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See detailPersistent low levels of serum hCG: please do not miss phantom hCG! (pseudohypergonadotropinemia syndrome)
VALDES SOCIN, Hernan Gonzalo ULg; SYRIOS, Petros ULg; GADISSEUR, Romy ULg et al

in Acta Clinica Belgica (2013), 68(6), 465

Introduction: Beyond pregnancy, persistent low levels of hCG may be associated with various benign and malignant conditions, i.e. quiescent gestational trophoblastic disease (QTD), raised pituitary hCG or ... [more ▼]

Introduction: Beyond pregnancy, persistent low levels of hCG may be associated with various benign and malignant conditions, i.e. quiescent gestational trophoblastic disease (QTD), raised pituitary hCG or false positive elevation caused by circulating heterophilic antibodies. This situation requires a clinico-biological approach in order to avoid misunderstandings that could lead to inappropriate diagnostic or therapeutic attitudes. Observation: A 23 years old woman (GOPO status) consulted his gynaecologist because of persistent abdominal pain. She was diagnosed of having trophoblastic disease on the basis of persistently positive human chorionic gonadotropin (hCG) test (Roche Modular) results, in the absence of pregnancy. Persistent low levels of hCG (around 10 U/L) were detected in her plasma. The patient underwent a trial with methotrexate chemotherapy. Abdominal pain was unrelieved whereas plasma hCG was 8.9 U/L. A serology test for Chlamydia indicated persistent infection and a course of antibiotic treatment was underwent without any relief. A laparoscopic exploration ruled out any trophoblastic residue or pelvic adherences. The patient was referred to the Endocrine Unit for further pituitary and hormonal investigations. Plasma and urine samples were sent to Biology Service to exclude a false hCG positive value. While low levels of hCG were detected in serum by assay, no significant hCG was detected in the urine (0,1 U/L). When serum was treated with HBT tube for the detection of heterophilic antibodies, hCG levels were 0.98 U/L. After mouse serum treatment, hCG was not further detected in our patient, indicating the presence of phantom hCG due to the presence of human anti mouse heterophilic antibodies. Conclusions: Textbooks on obstetrics and gynecology emphasize the importance of plasma hCG testing in patients with trophoblastic diseases. The ability of laboratory measurements to guide the clinician appropriately in every circumstance is limited. Caution should be exercised when clinical findings and laboratory results are discordant. Current protocols for the diagnosis and treatment of trophoblastic disease should include a compulsory test for hCG in urine and a test for heterophilic antibodies when appropriate. In this case report, we demonstrated that phantom hCG, was caused by heterogenous human anti mouse antibodies. [less ▲]

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See detailL’hyperglycémie provoquée par voie orale (HGPO) revisitée 2e partie : Indices d’insulinosécrétion, d’insulinosensibilité et de disposition orale
SCHEEN, André ULg; LUYCKX, Françoise ULg

in Médecine des Maladies Métaboliques (2010), 4(6), 684-690

Oral glucose tolerance test (OGTT) has been widely used for the diagnosis of impaired glucose tolerance, diabetes mellitus and gestational diabetes. Simultaneous measurements of plasma glucose and insulin ... [more ▼]

Oral glucose tolerance test (OGTT) has been widely used for the diagnosis of impaired glucose tolerance, diabetes mellitus and gestational diabetes. Simultaneous measurements of plasma glucose and insulin (or more rarely C-peptide) levels allow to derive indices of insulin secretion and insulin sensitivity that are helpful for the understanding of disturbances in glucose metabolism and, especially, for the prediction of progression from normal glucose tolerance to impaired glucose tolerance or type 2 diabetes. Certain indices, quite simple, may be used in clinical practice (“insulinogenic index” to assess early insulin secretion, Matsuda index to assess insulin sensitivity) while others, more complex (and most often based on modelling procedures), are essentially used in research. The oral disposition index, a recently introduced marker that integrates insulin secretion and insulin sensitivity, raises increasing interest, more particularly for the prediction of type 2 diabetes. [less ▲]

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See detailL’hyperglycémie provoquée par voie orale (HGPO) revisitée 1re partie : Tolérance au glucose, diabète gestationnel et hypoglycémie réactive
Scheen, André ULg; Luyckx, Françoise ULg

in Médecine des Maladies Métaboliques (2010), 4(5), 569-574

Oral glucose tolerance test (OGTT) has been widely used for the diagnosis of diabetes mellitus, gestational diabetes, impaired glucose tolerance or reactive hypoglycemia. Since almost 10 years, however ... [more ▼]

Oral glucose tolerance test (OGTT) has been widely used for the diagnosis of diabetes mellitus, gestational diabetes, impaired glucose tolerance or reactive hypoglycemia. Since almost 10 years, however, it has been proposed to limit the use of this dynamic test, favoring instead the measurement of either fasting plasma glucose or glycated hemoglobin. Nevertheless, almost all recent important studies used OGTT as reference test. In this first article, we will consider the potential interest of OGTT as diagnostic or prognostic test able to evaluate glucose regulation. In a second article, we will describe how to use OGTT to derive indices that quantitatively evaluate insulin secretion and/or insulin sensitivity. [less ▲]

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See detailAnalysis of the discriminant ability of shorter versions of the French ADAM questionnaire
Tancredi, Annalisa ULg; Legros, Jean-Jacques ULg; Pire, G. et al

in Aging Male : The Official Journal of the International Society for the Study of the Aging Male (2007), 10(3), 159-164

Objective. To investigate whether shorter versions of the ADAM test, a screening questionnaire for andropause, provide better diagnostic value than the original tool. Methods. Five thousand and twenty ... [more ▼]

Objective. To investigate whether shorter versions of the ADAM test, a screening questionnaire for andropause, provide better diagnostic value than the original tool. Methods. Five thousand and twenty-eight volunteer men aged 50-70 years attending a screening campaign for andropause, provided a fasting blood sample and completed the French ADAM test. Logistic regression analysis identified items that best predict andropause defined as serum free testosterone level below 70 ng/l. ROC curves assessed the diagnostic value of modified versions of the ADAM test, obtained by elimination of the less relevant predictors of andropause. Results. Only four items of the ADAM questionnaire may account for the diagnosis of andropause. These items concerned loss of height, decrease in libido and in enjoyment of life and deterioration in work performance. Item 9 was borderline significant. The area under the ROC curve for the short versions varied slightly from 0.555 to 0.560. As expected, model 6 has a greater specificity (56.02%) than the original tool while the efficiency increased slightly (54.85%). Conclusion. The modified versions of the ADAM test do not provide better diagnostic value than the original tool. Conclusion. The modified versions of the ADAM test do not provide better diagnostic value than the original tool. [less ▲]

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See detailLimited usefulness of CA125 measurement in the management of Hodgkin's and non-Hodgkin's lymphoma.
Bonnet, Christophe ULg; Beguin, Yves ULg; Fassotte, Marie-France ULg et al

in European Journal of Haematology (2007), 78(5), 399-404

BACKGROUND: Several papers have reported an association of high CA125 serum levels with advanced non-Hodgkin's lymphoma (NHL) as well as a relationship between high CA125 values and poor outcome. PATIENTS ... [more ▼]

BACKGROUND: Several papers have reported an association of high CA125 serum levels with advanced non-Hodgkin's lymphoma (NHL) as well as a relationship between high CA125 values and poor outcome. PATIENTS AND METHODS: Ninety-nine patients with NHL or Hodgkin's disease (HD) underwent serum CA125 assessment at diagnosis. Gender, age, presence of B symptoms, performance status (PS), histology, sites of tumor involvement, presence of effusion, clinical stage, age-adjusted International Prognostic Index, C-reactive protein (CRP), Hb, lactate deshydrogenase (LDH) and beta2-microglobulin were evaluated for their association with serum CA125 levels. The impact of CA125 levels and other features on overall (OS) and progression-free (PFS) survival was also assessed. RESULTS: CA125 serum levels were elevated in 34% of the patients, including 19% of patients with aggressive NHL, 45% of patients with indolent NHL, and 29% of patients with HD. Univariate analyses showed that CA125 levels correlated with poor PS, the presence of B symptoms, advanced clinical stage, abdominal, bone marrow or mediastinal involvement, presence of effusions, high aaIPI, low Hb levels and high CRP, LDH or beta2-microglobulin levels. In multivariate analysis, bone marrow involvement, the presence of effusions, and high aaIPI were all associated with high CA125 serum levels. In univariate analyses, OS and PFS were affected by age (PFS only), poor PS, B symptoms, advanced clinical stage, bone marrow or abdominal involvement (PFS only), high aaIPI, low Hb, high CRP or beta2-microglobulin levels. OS and PFS were not different in patients with normal or elevated CA125 levels. Multivariate analyses showed significantly inferior OS and PFS in patients with high beta2-microglobulin but no influence of CA125. CONCLUSION: While CA125 serum level correlates significantly with a number of features associated with more aggressive disease, it does not enhance the performance of standard prognostic markers in the management of patients with NHL or HD. [less ▲]

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See detailComment j'explore...le syndrome metabolique par sa nouvelle definition dite de "consensus".
Scheen, André ULg; Luyckx, Françoise ULg; Lefebvre, Pierre ULg

in Revue Médicale de Liège (2006), 61(1), 48-52

The International Diabetes Federation recently proposed a so-called consensus definition of metabolic syndrome. According to this new definition, a subject has the metabolic syndrome if he/she has ... [more ▼]

The International Diabetes Federation recently proposed a so-called consensus definition of metabolic syndrome. According to this new definition, a subject has the metabolic syndrome if he/she has abdominal obesity (considered as a prerequisite and assessed, in the European population, by a waist circumference > 80 cm in women and > 94 cm in men) and, in addition, at least two other risk factors among 1) elevated fasting triglycerides > or = 150 mg/dl; 2) low HDL cholesterol HDL < 50 mg/dl in women and < 40 mg/dl in men; 3) increased arterial blood pressure > or = 130/ 85 mm Hg; and 4) elevated fasting plasma glucose concentration > or = 100 mg/dl. We will discuss the advantages and limitations of this new definition as well as the consequences of its use on the prevalence of the metabolic syndrome in the Belgian population. [less ▲]

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See detailNo major month to month variation in free testosterone levels in aging mates. Minor impact on the biological diagnosis of 'andropause'
Tancredi, Annalisa ULg; Reginster, Jean-Yves ULg; Luyckx, Françoise ULg et al

in Psychoneuroendocrinology (2005), 30(7), 638-646

BACKGROUND: The measurement of bioavailable testosterone (BT) or free testosterone (FT) levels is currently considered the gold standard for the diagnosis of androgen deficiency in elderly men. While the ... [more ▼]

BACKGROUND: The measurement of bioavailable testosterone (BT) or free testosterone (FT) levels is currently considered the gold standard for the diagnosis of androgen deficiency in elderly men. While the impact of age on circulating testosterone levels (total, bioavailable and free) has been strongly documented, the existence of seasonal variations in testosterone levels remains debated. OBJECTIVE: We investigated whether seasonal variations in serum calculated free testosterone (cFT) levels may translate into variations in the prevalence of low testosterone levels. Diagnosis was on the basis of biochemical determinations and was cross-checked with the prevalence of clinical signs and symptoms of 'andropause', as assessed by the Androgen Deficiency in Aging Males (ADAM) questionnaire. METHODS: The study recruited 5028 men aged 50 years and over from September 2000 to January 2003. Their serum FT levels were assessed and they completed the French ADAM test. Men were considered eugonadal when cFT was > or =70 ng/l. The ADAM test was scored as described originally. The prevalence of 'andropause', diagnosed by the two methods, was compared throughout the year, on a month by month basis. RESULTS: The percentage of subjects with cFT levels below 70 ng/l increased significantly with age (P<0.001). Serum cFT levels (mean [SD]) varied significantly with the month of sampling (P<0.0001), the highest (88.1 [30.2] ng/l) and lowest (76.9 [28.0] ng/l) mean values occurring in April and in October, respectively. Conversely, the prevalence of testosterone deficiency (cFT<70 ng/l) reached a peak in October (45.7%) and a nadir in April (29.7%). Although the prevalence of 'andropause', based on the ADAM questionnaire, increased significantly with age (P<0.0001), no influence of the month of the year was noticed. CONCLUSIONS: Our results confirm a progressive age-related decline in FT levels. The monthly variations in serum FT values, observed throughout the year, do not show a major seasonal rhythm in elderly community-dwelling males, since the magnitude of the variations (<15%) remains marginal. This slight variation may, however, have an impact on the number of elderly men diagnosed with Partial Androgen Deficiency in Aging Males (PADAM). [less ▲]

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See detailAnalysis of the discriminant ability of shorter versions of the French ADAM questionnaire
Tancredi, Annalisa ULg; Legros, Jean-Jacques ULg; Pire, George et al

in Osteoporosis International (2005, March), 16(Suppl.3), 39

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See detailL'etude clinique du mois. Chirurgie bariatrique: les resultats a 10 ans de la Swedish Obese Subjects Study"."
Scheen, André ULg; Letiexhe, Michel ULg; Rorive, Marcelle ULg et al

in Revue Médicale de Liège (2005), 60(2), 121-5

The 10-year results of the prospective, controlled Swedish Obese Subjects Study were recently reported in the New England Journal of Medicine by L. Sjostrom and colleagues. This trial compared obese ... [more ▼]

The 10-year results of the prospective, controlled Swedish Obese Subjects Study were recently reported in the New England Journal of Medicine by L. Sjostrom and colleagues. This trial compared obese subjects who underwent gastric surgery and contemporaneously matched, conventionally treated obese control subjects. The follow-up rate for laboratory examinations was 74.5 percent at 10 years. At that time, data of 627 patients of the control group (mean age of 48 years, body mass index of 41 kg/m2) were compared to those of 641 patients who were submitted to surgery (banding n = 156, vertical banded gastroplasty n = 451 and gastric bypass n =34). At 10 years, the body weight had increased by 1.6 percent in the control group and decreased by 16.1 percent in the surgery group (p < 0.001), and similar changes were observed for waist circumference (+2.8 percent versus -10.1 percent, respectively, p < 0.001). Energy intake was lower and the proportion of physically active subjects higher in the surgery group than in the control group throughout the observation period. Ten-year rates of recovery from diabetes, hypertriglyceridaemia, low levels of high-density lipoprotein cholesterol, hypertension, and hyperuricaemia were more favourable in the surgery than in the control group. The surgery group had lower 10-year incidence rates of diabetes, hypertriglyceridaemia, and hyperuricaemia (but not of hypertension) than the control group. In conclusion, as compared with conventional therapy, bariatric surgery appears to be a valuable option for the treatment of severe obesity, resulting in long-term weight loss, improved lifestyle, and, except for hypercholesterolaemia that was not significantly affected, amelioration in cardiovascular risk factors that were elevated at baseline. Obtaining long-term data concerning the effect of weight loss on overall mortality and on the incidence rates of myocardial infarction, stroke, and cancer remains a key-objective of this landmark study. [less ▲]

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See detailInterest of the androgen deficiency in aging males (ADAM) questionnaire for the identification of hypogonadism in elderly community-dwelling male volunteers
Tancredi, Annalisa ULg; Reginster, Jean-Yves ULg; Schleich, FLorence ULg et al

in European Journal of Endocrinology (2004), 151(3), 355-360

Objective: To date, serum free testosterone measurement is considered to be the gold standard for the diagnosis of hypogonadism in elderly males but it is not available to all subjects suspected of a ... [more ▼]

Objective: To date, serum free testosterone measurement is considered to be the gold standard for the diagnosis of hypogonadism in elderly males but it is not available to all subjects suspected of a decrease in testicular function. Therefore, we evaluated whether the Androgen Deficiency in Aging Males (ADAM) questionnaire, in its original or in a modified 'quantitative' version (qADAM), could be used as a surrogate to biochemical determinations for the identification of hypogonadism in elderly males. Methods: 5028 men, aged 50-70 years, spontaneously consulting for the assessment of their gonadal function were studied. ADAM and qADAM, allocating a value of 1 point for any positive answer to each of the 10 questions of the ADAM test, were assessed for their ability to discriminate between males with free testosterone levels below or above 70 ng/l. Results: The sensitivity and specificity of the ADAM score were 81% and 21.6% respectively. The use of ADAM resulted in an appropriate classification of our population in normal or hypogonadal subjects in 44.5% of the cases. The area under the receiver operating characteristics (ROC) curve for the qADAM (0.529) revealed a highly marginal interest of this quantitative approach compared with the original scoring system. Conclusions: The ADAM test has a high sensitivity to identify aging males with low free testosterone levels. However, due to its lack of specificity, this test cannot be used as a surrogate to serum free testosterone testing for the identification of androgen deficiency in elderly, community-dwelling males. [less ▲]

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See detailImage analysis of the axonal ingrowth into poly(D,L-lactide) porous scaffolds in relation to the 3-D porous structure
Blacher, Silvia ULg; Maquet, Véronique; Luyckx, Françoise ULg et al

in Biomaterials (2003), 24(6), 1033-1040

Porous polymer scaffolds are promising materials for neural tissue engineering because they offer valuable three-dimensional (3D) supports for the in vitro and in vivo axonal growth and tissue expansion ... [more ▼]

Porous polymer scaffolds are promising materials for neural tissue engineering because they offer valuable three-dimensional (3D) supports for the in vitro and in vivo axonal growth and tissue expansion. At the time being, how the in vivo neuronal cell development depends on the scaffold 3-D architecture is unknown. Therefore, scanning electron micrographs of longitudinal sections of porous polylactide scaffolds and immunohistological sections of these scaffolds after implantation and neurofilament staining have been studied by image analysis. Pore orientation and axonal ingrowth have been investigated by spectral analysis on gray level SEM images. Binary image processing has been carried out and the binary images have been studied by spectral analysis in order to estimate the possible effect of the image noise on the real pattern. In addition to axonal orientation, density and length distribution of the regenerated axons into the polymer scaffold have been measured. Dependence of the axonal ingrowth on the 3D-polymer scaffold has been discussed on the basis of the collected data. (C) 2002 Elsevier Science Ltd. All rights reserved. [less ▲]

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See detailNonalcoholic steatohepatitis and insulin resistance: interface between gastroenterologists and endocrinologists.
Scheen, André ULg; Luyckx, Françoise ULg

in Acta Clinica Belgica (2003), 58(2), 81-91

Nonalcoholic steatohepatitis (NASH), along with other forms of nonalcoholic fatty liver disease, is an increasingly common clinico-pathological syndrome. It is frequently associated with obesity ... [more ▼]

Nonalcoholic steatohepatitis (NASH), along with other forms of nonalcoholic fatty liver disease, is an increasingly common clinico-pathological syndrome. It is frequently associated with obesity, especially visceral fat, and type 2 diabetes, and is intimately related to markers of the insulin resistance syndrome. Both the prevalence and the severity of liver steatosis are related to body mass index, waist circumference, hyperinsulinaemia, hypertriglyceridemia and impaired glucose tolerance. The pathophysiology of NASH involves two steps: 1) insulin resistance, which causes steatosis; 2) and oxidative stress, which produces lipid peroxidation and activates inflammatory cytokines. The identification of subjects who may progress from fatty liver to NASH, and from NASH to fibrosis/cirrhosis is an important clinical challenge as well as the finding of appropriate therapy that could prevent such deleterious process. Substantial weight loss is accompanied by a marked attenuation of insulin resistance and related metabolic syndrome and, concomitantly, by an important regression of liver steatosis in most patients, although mild inflammation may be detected in some subjects. Thus, NASH may be considered as another disease of affluence, as is the insulin resistance syndrome and perhaps being part of it. [less ▲]

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See detailLe syndrome metabolique: definitions et donnees epidemiologiques.
Scheen, André ULg; Luyckx, Françoise ULg

in Revue Médicale de Liège (2003), 58(7-8), 479-84

The metabolic syndrome is strongly related to visceral obesity and associated with a high risk of cardiovascular morbidity and mortality. Since the original description of Reaven in 1988, several working ... [more ▼]

The metabolic syndrome is strongly related to visceral obesity and associated with a high risk of cardiovascular morbidity and mortality. Since the original description of Reaven in 1988, several working definitions have been proposed, especially by the World Health Organisation in 1998-99, the National Cholesterol Education Program (NCEP-ATP III) Expert Panel in the United States in 2001 and the European Group for the Study of Insulin Resistance (EGIR) in 2002. The present paper attempts at comparing these various definitions and at reporting epidemiological data both in North America and in Europe, especially in Belgium. The prevalence is generally higher in men than in women and strongly increases with age. Overall, one may estimate that around 20% of adults have a metabolic syndrome, which should therefore be considered as an important public health problem. [less ▲]

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See detailComment j'explore ... la controverse a propos de la place de l'hyperglycemie provoquee par voie orale en clinique.
Luyckx, Françoise ULg; Scheen, André ULg

in Revue Médicale de Liège (2003), 58(11), 701-5

The oral glucose tolerance test (OGTT) has been widely used for the diagnosis of diabetes mellitus, gestational diabetes or impaired glucose tolerance. However, since 1997, OGTT is not considered anymore ... [more ▼]

The oral glucose tolerance test (OGTT) has been widely used for the diagnosis of diabetes mellitus, gestational diabetes or impaired glucose tolerance. However, since 1997, OGTT is not considered anymore as the first choice test for the diagnosis of diabetes mellitus or impaired glucose tolerance, being replaced by fasting glycaemia. Numerous studies, however, stressed the discrepancies between these two diagnostic approaches, so that OGTT still has defenders as a useful tool to diagnose diabetes. Besides, emphasis has been recently put on both postprandial hyperglycaemia, considered as a major cardiovascular risk factor, and impaired glucose tolerance as a predictor of progression toward overt type 2 diabetes, two parameters well addressed by the OGTT. Thus, even if the place to be reserved to the OGTT is controversial, in our opinion, this test still has a place in clinical biology. [less ▲]

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See detailObesity and liver disease.
Scheen, André ULg; Luyckx, Françoise ULg

in Best practice & research. Clinical endocrinology & metabolism (2002), 16(4), 703-16

Non-alcoholic steatohepatitis (NASH) is a disease of emerging identity and importance. It is frequently associated with obesity, especially visceral fat, and is intimately related to fatty liver and ... [more ▼]

Non-alcoholic steatohepatitis (NASH) is a disease of emerging identity and importance. It is frequently associated with obesity, especially visceral fat, and is intimately related to fatty liver and markers of the insulin resistance syndrome. Both the prevalence and the severity of liver steatosis are related to body mass index, waist circumference, hyperinsulinaemia, hypertriglyceridaemia and impaired glucose tolerance or type 2 diabetes. The identification of obese patients who may progress from steatosis to NASH and from NASH to fibrosis/cirrhosis is an important clinical challenge. Substantial weight loss is accompanied by a marked attenuation of insulin resistance and related metabolic syndrome and, concomitantly, by a remarkable regression of liver steatosis in most patients, although increased inflammation may be detected in some subjects. Thus, NASH may be considered as another disease of affluence, as is the insulin resistance syndrome, and perhaps being part of it, especially in obese patients. [less ▲]

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See detailComment j'explore ... les differentes formes de diabete sucre: diagnostic differentiel clinique et biologique.
Scheen, André ULg; Philips, Jean-Christophe ULg; Luyckx, Françoise ULg et al

in Revue Médicale de Liège (2001), 56(9), 650-5

Owing to the increasing prevalence of diabetes mellitus and the various aspects of this disease, we present a practical approach which allows the clinician to more easily differentiate type 1 diabetes ... [more ▼]

Owing to the increasing prevalence of diabetes mellitus and the various aspects of this disease, we present a practical approach which allows the clinician to more easily differentiate type 1 diabetes, type 2 diabetes and secondary diabetes of pancreatic origin, i.e. the most common forms of diabetes mellitus. Such an approach uses simple diagnostic criteria, based upon both clinical characteristics (family history, personal history, clinical presentation) and biological markers (C-peptide, autoantibodies,...). A right diagnosis should allow to optimize the management of the diabetic patient. [less ▲]

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See detailRecherche de macroprolactinémie chez des patients avec hyperprolactinémie
Valdes Socin, Hernan Gonzalo ULg; MAGIS, Delphine ULg; Luyckx, Françoise ULg et al

in XVIIIème Congrès de la Société Française d'Endocrinologie - Abstract book (2000)

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See detailRecherche de macroprolactine chez des patients en dialyse péritonéale
Valdes Socin, Hernan Gonzalo ULg; Dechenne, Charles ULg; Luyckx, Françoise ULg et al

in XVIIIème Congrès de la Société Française d'Endocrinologie - Abstract book (2000)

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