2021 innovations in endocrinology and diabetology

Maria-Cristina Burlacu, Raluca-Maria Furnica, Stefan Matei Constantinescu, Orsalia Alexopoulou, Dominique Maiter, Michel P Hermans, Jean-Paul Thissen Published in the journal : February 2022 Category : Endocrinologie et Nutrition

The 2021 year in endocrinology, diabetology, and metabolic diseases saw the arrival of new medical treatments, notably for Cushing's syndrome and hypercholesterolemia, in addition to the revival of treatments that were already known, yet without finding their correct place within our therapeutic arsenal.

All these treatments were likely promising, because of being effective and well tolerated. Although some of them are not yet available in Belgium, we thought it useful to actually discuss them, as they well illustrate the continuing dynamism of clinical research within this sector, whereas our activities have been somewhat thwarted by the current pandemic. We sincerely hope you enjoy the reading!

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Advocacy for improvements in clinical nutrition training during the medical cursus

Jean-Paul Thissen, Anne Boucquiau, Nicolas Paquot, Jean-Charles Preiser Published in the journal : April 2021 Category : Endocrinologie et Nutrition

The knowledge of physicians in the field of nutrition mostly lags far behind the patients’ expectations, without complying with official recommendations. However, poor-quality nutrition and diet represent the first cause of mortality worldwide. As a result of insufficient training and poor awareness, many physicians do not meet patients’ expectations. Moreover, nutrition is often perceived as of low scientific value, thereby opening the area to numerous pseudo-scientific errancies. We advocate an overall improvement in nutrition training during the medical cursus, including transversal integration of nutritional insights into medical courses, in addition to the recognition of post-university training validated by academic authorities. A clarification of the roles and recognition of the competency framework are urgently required in order to further promote the professionalism of nutritional counselling.

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Management of diabetic foot infections: practical recommendations and recommended use of antibiotics

Laura Orioli, Bernard Vandeleene, Dan Putineanu, Caroline Briquet, Hector Rodriguez-Villalobos, Jean-Cyr Yombi Published in the journal : September 2020 Category : Endocrinologie et Nutrition

Infections are a common complication of the diabetic foot ulcer. They are recognized as a factor of poor prognosis for both the foot and the patient. Their management is complex, requiring multidisciplinary collaboration. Our article summarizes the general principles of the management of diabetic foot infections, mainly based on the new recommendations of the International Working Group for the Diabetic Foot (IWGDF). It also presents the recommendations on the use of antibiotics, based on the PEDIS classification, as applied in the Saint-Luc University Hospital.

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Endoscopic ultrasound-guided radiofrequency ablation, insulinoma

Raluca Maria Furnica, Ivan Borbath, Bernard Vandeleene, Dominique Maiter, Pierre Deprez Published in the journal : February 2020 Category : Endocrinologie et Nutrition

Endoscopic utrasound-guided ablation: an interesting alternative in the treatment of benign localized insulinomas Endoscopic ultrasound-guided radiofrequency (RF) is an innovative technique that may represent an interesting and less invasive alternative for the radical treatment of patients with a benign insulinoma. Since June 2018, we have been able to treat at the Cliniques universitaires Saint-Luc four patients with a localized benign insulinoma using a Starmed RF electrode (Taewong). The effectiveness of the treatment was evident immediately after the procedure in all patients. Among all pancreatic neuroendocrine tumors, insulinomas are probably the best indication for endoscopic ultrasound-guided RF ablation due to their small size and low malignant potential, as well as the technique’s relative safety.

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Tetraparesis and thyrotoxicosis

Louise Ghosez (1), Christian Davin (2), Karim Bochouari (3), David Guery (4), Isabelle Paris (4), Ides Colin (4), Pol Vincent (3) Published in the journal : January 2019 Category : Endocrinologie et Nutrition

Thyrotoxic hypokalemic periodic paralysis is rare, especially in Caucasians. Affected patients have muscle weakness secondary to hypokalemia associated with hyperthyroidism. We report the case of a 23-year-old patient who was admitted to the emergency department for sudden-onset tetraparesis without any trauma. Tetraparesis was accompanied by severe hypokalemia. Etiologic investigations have led to the diagnosis of Graves' disease. Hypokalemic periodic paralysis is a rare neuromuscular complication of hyperthyroidism. It originates from hypokalemia secondary to intracellular transfer caused by both Na+/K+ ATPase pump overstimulation and abnormal potassium efflux due to a mutation in the potassium efflux channel. The clinical management consists in conservative potassium supplementation and administration of ß-blockers. The neuromuscular deficit is transient and reverses rapidly after the correction of hyperthyroidism.

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Cushing's syndrome secondary to ectopic ACTH secretion from pheochromocytoma

Anne Dysseleer (1), Dominique Maiter (2) Published in the journal : January 2019 Category : Endocrinologie et Nutrition

Pheochromocytoma is a rare cause of Cushing’s syndrome (<0.5% of cases) due to ectopic ACTH secretion. This condition proves very challenging regarding both diagnosis and treatment. Our case report illustrates the necessity of a thorough endocrinological investigation for all adrenal incidentalomas, particularly in the presence of clinical symptoms indicative of excessive hormonal secretion. We also show that Cushing’s syndrome secondary to ectopic ACTH secretion displays some typical characteristics as compared to the more common pituitary Cushing’s disease. Furthermore, we conducted a literature review regarding Cushing’s syndrome due to ectopic ACTH secretion from pheochromocytomas.

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Management of gestational diabetes in 2016: literature review

N. Pirson, D. Maiter, O. Alexopoulou Published in the journal : December 2016 Category : Endocrinologie et Nutrition

Gestational diabetes refers to first-onset glucose intolerance occurring during pregnancy. The prevalence of this pathology was shown to vary widely, whilst currently increasing worldwide in relation to obesity and diabetes outbreak. The pathophysiology of gestational diabetes is similar to that of Type 2 diabetes, as characterized by increased insulin resistance and subsequent pancreatic beta-cell dysfunction. Even though complications of gestational diabetes are well-known, there is no universal consensus with respect to screening criteria. The cornerstone of treatment is diet, which may be followed by insulin therapy, if necessary. Post-partum follow-up appears essential, considering the high risk of diabetes in the patient's future.

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Liraglutide 3 mg ( SAXENDA® ): a new drug for obesity

J.P. Thissen Published in the journal : September 2015 Category : Endocrinologie et Nutrition

Liraglutide, an analog of glucagon-like peptide (GLP)-1, prescribed to date in Type 2 diabetes mellitus at 0.6-1.8mg /day (Victoza®) is now available for the treatment of excess weight at a dose of 3mg/day (Saxenda®). Besides the insulinostimulating properties responsible for its anti-hyperglycemic activity, the drug exerts an anorectic action at the hypothalamus level, thereby promoting weight loss. Liraglutide 3mg is indicated for the treatment of obesity (BMI> 30Kg/m2) or overweight (BMI>27Kkg/m2) in patients with at least one comorbid condition. The agent's exact place in the treatment of obesity, particularly in the long-term, remains to be further specified.

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M. Buysschaert Published in the journal : March 2016 Category : Endocrinologie et Nutrition

GLP-1 analogs are nowadays a validated treatment in type 2 diabetes, due to both their glycemic and extraglycemic effects. Dulaglutide (Truliciy®) is a new long-acting analog. Treatment pattern is characterized by once-weekly injection of 1.5 (or 0.75) mg. The aim of this article is to review recent results of the AWARD program and to discuss the position of this new agent in a modern therapeutic approach of type 2 diabetes.

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Complex therapeutic management of an ectopic parathyroid adenoma: a clinical case report* and literature review

Ch. Doalto, D. Maiter Published in the journal : March 2016 Category : Endocrinologie et Nutrition

Primary hyperparathyroidism is a common endocrine disorder, primarily caused by parathyroid adenomas localized in the cervical region. We report the case of a patient with recurrent primary hyperparathyroidism due to a parathyroid adenoma located in the mediastinum, close to the thymus. Both localization and management of the adenoma proved laborious. At the light of this complex case report, we reviewed the diagnostic criteria and therapeutic guidelines for primary hyperparathyroidism. After multiple surgical procedures leading to the resection of the four parathyroid glands located in the cervical region and of the ectopic parathyroid adenoma located in the mediastinum, the patient developed postoperative hypocalcemia, which was quite difficult to manage.

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