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Abstract: Thyroid hormones alter bone metabolism. During childhood, hypothyroidism slows bone maturation whereas hyperthyroidism accelerates it. In adults, hypothyroidism has few consequences on bone mass. Hypothyroidism is responsible for decreased bone mineral density and increased fracture risk. These changes are well documented in postmenopausal women. Subclinical hyperthyroidisms have been studied in many discrepant trials. Bone consequences are better documented with modern investigation tools. TSH suppressive therapies have limited consequences. These treatments should be considered as an additive risk factor for osteoporosis in postmenopausal women. Substitutive thyroid hormone treatments have no consequences of clinical importance. [Copyright &y& Elsevier]

Background Alpha-blockade is the standard management preoperatively to prevent intraoperative hemodynamic instability (IHD) during resection of a pheochromocytoma. Calcium channel blockers also have been shown to lessen the risk of IHD. We aim to determine differences between these classes of antihypertensive agents in minimizing IHD. Methods This was a retrospective analysis from a tri-institutional database. Inclusion criteria were unilateral transabdominal adrenalectomy for pheochromocytomas between 2002 and 2012. IHD was defined as at least one systolic blood pressure (SBP) measurement >160 mm Hg and at least one episode of mean arterial pressure 60 mm Hg. Results A total of 155 patients were included: 110 receiving calcium channel blockers, 41 alpha-blockade, and 4 no medication. Intraoperatively, mean maximal SBP was less after alpha-blockade ( P < .0001) as well as the incidence and duration of episodes of SBP >200 mm Hg ( P < .01); however, severe hypotensive episodes (MAP <60 mm Hg) were more frequent ( P < .001) and longer ( P < .0001) with alpha-blockade. Consequently, intraoperative vasoactive drugs were used more frequently ( P = .03), and mean fluid volume infused was larger ( P < .001). Fifty-four patients had IHD, but these were independent of type of preoperative medication used. Familial disease was the only independent predictor of IHD. Conclusion IHD was independent of type of preoperative medical management but was dependent on familial disease. These findings broaden options for clinicians in the preoperative management of pheochromocytoma. [ABSTRACT FROM AUTHOR]

Background: Primary hyperparathyroidism is associated with an increased cardiovascular morbidity and mortality. However, mechanisms underlying this association are currently unclear. As there is clear evidence of the independent role of aldosterone on the cardiovascular system, the aim of this study was to evaluate aldosterone levels in patients with primary hyperparathyroidism. Methods: A prospective study of 134 consecutive patients with primary hyperparathyroidism before and 3 months after parathyroidectomy. Results: Pre-operative serum aldosterone and parathyroid hormone (PTH) levels were correlated positively in all patients (.238; P = .005). In the 62 patients (46%) that were not on antihypertensive medications, this correlation was stronger (.441; P = .0003). In the 72 patients (54%) treated with at least 1 antihypertensive medication, no correlation between preoperative aldosterone and PTH serum levels was observed. By multivariate analysis, pre-operative PTH level (.409; P = .005) was an independent predictor of aldosterone. Pre-operative PTH level >100 ng/L was an independent predictor of abnormally elevated plasma aldosterone level (odds ratio 3.5; P = .01). At 3 months after parathyroidectomy, no correlation was observed between postoperative PTH and aldosterone levels. Conclusion: Aldosterone is correlated positively to preoperative PTH levels in patients with primary hyperparathyroidism. Aldosterone might be a key mediator of cardiovascular symptoms in patients with primary hyperparathyroidism. [Copyright &y& Elsevier]

Introduction: The aim of this study was to evaluate the influence of fat and lean mass on both arterial stiffness and bone mass density (BMD) in elderly men. Methods: This study was performed in 169 French males over 60 years. Aortic stiffness was assessed by carotid/femoral pulse wave velocity (PWV). BMD and body composition were determined with a DEXA device in lumbar spine L1-L4, femoral neck and total body. Results: Lean mass was positively correlated with the three T-scores accounting for 11.6 %, 26.6 % and 12.2 % of the variability in lumbar spine L1-L4, femoral neck and total body BMD T-scores respectively. Fat mass had no effect on BMD. However, fat mass was positively correlated with aortic PWV accounting for 9.8 % of its variability. Lean mass was not a determinant of PWV. Hypertension, diabetes and dyslipidemia were associated with higher PWV but had no effect on BMD. Conclusions: In males from a general population over 60 years of age, bone and arterial aging are differently influenced by lean and fat mass. Our results indicate that elderly men with high lean mass and low fat mass exhibit the best arterial and bone profile, with the lowest arterial stiffness and the highest BMD. [Copyright &y& Elsevier]

Résumé Objectifs Actualiser sous l'égide de la section os de la Société française de rhumatologie (SFR) et du groupe de recherche et d'information sur les ostéoporoses (GRIO) en collaboration avec des sociétés savantes (Collège national des généralistes enseignants, Collège national des gynécologues et obstétriciens français, Fédération nationale des collèges de gynécologie médicale, groupe d'étude de la ménopause et du vieillissement hormonal, Société française de chirurgie orthopédique, Société française d'endocrinologie, Société française de gériatrie et de gérontologie) les recommandations du traitement médicamenteux de l'ostéoporose post-ménopausique publiées précédemment en 2012. Méthodes Un groupe de travail, représentatif des spécialités médicales intervenant dans la prise en charge de ces patientes a élaboré ces recommandations à partir d'une analyse systématique de la littérature selon la méthode HAS. Discussion et conclusion Ces recommandations insistent sur la prise en charge des femmes avec une fracture sévère chez lesquelles un traitement anti-ostéoporotique est recommandé. En cas de fracture sévère, tous les traitements peuvent être prescrits ; l'acide zolédronique est à privilégier en première intention après une fracture de hanche. Dans les autres cas (avec ou sans fracture non sévère) l'indication thérapeutique dépend des valeurs de la densité minérale osseuse (DMO) et dans les cas difficiles d'outils comme le FRAX®. Tous les traitements peuvent être utilisés ; le raloxifène est à réserver aux patientes à faible risque de fracture périphérique. Le risque de fracture doit réévaluer tous les 2 à 3 ans pour décider des suites de la prise en charge. Ces recommandations abordent le choix du premier traitement et les séquences thérapeutiques. [ABSTRACT FROM AUTHOR]

Objectives: To update the 2012 recommendations on pharmacotherapy for postmenopausal osteoporosis, under the aegis of the Bone Task Force of the French Society for Rheumatology (SFR) and of the Osteoporosis Research and Information Group (GRIO), in collaboration with scientific societies (Collège national des généralistes enseignants, Collège national des gynécologues et obstétriciens français, Fédération nationale des collèges de gynécologie médicale, Groupe d'étude de la ménopause et du vieillissement hormonal, Société française de chirurgie orthopédique, Société française d'endocrinologie, and Société française de gériatrie et de gérontologie).Methods: Updated recommendations were developed by a task force whose members represented the medical specialties involved in the management of postmenopausal osteoporosis. The update was based on a literature review and developed using the method advocated by the French National Authority for Health (HAS).Discussion and Conclusion: The updated recommendations place strong emphasis on the treatment of women with severe fractures, in whom the use of osteoporosis medications is recommended. All the available osteoporosis medications are suitable in patients with severe fractures; zoledronic acid deserves preference as the fist-line drug after a hip fracture. In patients with or without non-severe fractures, the decision to use osteoporosis medications is based on bone mineral density values and in challenging cases, on probabilities supplied by prediction tools such as FRAX®. All osteoporosis medications are suitable; raloxifene should be reserved for patients at low risk for peripheral fractures. The fracture risk should be reevaluated every 2 to 3 years to decide on the best follow-up treatment. These updated recommendations discuss the selection of first-line osteoporosis medications and treatment sequences. [ABSTRACT FROM AUTHOR]

Résumé Objectif À l’approche de la réforme des Diplômes d’études spécialisées (DES), une première évaluation nationale du DES de gynécologie médicale était nécessaire. L’objectif a été d’évaluer les pratiques d’enseignement théorique auprès de l’ensemble des étudiants en TCEM, en recueillant leurs avis et volontés d’évolution, et en proposant des mesures d’amélioration. Patient(e)s et méthodes L’auto-questionnaire confectionné par des membres de l’Association des internes et assistants (AIGM) et le Collège des enseignants (CNEGM) a été administré aux étudiants inscrits au DES de gynécologie médicale lors de l’enseignement national de juin 2014. Résultats Cinquante-six réponses ont été recueillies pour 145 étudiants inscrits au DES (38,6 %). Douze demi-journées de formation théorique nationale sont organisées annuellement. L’adaptation des enseignements théoriques nationaux au niveau des étudiants est évaluée en moyenne à 7,8 (EVA de 0 à 10). Les niveaux scientifique et pédagogique des intervenants sont évalués à 8,9 et 7,8. La formation théorique du DES a été jugée satisfaisante pour 76,6 % des répondants. Discussion et conclusion Malgré une évaluation globalement satisfaisante, certains points peuvent être améliorés dans l’organisation du DES. La création des modules installation, actes et imagerie, la mise en place d’une progressivité des enseignements, le développement des mises en situation et des travaux pratiques, l’évaluation réciproque des étudiants, et des enseignements/enseignants sont à mettre en place. Objectives As far as the reform of the “Diplômes d’études spécialisées” (DES) is approaching, a first national evaluation of the Medical Gynecology diploma was necessary. The objective was to evaluate the practices of the theoretical teaching with the whole students, by receiving their opinions and their wishes of changing, and by proposing some improving measures. Patients and methods The self-evaluation form made by members of the Association of residents (AIGM) and the Teacher's College (CNEGM) was submitted to the students during the national teaching session of June 2014. Results Fifty-six results were gathered among 145 students enrolled at the DES (38.6 %). Twelve half days of national theoretical training are yearly scheduled. The accordance of the national theoretical training to the level of the students was assessed on average at 7.8 (VAS from 0 to 10). The scientific and pedagogical skills of the speakers are evaluated at 8.9 and 7.8. The theoretical training of the diploma was considered as satisfying for 76.6 % of the respondents. Discussion and conclusion Despite a globally satisfying evaluation, some points can be improved in the organization of the diploma. The introduction of courses about establishment, medical acts and imaging, the implementation of gradual progress teaching, the development of hands-on training and practical works, reciprocal evaluation of the students and the teachings/teachers, should be set up. [ABSTRACT FROM AUTHOR]

Objectives: To update the recommendations on the prevention and treatment of glucocorticoid-induced osteoporosis issued in 2003 by the French National Authority for Health (HAS). This update was performed under the aegis of the Bone Section of the French Society for Rheumatology (SFR) and Osteoporosis Research and Information Group (GRIO), in collaboration with four French learned societies (primary-care, gastroenterology, internal medicine, and nephrology).Methods: A task force composed of members of the medical specialties involved in managing patients with glucocorticoid-induced osteoporosis conducted a systematic literature review according to the method developed by the HAS then used the results to develop updated recommendations.Results: These recommendations are intended for all physicians involved in the management of patients who are scheduled to start, or are taking, long-term glucocorticoid therapy (≥ 3 months) in any dose and for any reason. In postmenopausal women and men older than 50 years of age, treatment is warranted in the presence of any of the following risk factors for fracture: history of bone frailty fracture after 50 years of age, bone mineral density T-score ≤ −2.5 at one or more sites, age ≥ 70 years, and dosage ≥ 7.5 mg/d prednisone-equivalent for longer than 3 months. Bisphosphonates can be used in all these situations; teriparatide can be given as first-line therapy in patients at high fracture risk but is reimbursed by the French statutory health insurance system only in patients having two or more prevalent vertebral fractures. The fracture risk is lower in non-menopausal women and in men younger than 50 years of age,in whom treatment decisions should rest on a case-by-case evaluation.Conclusion: These recommendations are intended to clarify the pharmacological management of glucocorticoid-induced osteoporosis. [ABSTRACT FROM AUTHOR]

Résumé Sous l’égide de la section Os de la Société française de rhumatologie (SFR) et du Groupe de recherche et d’information sur les ostéoporoses (GRIO) en collaboration avec des sociétés savantes (collège national des généralistes enseignants généralistes, Société nationale française de gastroentérologie, Société nationale française de médecine interne, Société de néphrologie) les recommandations sur la prévention et le traitement de l’ostéoporose cortico-induite publiées en 2003 par la Haute Autorité de santé (HAS) ont été actualisées. Un groupe de travail représentatif des spécialités médicales intervenant dans la prise en charge de ces patientes a élaboré ces recommandations à partir d’une analyse systématique de la littérature selon la méthode HAS. Ces recommandations sont destinées à tous les médecins amenés à prendre en charge des patients allant débuter ou recevant une prise prolongée de glucocorticoïdes (durée ≥ 3 mois) quelles que soient la dose et la maladie. Chez les femmes ménopausées et les hommes après 50 ans, les situations à haut risque de fracture justifiant d’un traitement sont antécédent personnel de fracture par fragilité osseuse après 50 ans ou T score bas (≤ −2,5 à au moins un site) ou âge ≥ 70 ans ou corticothérapie prolongée à fortes doses (≥ 7,5 mg/j d’équivalent prednisone pour une durée supérieure à 3 mois). Dans tous les cas, peuvent être prescrits les bisphosphonates ; le tériparatide peut être prescrit en première intention chez des patients à risque élevé de fracture mais n’est remboursé s’il existe au moins deux fractures vertébrales prévalentes. Chez les femmes non ménopausées et les hommes de moins de 50 ans, le risque de fracture est plus faible et la décision thérapeutique est individuelle. Ces recommandations ont pour but de clarifier la prise en charge pharmacologique de l’ostéoporose cortico-induite pour les médecins. [ABSTRACT FROM AUTHOR]

Abstract: Although the management of diabetes as a simple entity has been extensively developed, there is a dearth of evidence in elderly, frail patients with multiple comorbidities and polymedication. This population represents a large proportion of the residents of nursing homes (NHs). As a multidisciplinary group of French experts (geriatricians, endocrinologists, diabetologists, and general practitioners) with practical experience in this area, which is growing in magnitude throughout the world, we convened to compile pragmatic, simple advice on the management of elderly, frail diabetic patients. Given demands on NH personnel (manager, medical coordinator, nurses, and, at the front line of care provision, the undertrained and overworked carers), coupled with the quasiconstant of high staff turnover, the foundation stone of a patient's diabetes management is an Individual Care Plan (ICP) expressed in layman's language. This document that is opened on the patient's admission aims to make sure that the prescriptions established at admission are followed, notably to ensure correct treatment and adapted, regular monitoring with dates and times when examinations and tests are due. This includes monitoring of the diabetes control (HbA1c and, if necessary, blood and urine glucose) and its complications (cardiovascular disease, hypoglycemia, ocular problems, foot disorders, malnutrition, peripheral neuropathy, kidney failure). A necessary corollary is the training of staff to understand the specificities of caring for a frail patient with diabetes, on what to do in a potential emergency, and how to keep the ICP up to date for consultation by doctors and nurses. [Copyright &y& Elsevier]

Abstract: Summary: Aspects of osteoporosis in men, such as screening and identification strategies, definitions of diagnosis and intervention thresholds, and treatment options (both approved and in the pipeline) are discussed. Introduction: Awareness of osteoporosis in men is improving, although it remains under-diagnosed and under-treated. A European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) workshop was convened to discuss osteoporosis in men and to provide a report by a panel of experts (the authors). Methods: A debate with an expert panel on preselected topics was conducted. Results and conclusions: Although additional fracture data are needed to endorse the clinical care of osteoporosis in men, consensus views were reached on diagnostic criteria and intervention thresholds. Empirical data in men display similarities with data acquired in women, despite pathophysiological differences, which may not be clinically relevant. Men should receive treatment at a similar 10-year fracture probability as in women. The design of mixed studies may reduce the lag between comparable treatments for osteoporosis in women becoming available in men. [Copyright &y& Elsevier]

Abstract: Chromosomal abnormalities are common in patients with oligozoospermia or azoospermia. We report the case of a 32-year patient, with male phenotype, and without hormonal or morphological abnormalities, with a severely reduced spermatogenesis. It was revealed a 45,X/46,XY gonadal dysgenesis. We have reviewed the various problems inherent in the discovery of this rare gonadal dysgenesis, including genetic, cancer and fertility risks. [Copyright &y& Elsevier]

Abstract: Background: This study evaluates the perioperative outcomes of robotic-assisted adrenalectomy (RA) compared with lateral transperitoneal laparoscopic adrenalectomy (LA). Methods: Prospective evaluation of 50 patients who underwent unilateral RA versus 59 patients who underwent unilateral LA. Results: RA was associated with lower blood loss (49 mL) but longer operative times (104 minutes) (P <.001). However, the difference in operative time was not significant after the learning curve of 20 cases. In patients with body mass index (BMI) ≥30 kg/m2, mean operative time was longer in the LA group (90 vs 78 minutes, P = .03) but not in the RA group. In patients with large tumors (≥55 mm), mean operative time was longer in the LA group (100 vs 80 minutes, P = .009) but not in the RA group. Conversion rate, morbidity, and hospital stay were similar in both groups. Conclusions: After a learning curve of 20 cases, RA has similar perioperative outcomes compared to lateral transperitoneal LA. Several criteria (previous laparoscopic expertise, first assistant’s skill and tumor side) remain determinative on RA operative time. [Copyright &y& Elsevier]

Résumé: La prise en charge chirurgicale des tumeurs endocrines gastro-intestinales doit être adaptée à chaque localisation tumorale et au bilan d’extension locale et générale. Le but de ce travail a été de revoir la prise en charge chirurgicale de ces tumeurs peu fréquentes pour chaque site tumoral à l’aide d’une revue récente de la littérature. [Copyright &y& Elsevier]