Sheehan's syndrome with pancytopenia: a case report and review of the literature

<p>Abstract</p> <p>Introduction</p> <p>Sheehan's syndrome is defined by varying degrees of anterior pituitary deficiency due to postpartum ischemic necrosis of the pituitary gland after massive bleeding. It is a rare disorder in western countries and even in Tunisia. Hematologic abnormalities such as normochromic anemia have been reported in these patients. However, pancytopenia is rarely observed.</p> <p>Case presentation</p> <p>We describe the case of a 48-year-old Tunisian woman with features of hypopituitarism. Laboratory tests showed pancytopenia that was completely reversed after adequate hormone replacement.</p> <p>Conclusion</p> <p>Clinicians should consider the possibility of hypopituitarism as a cause of pancytopenia. This is an original case report that is of interest to hematologists, who should be aware of Sheehan's syndrome as a treatable etiology of pancytopenia for women.</p

Leydig Cell Tumor Associated with Testicular Adrenal Rest Tumors in a Patient with Congenital Adrenal Hyperplasia due to 11β-Hydroxylase Deficiency

Congenital adrenal hyperplasia (CAH) describes a group of inherited autosomal recessive disorders characterized by enzyme defects in the steroidogenic pathways that lead to the biosynthesis of cortisol, aldosterone, and androgens. Chronic excessive adrenocorticotropic hormone (ACTH) stimulation may result in hyperplasia of ACTH-sensitive tissues in adrenal glands and other sites such as the testes, causing testicular masses known as testicular adrenal rest tumors (TARTs). Leydig cell tumors (LCTs) are make up a very small number of all testicular tumors and can be difficult to distinguish from TARTs. This distinction is interesting because LCTs and TARTs require different therapeutic approaches. Hereby, we present an unusual case of a 19-year-old patient with CAH due to 11β-hydroxylase deficiency, who presented with TARTs and an epididymal Leydig cell tumor

Obésité, activité physique et temps de sédentarité chez des adolescents scolarisés, âgés de 15 à 18 ans de la ville de Sfax (Tunisie)

Introduction: Le but de notre étude était d'évaluer la prévalence du surpoids et de l'obésité chez des adolescents scolarisés dans la ville de Sfax mais aussi, d'étudier son association avec le temps de sédentarité et l'activité physique (AP). Méthodes: La population étudiée était composée de 1695 adolescents âgés de 15-18 ans. Tous les participants avait rempli un questionnaire porté sur leurs activités physiques et temps de sédentarité, donné lors d'un entretien direct. Le niveau d'AP était évalué avec l'International Physical Activity Questionnaire (IPAQ) version courte. Résultats: Notre étude comportait 43,7% de garçons et 56,3% de filles. L'âge moyen était de 16,78 ± 1, 1 an. Dans notre échantillon, 23,4% des adolescents étaient en surpoids ou obèses. Le score de l'IPAQ nous a montré que le niveau d'AP de nos participants était faible dans 6,4%, modéré dans 65,4% et élevé dans 28,2% des cas. Nos résultats avaient démontré que l'augmentation du temps de sédentarité (plus de 2 h / jour) est associée à une augmentation significative de l'indice de masse corporelle (IMC) et du tour de taille (TT) (P &lt;0,001). Alors qu'un niveau d'AP élevé et/ou la participation aux séances d'AP structurées dans le cadre scolaire et hors scolaire est accompagnée par une diminution significative de l'IMC et du TT (P &lt;0,001). Conclusion: Nos résultats apportent une preuve supplémentaire sur la nécessité de promouvoir la vie active chez les jeunes Tunisiens.Pan African Medical Journal. 2015; 2

Atteinte hépatique au cours de la maladie de Rendu-Osler: à propos d’un cas et revue de la littérature

Patiente âgée de 48 ans était hospitalisée pour une cholestase asymptomatique hépatique. Elle rapportait une histoire personnelle et familiale d’épistaxis récidivante. Le bilan biologique révélait une anémie ferriprive et une cholestase modérée. Les sérologies virales ainsi que les anticorps anti tissu hépatique étaient négatifs. Le scanner abdominal objectivait de multiples shunts artério-veineux dans la région sous-capsulaire du foie. Le diagnostic d’une atteinte hépatique dans le cadre d’un Rendu Osler était retenu. Un traitement martial était prescrit et une surveillance biologique et morphologique du foie était entreprise.The Pan African Medical Journal 2016;2

Analysis of skewed X-chromosome inactivation in females with rheumatoid arthritis and autoimmune thyroid diseases

Introduction: The majority of autoimmune diseases such as rheumatoid arthritis (RA) and autoimmune thyroid diseases (AITDs) are characterized by a striking female predominance superimposed on a predisposing genetic background. The role of extremely skewed X-chromosome inactivation (XCI) has been questioned in the pathogenesis of several autoimmune diseases. Methods: We examined XCI profiles of females affected with RA (n = 106), AITDs (n = 145) and age-matched healthy women (n = 257). XCI analysis was performed by enzymatic digestion of DNA with a methylation sensitive enzyme (HpaII) followed by PCR of a polymorphic CAG repeat in the androgen receptor (AR) gene. The XCI pattern was classified as skewed when 80% or more of the cells preferentially inactivated the same X-chromosome. Results: Skewed XCI was observed in 26 of the 76 informative RA patients (34.2%), 26 of the 100 informative AITDs patients (26%), and 19 of the 170 informative controls (11.2%) (P 90% inactivation of one allele, was present in 17 RA patients (22.4%), 14 AITDs patients (14.0%), and in only seven controls (4.1%, P 0.05). Conclusions: These results suggest a possible role for XCI mosaicism in the pathogenesis of RA and AITDs and may in part explain the female preponderance of these diseases. © 2009 Chabchoub et al.; licensee BioMed Central Ltd

Insulinoma with equivocal imaging Wafa

A 55-year-old patient was admitted to our department for the management of a repetitive alteration of consciousness. Biological investigation results were consistent with endogenous hyperinsulinemic hypoglycemia. Insulinoma was therefore suspected. Abdominal computed tomography and endoscopic ultrasound showed no obvious pancreatic mass. Somatostatin receptor scintigraphy showed abnormal radioactive uptake in both the pancreatic tail and the uncinate process. Contrariwise, abdominal magnetic resonance imaging showed a unique lesion in the pancreas tail. The patient was then proposed for pancreatic surgery. Both intraoperative manual palpation and intraoperative ultrasonography of the pancreas showed a single corporal lesion of 1.5 cm. No lesion was found in the uncinate process. After a left pancreatectomy, the lesion was histopathologically confirmed to be a well-differentiated neuroendocrine tumor. The symptoms of the patient resolved almost immediately following the surgery. The follow-up is one and a half years to date