L’acromégalie du sujet âgé: quelles particularités?

Les adénomes somatotropes de la personne âgée sont rares, et caractérisés par un retard diagnostique, un tableau clinique peu bruyant. Leurs critères diagnostiques rejoignent ceux des patients plus jeunes. La chirurgie, si possible, reste le traitement de choix de l’acromégalie du sujet âgé. Les analogues de la somatostatine ont montré leur efficacité dans le traitement de ces patients. Le pronostic des patients acromégales est inversement corrélé à l’âge du patient, à la durée de la maladie, au dernier taux de GH sous traitement. L’âge est un déterminant majeur de la mortalité en dehors de l’évolutivité de l’acromégalie. Nous rapportons trois observations de patientes acromégales âgées respectivement de 75, 70 et 66 ans avec une revue de la littérature.Mots clés: Acromégalie, sujet âgé, chirurgie hypophysaire, pronosticEnglish Title: Acromegaly features in the aging populationEnglish AbstractSomatotroph adenomas are rare in the aging population. Diagnosis of somatotroph adenomas is often long delayed and they are characterized by atypical clinical picture. Their diagnostic criteria are similar to those used for younger patients. Surgery, if possible, is the treatment of choice for acromegaly in the elderly. Somatostatin analogues have shown to be effective in these patients. Prognosis is inversely correlated with patient’s age, duration of disease and last GH level under treatment. Beside evolution of disease, age is a major determinant of mortality. We report three cases of elderly patients with acromegaly aged 75, 70 and 66 years respectively with a literature review.Keywords: Acromegaly, aging population, pituitary surgery, prognosi

Thyroid and pregnancy

Thyroid diseases are common in women of childbearing age. Different factors of maternal thyroid function occur during pregnancy; therefore, guidelines recommend trimester-specific pregnancy reference range for thyroid-stimulating hormone. Manifestly, thyroid dysfunctions have deleterious obstetrical and neonatal outcomes. Therefore, an adequate treatment is important to prevent adverse pregnancy complications. Furthermore, iodine deficiency during pregnancy could originate maternal and fetal problems. Consequently, scientific organizations recommend prenatal iodine supplementation for all pregnant women. However, treatment of thyroid autoimmunity is intriguing, but adequately powered randomized controlled trials are needed. The aim of this article was to summarize the reported results of the literature related to the management of thyroid disease during pregnancy in order to help endocrinologists in decision-making processes

NON-CARDIAC DIGEORGE SYNDROME IN AN ADOLESCENT GIRL WITH EPILEPSY (A CASE REPORT)

22q11.2 deletion syndrome is a fairly common neurogenetic syndrome, presenting with a wide range of clinical. It can manifest as facial dysmorphia, congenital heart defects, thymic hypoplasia responsible for a predominantly cellular immune deficiency, parathyroid and thyroid abnormalities, speech delay, growth retardation and neuropsychological disorders. We report the case of a patient with this deletion presenting with severe hypocalcaemic crises complicated by neurological impairment without cardiac or immune involvement

Incidental Finding of Thyroid Tuberculosis by Operation for Graves’ Disease: A Rare Case Presentation

Thyroid tuberculosis is a rare form of extrapulmonary tuberculosis, even in endemic countries such as Morocco; its precise incidence is not well-defined. The clinical presentation of thyroid tuberculosis can vary, often being asymptomatic. Consequently, the diagnosis may be overlooked or delayed. Intriguingly, thyroid tuberculosis can manifest alongside thyrotoxicosis due to Graves’ disease, an exceptional association. This article reports a distinctive case of thyroid tuberculosis coexisting with Graves’ disease, one of the autoimmune thyroid diseases. A 33-year-old female presented symptoms consistent with hyperthyroidism and bilateral exophthalmos. She was subsequently diagnosed with Graves’ disease. Despite initially managed medically, recurrences of the disease led to definitive treatment by total thyroidectomy. Histopathological examination revealed concurrent presence of thyroid tuberculosis

Stature–weight growth delays: Clinical and etiological aspects

Background: Stature–weight growth delay (SWGD) is a frequent motivation of consultation. It could be a consequence of a known chronic affection, congenital or acquired affection. The purpose of this study is to describe epidemiological, clinical, paraclinical, and etiological aspects of SWGD. Patients and Methods: This retrospective study included 103 patients presenting a growth delay with an average age of 14.44 years and ranging between 5 and 21 years. Male predominance was noticed in 68.93% of cases. Patients showed a stature lower to −2 standard deviation (SD) for corresponding age compared to Sempe and Pedron reference. Patients were hospitalized in Endocrinology and Metabolic Diseases Department of the University Hospital of Fez, Fez, Morocco. Results: Patient's history included a perinatal suffering in 6.7% of cases, a chronic pathology follow-up in 17.6% of cases, and psychomotor development disorder in 10.6% of cases. The average weight was −2.37 SD with extremes varying from −4 to −0.5 SD. The stature values varied between −4.5 and −2 SD for the given age, with an average of −3.12 SD. A severe stature delay (< −3 SD) was recorded in 39.6% of cases and the targeted average size was −2.44 SD with extremes varying from −4 to −1.5 SD. Growth delay etiologies were dominated by a deficit in growth hormones (GHs) in 60% of cases. Discussion and Conclusion: Dynamic tests objectified a total deficit and partial deficits in GH in 41.7 and 30% of patients, respectively. The hypothalamo–pituitary magnetic resonance imaging was pathological in 23.3% of patients and showed a syndrome of interruption of pituitary stem in seven patients, pituitary hail gland in three patients, a craniopharyngioma in two patients, prolactin microadenoma in one patient, and nonfunctional pituitary microadenoma in one patient. GH treatment was established in 16 children that were presenting a deficit in GH, and two girls presenting Turner syndrome, whereas etiological treatment was suggested in all remaining cases