The concept of «metabolic syndrome» was brought to the forefront in the early 2000s in international literature, but this interest seems to have faded somewhat in recent years. However, this constellation of cardiovascular risk factors should not be neglected. Taken individually, they hardly seem problematic, but when they are present within the same individual, they significantly increase the risk of cardiovascular morbidity and mortality. This clinical vignette aims to draw attention to the usefulness of the search for metabolic syndrome in clinical practic.

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.

While overt thyroid disturbances, characterized by symptoms and/or clinical signs with abnormal serum levels of thyroid hormones, are generally associated with perturbations in the lipid profile, the situation is less clear as far as subclinical thyroid disturbances, defined by isolated abnormalities of thyroid stimulating hormone (TSH) levels, are concerned. In severe hyperthyroidism, a decrease of total cholesterol, LDL cholesterol and apoprotein B concentrations is generally observed. These biological parameters are normalized when appropriate antithyroid treatment is given. In profound hypothyroidism, on the contrary, elevated levels of total and LDL cholesterol levels are observed, which decrease after hormonal replacement. In both cases, the changes in serum levels of HDL cholesterol, triglycerides and lipoprotein (a) are less systematic, both before and after treatment. Lipid abnormalities associated with subclinical thyroid disturbances remain controversial. However, two recent meta-analyses have shown higher LDL cholesterol levels in presence of subclinical hypothyroidism and a significant reduction of such lipid abnormality after administration of thyroxine. Furthermore, they demonstrated a higher prevalence of subclinical hypothyroidism in a population with hypercholesterolaemia when compared to a population with normal cholesterol levels. Finally, a significant reduction in both total and LDL cholesterol concentrations has been reported after administration of thyroxine in a small group of hypercholesterolaemic patients with basal TSH levels in the upper range of normal values. In view of the results of the literature, strategies are proposed to help the clinician in the management of patients with overt or subclinical thyroid disturbances, associated with dyslipidaemia.

L'exploration d'un sujet obese vise a mieux comprendre la maladie, ses causes et ses consequences, de facon a optimaliser la prise en charge ulterieure. De facon schematique, elle peut etre realisee en trois etapes successives. D'abord, il faut prendre en compte les donnees appartenant au passe, en retracant l'histoire familiale et personnelle du sujet. Ensuite, il convient d'analyser soigneusement les donnees presentes, notamment la severite de la surcharge ponderale, son type de distribution et l'importance des complications. Enfin, il faut mettre ces donnees en perspective, de facon a estimer le pronostic final du patient obese pour mieux fixer les objectifs et les strategies therapeutiques.

La silymarine, commercialisee par la firme Madaus Pharma sous le nom de Legalon®, possede des proprietes antioxydantes susceptibles de proteger la membrane cellulaire des hepatocytes. Elle est presentee sous forme d'ampoules de poudre lyophilisee destinee a la perfusion intraveineuse (Legalon-Sil® dose a 75,5 mg de silybinine, compose essentiel de la silymarine, sous forme de sel disodique) et, depuis peu, sous la forme de capsules dosees a 140 mg de silymarine (Legalon® 140 capsules), destinees a l'administration orale. Alors que la forme injectable est exclusivement reservee au traitement de l'intoxication severe par l'Amanite phalloide, la forme orale est indiquee dans l'amelioration du fonctionnement du foie, lors de certaines affections de la cellule hepatique (atteintes toxiques), et ce, apres exclusion des affections hepato-biliaires organiques et de toute maladie severe. La dose usuelle est de 2 a 3 capsules de Legalon® 140 mg par jour.