris, France
| | - Philippe Chanson
- Service d'Endocrinologie et des Maladies de la Reproduction, Hôpital de Bicêtre, AP-HP, 94275 Le Kremlin-Bicêtre, France; UMR S693, Faculté de Médecine Paris-Sud, Université Paris-Sud 11, 94276 Le Kremlin-Bicêtre, France; Inserm U693, 94276 Le Kremlin-Bicêtre, France.
| |
Collapse
|