Syndrome d’interruption de la tige pituitaire à révélation tardive

Le syndrome d'interruption de la tige pituitaire est une cause assez fréquente de déficit en hormone de croissance et d'hypopituitarisme souvent révélé pendant la période néonatale et l'enfance. Cette observation illustre les particularités d'une révélation tardive de ce syndrome. Il s'agit d'une patiente âgée de 17ans hospitalisée pour aménorrhée primaire et impubérisme. Elle n'a pas d'antécédent d'incident néonatal. L'examen clinique révèle un retard de croissance sévère. L'hypophysiogramme a montré un hypopituitarisme complet sans diabète insipide. L'imagerie par résonnance magnétique a montré une interruption de la tige pituitaire avec une post hypophyse ectopique. Une malformation rénale a été objectivée, ce qui est en faveur d'une origine congénitale malformative de ce syndrome. Une substitution hormonale a été administrée à cette patiente. Cette forme clinique tardive souligne la nécessité de diagnostic précoce d'impubérisme et/ou de retard de croissance révélant une pathologie à potentiel de gravité important.Pan African Medical Journal 2016; 2

Obstructive sleep apnea presenting as pseudopheochromocytoma

A 52-year-old female with a history of poorly controlled resistant hypertension was admitted to our hospital with severe hypertension. She had a history of fatigue and intermittent episodes of palpitations. Laboratory evaluation was significant for elevated 24-h urinary catecholamine levels (3,5 times the upper normal levels). This case was presenting with a clinical and biochemical picture indistinguishable from that of pheochromocytoma. However, neither computed tomography nor meta-iodo-benzyl-guanidine scintigraphy detected any catecholamine-producing tumor in or outside the adrenal glands. Our patient was screened with full polysomnography because of heavy snoring, daytime somnolence and obesity. It revealed severe obstructive sleep apnea syndrome. After three months of continuous positive airway pressure therapy, the patient experienced resolution of his presenting symptoms, improved blood pressure control and normalization of his urinary catecholamine levels. This case highlights sleep disordered breathing as a potentially reversible cause of pseudo-pheochromocytoma.Pan African Medical Journal 2016; 2

Graves' Disease Associated with Cerebrovascular Disease and Antiphospholipid Antibody Syndrome

Thyroid disorders are commonly associated with coagulopathy. Patients with hyperthyroidism have increased risk for developing thromboembolic accidents, which are favoured by a simultaneous presence of antiphospholipid antibodies syndrome. in this paper, we describe the case of a patient with Graves' disease, who developed strokes with antiphospholipid antibodies syndrome

Case Report Graves' Disease Associated with Cerebrovascular Disease and Antiphospholipid Antibody Syndrome

Thyroid disorders are commonly associated with coagulopathy. Patients with hyperthyroidism have increased risk for developing thromboembolic accidents, which are favoured by a simultaneous presence of antiphospholipid antibodies syndrome. in this paper, we describe the case of a patient with Graves' disease, who developed strokes with antiphospholipid antibodies syndrome

Hughes-Stovin syndrome revealing the presence of Behçet’s Disease

Background: Hughes-Stovin Syndrome (HSS) is a rare clinical disorder characterized by deep venous thrombosis and multiple pulmonary and/or bronchial aneurysms. Aneurysms in systemic circulation can also be seen. Case presentation: We report the first case of HSS with aortic aneurysm in a 55-year-old man who initially presented with deep venous thrombosis. The diagnosis of HSS revealing Behçet’s disease was made given the history of recurrent oral and genital ulcers. Treatment consisted of 3 daily pulses of methylprednisolone (1g) followed by oral prednisone (1mg/kg daily) and 6 monthly pulses of cyclophosphamide. Oral anticoagulation treatment was  held  3 months and then was stopped with good outcome. Conclusion: Systemic aneurysms in Hughes Stovin is a worth knowing complication which may reveal Behçet’s disease

Lung function in poorly controlled type 1 North African diabetic patients: A case-control study

Aim: To compare the lung function parameters of poorly controlled type-1-diabetes-mellitus (T1DM) patients with age-; height and sex-matched healthy-non-smokers (HNS). Population and methods: Subjects aged 35–60 Yrs who have a poorly controlled T1DM (glycated-Haemoglobin level >7%) with a disease history of more than 10 Yrs (n = 14) and HNS subjects (n = 14) were recruited. Clinical, anthropometric and fasting biological data were collected. Plethysmographic data (flows, volumes, estimated-lung-age (ELA), lung-capacity-to-transfer-carbon-monoxide (DLCO)) were measured. Large-airway-obstructive-ventilatory-defect (LAOVD) was defined as first–second-forced-expiratory-volume (FEV1)/forced-vital-capacity (FVC) below the lower-limit-of-normal (LLN). Restrictive-ventilatory-defect (RVD) was defined as total-lung-capacity (TLC)  upper-limit-of-normal. Student t-test and chi-2 test were used to compare plethysmographic data and profiles of the two groups. Results: The two groups were matched in chronological-lung-age (CLA) (respectively 47 ± 7 vs. 50 ± 8 Yrs) and sex (7 males and 7 females in each group) and height. Compared to the HNS group, the T1DM one had significantly lower FEV1, FVC, slow-vital-capacity and maximal-mid-expiratory-flow (respectively 99 ± 11% vs. 83 ± 11%, 99 ± 9% vs. 86 ± 11%, 80 ± 8% vs. 67 ± 15% and 98 ± 23% vs. 72 ± 23%), had significantly higher TLC and RV (respectively, 105 ± 20% vs. 123 ± 24% and 108 ± 22% vs. 131 ± 24%) and had significantly higher percentage of subjects with lung-hyperinflation (7.1% vs. 43.0%). Both groups had similar percentages of LAOVD and RVD and similar corrected DLCO values. ELA of the T1DM group (57 ± 10 Yrs) was significantly higher than CLA. Conclusion: Poorly controlled T1DM seems to alter ventilatory mechanics without effect on the alveolo-capillary-membrane. In addition, it accelerates the respiratory ageing

A case of Kallmann syndrome associated with a non-functional pituitary microadenoma

Kallmann syndrome (KS) is a form of hypogonadotropic hypogonadism in combination with a defect in sense of smell, due to abnormal migration of gonadotropin-releasing hormone-producing neurons. We report a case of a 17-year-old Tunisian male who presented with eunuchoid body proportions, absence of facial, axillary and pubic hair, micropenis and surgically corrected cryptorchidism. Associated findings included anosmia. Karyotype was 46XY and hormonal measurement hypogonadotropic hypogonadism. MRI of the brain showed bilateral agenesis of the olfactory bulbs and 3.5 mm pituitary microadenoma. Hormonal assays showed no evidence of pituitary hypersecretion

Knowledge gaps and perceptions of future research directions on management of diabetes during Ramadan fasting: an online survey of physicians

Objectives: Current knowledge and research on diabetes and Ramadan form the basis for evidence-based clinical practice. In this context, we aimed to explore physicians' perceptions of current knowledge gaps about research fasting (RF), barriers to, and foreseeable directions for advancement of the field. Methods: We conducted an online survey of a convenience sample of 260 physicians from 27 countries. The survey questionnaire addressed three main domains: perceived current knowledge gaps and unmet needs in research about RF and diabetes, barriers to the conduct of research, and future directions for furthering the evidence in this field. Results: Majority of respondents (65.7%) were senior physicians in adult endocrinology/diabetes (45.9%) working at tertiary centers (65.2%). The majority (67.3%) reported seeing an average of 20+ patients with diabetes weekly and felt “very or fairly confident” in managing diabetes during RF (67.7%). The knowledge gaps identified were the management of high-risk patients with diabetes (54.1%), such as renal impairment (59.8%), and pregnancy (61.5%). The main barriers to research were lack of adequate funding to academic centers (75.7%) and lack of interest of institutions in the subject (64.6%). Future efforts should be directed at the conduct of large epidemiological studies (49.5%) or double-blinded, placebo-controlled clinical trials (48.6%) to address the former gaps. Research findings should be widely disseminated via hands-on workshops (recommended by 70.3% of respondents) or international conferences (61.2%). Conclusions: There is a wide agreement regarding the knowledge gaps in the management of diabetes during RF. Future efforts should focus on addressing these critical deficiencies

Increased skin autofluorescence of advanced glycation end products (AGEs) in subjects with cardiovascular risk factors

Background As a clinical and non-invasive tool, the AGE Reader measures skin autofluorescence (SAF) to estimate the accumulation of advanced glycation end products (AGEs) in the skin. Accumulation of AGEs has been implicated in several inflammation-associated diseases, including diabetes and cardio-metabolic diseases. This study aimed to assess SAF in subjects with and without cardiovascular risk (CVR) factors and examine the association between SAF and various bio-clinical parameters. Methods In a cross-sectional study, we included 250 participants between 19 and 86 years of age divided into two groups: a healthy group (n = 88) and subjects with CVR factors (n = 162 in total, diabetes n = 48, hypertension n = 62, and both n = 52). We assessed skin AGE measures and biological and clinical data. Results SAF was significantly higher in subjects with CVR factors than in healthy participants (2.42 +/- 0.38 vs 1.90 +/- 0.29 respectively; p &lt; 0.001). SAF was associated with age, gender, BMI, duration of diabetes, HbA1c, triglyceride, and obesity. Multivariate analysis showed that age and duration of diabetes were the independent determinants of SAF. The ROC analysis indicated that a SAF &gt; 2.25 AU was the optimal cut-off point to predict the presence of diabetes and/or hypertension and dyslipidemia (p &lt; 0.001). Conclusion This Tunisian population-based study shows an increased SAF level in subjects with diabetes and/or hypertension and dyslipidemia compared to healthy subjects. The AGE Reader device is a rapid and non-invasive tool in clinical practice to evaluate and screen CVR factors in Tunisia with a North African phototype.</p