M. Chihaoui

Ramadan fasting in patients with adrenal insufficiency

AimThe risks of fasting during Ramadan in patients with adrenal insufficiency are unknown. The aims of this study were to evaluate these risks in such patients, to determine the risk factors and finally to set some recommendations.MethodsIt is a cross-sectional study about 180 patients with known and treated adrenal insufficiency. The patients responded to a 14-item questionnaire concerning their knowledge about the disease and fasting during the last month of Ramadan.ResultsThere were 132 women and 48 men. The mean age was 47.6 ± 15.0 years (14–79). One hundred and thirty eight patients (76.7 %) were advised by their physician not to fast. Ninety-one patients (50.5 %) tried to fast. Complications occurred in 61 cases (67.0 %): asthenia in 88.5 % of cases, intense thirst in 32.8 %, symptoms of dehydration in 49.2 % and symptoms of hypoglycaemia in 18 %. One patient was hospitalized. Fifty-five patients (60.4 %) were able to fast for the whole month. Age, gender, duration of the disease, its primary origin, associated hypothyroidism, diabetes mellitus, hypertension or diabetes insipidus and daily dose of hydrocortisone did not significantly differ between fasters and non-fasters, full-month-fasters and partial-month-fasters, and fasters with complications and fasters without complications. The frequency of adequate knowledge about the disease was significantly higher in full-month-fasters vs. partial-month-fasters, and in fasters without complications vs. those with complications.ConclusionIn patients with adrenal insufficiency, fasting can cause complications especially if the level of knowledge about the disease is low.

Testicular adrenal rest tumours in young adult males with congenital adrenal hyperplasia: prevalence and impact on testicular function.

Testicular adrenal rest tumours (TARTs) have been described in patients with congenital adrenal hyperplasia (CAH). The aim of the study was to determine the prevalence of TARTs in patients with CAH, the associated factors and their impact on gonadal function. It is a prospective study concerning six young adult men with CAH, four cases with 21‐hydroxylase deficiency and two cases with 11‐hydroxylase deficiency. All patients were under glucocorticoid therapy. The mean age was 25 years (range: 20–31). All patients underwent a physical examination with testicular palpation, scrotal ultrasonography, a blood sample for serum testosterone, FSH, LH, inhibin B, ∆4‐androstenedione and 17‐OH‐progesterone measurements and a semen analysis. Ultrasound revealed TARTs in four patients; three were bilateral. The mean tumour size was 6.3 ml (range: 0.02–14.1). The tumours were palpable in two cases. 17‐OH‐progesterone was <10 ng/ml in all cases. Decreased testosterone level was found in one case. The semen analysis revealed azoospermia in one case and poor semen quality in four patients. TARTs were common and associated with impaired spermatogenesis.

Bone Mineral Density in Sheehan's Syndrome; Prevalence of Low Bone Mass and Associated Factors

Hypopituitarism is a known cause of bone mineral loss. This study aimed to evaluate the frequency of osteopenia and osteoporosis in patients with Sheehans syndrome (SS) and to determine the risk factors. This is a retrospective study of 60 cases of SS that have had a bone mineral density (BMD) measurement. Clinical, biological, and therapeutic data were collected. The parameters of osteodensitometry at the femoral neck and the lumbar spine of 60 patients with SS were compared with those of 60 age-, height-, and weight-matched control women. The mean age at BMD measurement was 49.4 ± 9.9 yr (range: 25-76 yr). The mean duration of SS was 19.3 ± 8.5 yr (range: 3-41 yr). All patients had corticotropin deficiency and were treated with hydrocortisone at a mean daily dose of 26.3 ± 4.1 mg. Fifty-seven patients (95%) had thyrotropin deficiency and were treated with thyroxine at a mean daily dose of 124.3 ± 47.4 µg. Thirty-five of the 49 patients, aged less than 50 yr at diagnosis and having gonadotropin deficiency (71.4%), had estrogen-progesterone substitution. Osteopenia was present in 25 patients (41.7%) and osteoporosis in 21 (35.0%). The BMD was significantly lower in the group with SS than in the control group (p < 0.001). The odds ratio of osteopenia-osteoporosis was 3.1 (95% confidence interval: 1.4-6.8) at the femoral neck and 3.7 (95% confidence interval: 1.7-7.8) at the lumbar spine. The lumbar spine was more frequently affected by low bone mineral mass (p < 0.05). The duration of the disease and the daily dose of hydrocortisone were independently and inversely associated with BMD at the femoral neck. The daily dose of thyroxine was independently and inversely associated with BMD at the lumbar spine. Estrogen-progesterone replacement therapy was not associated with BMD. Low bone mineral mass was very common in patients with SS. The lumbar spine was more frequently affected. The duration of the disease and the doses of hydrocortisone and thyroxine were involved in bone mineral loss.

Pheochromocytoma in a 45 X, iso (Xq) Turner syndrome.

A 48-year-old woman was admitted to the department of ndocrinology for right adrenal incidentaloma. She was single nd had a primary amenorrhea. She complained of weakess and weight loss. A physical examination revealed a short tature (132 cm) and a weight of 38 kg. She lacked of pubic nd axillary hair. She had eyelid edema, multiple pigmented evi without clinical malignant signs, an insufficient breast evelopment with widely spaced nipples. She had hypoplasic genitalia with no clitoris, no inner labia and a signal rogenital orifice. The 24-h ambulatory blood pressure (BP) onitoring showed that the systolic blood pressure (SBP) mean as 148 ± 12 mmHg and the diastolic blood pressure (DBP) ean was 96 ± 9 mmHg. Biological tests showed hyperchoesterolemia, hypokalemia (K+: 3,2 mmol/L) and impairment f liver parameters (SGOT: 124 UI/L [1–44], SGPT: 82 UI/L 2–40], alkaline phosphatase: 473 UI/L [40–150] and gammalutamyl-transferase: 632 UI/L [11–49]). The prothrombin level as 100%. Hormonal evaluation showed hyper-gonadotrophic ypogonadism (FSH: 36.9 UI/L) and primary hypothyroidism TSH > 100 UI/mL). Celiac disease antibodies were negative. he karyotype on peripheral blood cells was 46,Xi (Xq)/45,X: onosomy 45X in 45% of cells and 46 Xiso (Xq) in 55% of ells. Bone mineral density was low (T score: −5 SD at lombar pine and −4 SD at the femoral neck). Abdominal computed omography showed a 60 × 50 × 45 mm heterogeneous hypoense mass in the right adrenal area and multiple hypodense epatic nodules (Fig. 1). Adrenal MRI showed an hyper vasular largely necrotic right adrenal mass. Pelvic MRI showed n atrophy of the uterus which merges to the urethra with no agino-urethral fistula. Colonoscopy revealed multiple polyps itch biopsy showed serrated adenoma with low grade metaplaia. Tumoral markers were inside normal range; ACE: 2,2 ng/mL 0.5–5), CA19–9: 4,6 U/mL (0–33) and FP: 3,8 ng/mL (1–15). rinary metanephrines (MN) were very high: metanephrines: 709 g/24 hours (normal range 20–345), normetanephrines: 475 g/24 hours (normal range 30–440). MIBG scintigraphy a m f

Characteristics of Ketosis-onset Diabetes in Tunisian Population

Different types of diabetes can be presented by a ketosis (DK) or ketoacidosis (DKA). The objectives of this study were to analyze the characteristics of patients with newly diagnosed diabetes revealed by DK or DKA and discuss the different types of diabetes particularly ketone prone type 2 diabetes. Subjects and methods: Retrospective study including 288 patients with new ketosis onset diabetes; 178 men, mean age: 35.5 years. We analyzed clinical, biological, therapeutic and subsequent clinical course data. Diabetes was classified according to clinical, biological and follow-up data. Results: It was a DKA in 39 cases (13.5 %). Patients were classified as type 1 in 62.2% of cases and ketosis type 2 diabetes in 34.7 % of cases. As compared to type 1 diabetes, ketosis type 2 diabetes patients had a more advanced age, higher body mass index and waist circumference, and less frequent DKA. After the acute episode, 60% of ketosis type 2 diabetes was treated with insulin and half of them had associated metformin. After a mean follow-up of 2.4 years, 52% of ketosis type 2 diabetes patients were treated with oral hypoglycemic agents. Conclusion: Ketosis type 2 diabetes is a relatively new entity accounting for about one third of all new cases of DK or DKA in our population.

Apoplexie hypophysaire : à propos de 8 cas

Objectif L’apoplexie hypophysaire (AH) est une urgence neurochirurgicale rare et potentiellement mortelle. L’objectif de ce travail est d’etudier ces manifestations cliniques, ces signes radiologiques, son traitement et son evolution. Methodes Etude retrospective de 8 patients presentant une AH. Seuls les patients presentant une symptomatologie clinique aigue en rapport avec une lesion hypophysaire diagnostiquee a l’imagerie ont ete retenus. Resultats Il s’agit de 6 hommes et 2 femmes, âges de 25 a 73 ans avec une moyenne d’âge de 41,7 ans. L’AH etait inaugurale dans 4 cas. Dans les autres cas, il s’agissait d’un prolactinome chez 2 patients, d’un macroadenome a GH dans un cas et d’un adenome hypophysaire non secretant dans un cas. La symptomatologie allait d’une paralysie oculomotrice isolee a un etat de mal convulsif. Elle etait dominee par les signes d’hypertension intracrânienne. Six patients avaient une baisse de l’acuite visuelle avec un ptosis unilateral et un strabisme divergent dans un cas et une amputation du champ visuel dans 3 cas. L’IRM a montre un macroadenome hypophysaire avec remaniements hemorragiques dans tous les cas. L’indication operatoire etait portee chez 3 patients ayant permis la recuperation d’une acuite visuelle normale dans 2 cas. Un traitement medical etait indique chez un patient porteur d’un prolactinome. Pour les autres cas, une simple surveillance etait indiquee vu la stabilisation des lesions avec un risque operatoire important. Le bilan hormonal a objective une insuffisance antehypophysaire dans 6 cas. Discussion Cette etude souligne la presentation clinique variable de l’AH. Le tableau clinique typique est assez bruyant. L’evolution est en general favorable au depend souvent d’un deficit hypophysaire. Une prise en charge precoce permet de preserver le pronostic visuel.

Retentissement métabolique et cardiovasculaire de l’hypothyroïdie fruste : mythe ou réalité ?

L’hypothyroidie fruste (HF) est definie biologiquement par une elevation isolee du taux de thyreostimuline (TSH), sans anomalie de la concentration des hormones thyroidiennes libres. Sa decouverte est souvent faite de maniere fortuite chez un sujet asymptomatique. Contrairement a l’hypothyroidie averee dont les repercussions cliniques, metaboliques et cardiovasculaires sont bien etablies, les repercussions de l’HF restent controversees. L’amelioration du profil metabolique et celle du pronostic cardiovasculaire par le traitement hormonal substitutif sont encore incertains, notamment lorsqu’il s’agit d’une forme moderee d’HF avec un taux de TSH inferieur a 10 μUI/mL.

Factors Predicting Glycemic Control in Type 1 Diabetic Patient

Background: Recent years have been marked by numerous advances in the quality of type 1 diabetes care. However, glycemic control remains suboptimal for many patients with type 1 diabetes. The aim of our study was to identify factors associated with poor glycemic control in type 1 diabetic patients. Methods:

Myasthénie - maladie de Basedow : à propos de 2 cas

Introduction.– La prévalence des dysthyroïdies au cours de la myasthénie est relativement fréquente, de l’ordre de 10 %. L’association d’une myasthénie à une maladie de Basedow peut rendre le diagnostic respectif de ces deux pathologies difficiles, du fait de la similarité de certains signes cliniques, en particulier en cas de manifestations oculaires. Observations.– Nous rapportons le cas de 2 patientes âgées respectivement de 44 et 63 ans. Dans le premier cas, la myasthénie a précédé la maladie de Basedow de 16 ans alors que dans le second cas, la découverte des 2 pathologies était concomitante. Une ophtalmopathie était présente dans les 2 cas. La survenue de la maladie de Basedow était responsable d’une aggravation des manifestations de la myasthénie dans le premier cas. Les 2 patientes avaient un thymome et ont bénéficié d’une thymomectomie. La prise en charge de l’hyperthyroïdie a reposé sur l’iode radioactif dans le premier cas et la thyroïdectomie totale dans le second cas. Discussion.– La maladie de Basedow est plus fréquente chez les myasthéniques que dans la population générale. La réalisation d’un bilan thyroïdien, à la recherche d’une hyperthyroïdie, devrait être effectuée au moindre doute clinique chez ces patients, en particulier, en cas d’aggravation inexpliquée des symptômes de la myasthénie.

Digital ischaemia in a diabetic patient: what’s the diagnosis?

Introduction The occurrence of a peripheral arteriopathy in diabetic patients is generally related to diabetes. However, finger necrosis is not classically seen in diabetes. So, an atypical form of arteriopathy, in particular the presence of finger ischaemia, suggests another diagnosis of distal arteriopathy. We report the case of a 53-year-old woman with type 2 diabetes who had successive episodes of distal digital ischaemia of her toes and then her fingers. Initial diagnosis was diabetic arteriopathy. However, capillaroscopy and immunological exploration led to the diagnosis of scleroderma.