Diagnostic étiologique du diabète insipide central: à propos de 41 cas

La survenue d'un syndrome polyuro-polydipsiqueavec des urines hypotoniques nécessite une stratégie diagnostique rigoureuse. Le but de cette étude était d’étudier les modalités de diagnostic du diabète insipide central. A travers une étude rétrospective de 41 cas de diabète insipide central(DIC) colligés au service d’Endocrinologie à l’hôpital de la Rabta de Tunis, allant de l’année 1990 à l’an 2013,nous avons relevé les circonstances de découverte du DIC, les anomalies du bilan anté-hypophysaire etde l’imagerie hypophysaire. Le DIC était post opératoire chez 20 patients. La diurèse moyenne de 24 heures était significativement plus élevée chez les patients ayant un DIC en dehors d’un contexte chirurgical. L’épreuve de restriction hydrique était concluante chez tous les patients qui en ont bénéficié. En dehors d’un contexte neurochirurgical, les causes infiltratives étaient retrouvées chez 6 patientset les causes tumorales chez 6 patients. Le DIC était associé à une selle turcique vide dans 1 cas et idiopathique chez 3 malades. L’imagerie par résonnance magnétique hypothalamo-hypophysaire et le bilan anté-hypophysaire sont systématiques en dehors d’un contexte de chirurgie hypophysaire et d’une polydipsie primaire évidente. The Pan African Medical Journal 2016;2

A diffuse large B‐cell thyroid lymphoma presented as a compressive goiter in a young woman with no evidence of Hashimoto's thyroiditis

Abstract Thyroid lymphoma should be suspected in case of rapid enlargement of the thyroid gland even in a young patient with no history of Hashimoto thyroiditis. The confirmation is based on histopathology and immunohistochemistry

Late-Onset Isolated Corticotrope Deficiency in a Woman with Down Syndrome

Isolated corticotrope deficiency is a rare cause of secondary adrenocortical insufficiency. Its occurrence in patients with Down syndrome is exceptional. Herein, we report a case of an isolated corticotrope deficiency diagnosed at the age of 33 years in a woman with Down syndrome and discuss its possible mechanisms. A 33-year-old woman with Down syndrome was referred to our department for the investigation of low blood pressure. She complained of asthenia, dizziness, and palpitation with arterial hypotension for the past 4 years. The thyroid function was normal and anti-thyroperoxidase antibodies were negative. The peak of cortisol level in response to the insulin-induced hypoglycemia test was 9.4 μg/dl. ACTH level was normal, indicating corticotrope deficiency. Other pituitary hormones were normal. Magnetic resonance imaging scan revealed a partially empty sella turcica. Genetic analysis showed no mutations and no copy number variants of the TBX19 and NFKB2 genes. The mechanism of isolated corticotrope deficiency is unclear, but it may be induced by autoimmune mechanism in similar to other disorders of patients with Down syndrome

De Novo Psychiatric Disorders in a Woman With Giant Prolactinoma Treated With Cabergoline

Dopamine agonists are the first-line treatment of prolactinomas. The risk of developing de novo psychiatric symptoms during dopamine agonist therapy is low. Herein, we report the case of a 42-year-old woman with a giant prolactinoma who developed a psychiatric disorder after 1 day of cabergoline therapy initiation. She presented with amenorrhea, galactorrhea, headaches, and disturbed vision. Biological investigations revealed hyperprolactinemia (2975 ng/ml) with gonadotropin deficiency. Pituitary MRI showed a giant pituitary adenoma. The patient was treated with cabergoline at the dose of 1 mg twice weekly. One day after the treatment initiation, she developed acute delirium with temporospatial disorientation and compulsive medication use. These symptoms disappeared 1 week after the reduction of the dose of cabergoline. Patients with hyperprolactinemia receiving an initial high dose of cabergoline may develop changes in mood and behavior regardless of prior psychiatric history

A Case of Von Hippel–Lindau Disease with Bilateral Pheochromocytoma and Ectopic Hypersecretion of Intact Parathyroid Hormone in an Adolescent Girl

Von Hippel–Lindau disease is an autosomal dominant inherited syndrome predisposing to a variety of highly vascularised tumors in different organs. Although bilateral pheochromocytoma was reported in patients with von Hippel–Lindau disease, the coexistence of primary hyperparathyroidism is not a common condition. We report an observation of a primary hyperparathyroidism secondary to an ectopic secretion of intact parathyroid hormone in a 17-year-old girl with von Hippel–Lindau disease and bilateral pheochromocytoma. She presented with a newly diagnosed diabetes mellitus and a severe arterial hypertension. Blood tests disclosed hypercalcemia with increased intact PTH level. Cervical ultrasound and sestamibi scintigraphy were normal. Twenty-four-hour urinary normetanephrine level was highly elevated pointing to a catecholamine-secreting tumor. The abdominal computed tomography showed bilateral adrenal masses. MIBG scintigraphy exhibited a high accumulation of the tracer in both adrenal tumors. Genetic testing revealed a mutation of the VHL gene. The patient underwent a bilateral adrenalectomy. The postoperative outcome was marked by normalization of blood pressure, blood glucose, calcium, and PTH levels. In our case, the elevation of intact PTH and its spontaneous normalization after surgical treatment of pheochromocytomas confirms its ectopic secretion

Tuberculosis of the Thyroid Gland Presented as a Rapid Enlargement of a Preexisting Goiter

Thyroid involvement with tuberculosis is an uncommon condition even in endemic countries. As its clinical presentation is not specific, diagnosis is often difficult and requires histopathological confirmation. Herein we report an observation of secondary tuberculosis of the thyroid gland in a woman with a type 2 diabetes mellitus and a primary hypothyroidism. She presented with a rapid enlargement of a preexisting goiter without compressive symptoms. The imaging exams showed a voluminous plunging multinodular thyroid gland and multiple bilateral lung nodules. Malignancy was suspected and the patient underwent a total thyroidectomy and a lung biopsy. Histopathological examination revealed multiple tuberculous foci involving both the thyroid gland and the lungs

Place des supports vidéo disponibles en ligne dans l’éducation thérapeutique des diabétiques : étude évaluative chez une population de diabétiques à haut risque podologique

Les capsules vidéo sont de plus en plus utilisées dans l’éducation thérapeutique. L’objectif de notre étude était d’évaluer l’impact d’une vidéo éducative sur l’amélioration des connaissances des diabétiques à haut risque podologique. Méthodes : Étude quasi expérimentale menée chez 40 patients diabétiques à haut risque podologique selon la classification du groupe international de travail sur le pied diabétique (IWGDF). Une évaluation des connaissances sur les moyens de prévention des lésions du pied a été réalisée à l’aide d’un questionnaire préétabli avant et après visionnage d’une vidéo éducative. Résultats : L’âge moyen des patients était de 57,8 ± 1,5 ans (22 femmes et 18 hommes). L’ancienneté moyenne du diabète était de 15,6 ± 8,8 ans. Le niveau de connaissance était classé médiocre (score entre −14 et 0) chez 13 % des patients, moyen (score entre 1 et 11) chez 50 % des patients et bon (score > 11) chez 37 % des patients. Après visionnage de la vidéo, le score moyen d’évaluation des connaissances des patients est passé de 10,4 ± 4,5 à 16,8 ± 4,0 (p  20 % du score d’évaluation des connaissances était plus fréquemment observée chez les sujets dont le niveau de connaissance initial était classé moyen ou médiocre (p < 0,001) et chez ceux ayant un bas niveau d’instruction (p = 0,07). Conclusion : Les supports vidéo disponibles en ligne représentent un moyen efficace pour améliorer le niveau de connaissance des diabétiques à risque podologique sur les moyens de prévention des lésions du pied, en particulier, si le niveau de connaissance initial est faible et en cas de bas niveau d’instruction

Factors associated with knowledge level in adult type 1 diabetic patients

Background: The objective of the study is to determine the factors associated with the level of knowledge of Tunisian type 1 diabetic (T1D) patients in adulthood. Methods: This is a cross-sectional study including 93 T1D patients over 18 years old. The knowledge assessment was carried out by a questionnaire rated out of 20 points. The subjects with an „unsatisfactory” level of knowledge (score &lt; 10/20) were compared with subjects whose level of knowledge was „satisfactory” according to their socio-demographic, clinical, and paraclinical characteristics. Results: The mean age of the patients was 37.2 ± 12.4 years. The level of knowledge was „unsatisfactory” in 21 patients (23%). After univariate analysis, an „unsatisfactory” level of knowledge was associated with a low level of education (p = 0.001), a poor socioeconomic level (p = 0.03), a poor glycemic control (p = 0.003) and the absence of self-monitoring (p = 0.002). After multivariate analysis, only a low level of education and a lack of practice of self-monitoring were associated with an „unsatisfactory” level of knowledge (respectively p = 0.03 and 0.03; adjusted OR [95% confidence interval] = 7.3 [1.2–43.5] and 13.7 [1.3–143.3]). Conclusions: The factors independently associated with the level of knowledge in adult T1D patients are the level of education and the practice of self-monitoring. This encourages better tailoring of educational messages to patients with low levels of education and suggests that a better level of knowledge ensures better self-management of diabetes. However, the relationship with the quality of glycemic control remains uncertain

Metabolic disorders during endogenous Cushing’s syndrome: prevalence, associated factors, and outcome after remission

Objective. The prognosis of Cushing’s syndrome (CS) is related to a higher cardiovascular morbidity and mortality. This study aimed to determine the prevalence of metabolic disorders in patients with CS, the associated factors, and the rate of remission of these disorders after the remission from CS