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Factitious Cushing's syndrome is extremely rare. The difficulty of its diagnosis lies in the cross-reaction between synthetic corticosteroids and plasma or urinary cortisol during immunological tests, which can make it difficult to distinguish between the real Cushing's syndrome and its factitious version. We present in this article a case of 33-year-old women, followed for ankylosing spondylitis for which she had received corticosteroid therapy in the past, who presented for a frank physical stigma of Cushing's syndrome, for which she had consulted several times. The biological evaluation found evidence of elevated free cortisol urinary levels contrasting with inhibited plasma cortisol and inhibited ACTH. The dynamic tests carried out were negative. The adrenal imaging was without particularities. Although the patient has always denied taking exogenous corticosteroids, the measurement of urinary free cortisol using liquid chromatography coupled with mass spectrometry who was decisive and showed drug interference during measuring. In this rare case, we expose the difficulties encountered by the clinician on two levels, proving the exogenous origin of glucocorticoid toxicity on the one hand and confronting the patient and their relatives on the other hand. Finally, it is important to consider this differential diagnosis in cases of hypercortisolism, especially when the patient's medical history and the results of investigations are contradictory. [ABSTRACT FROM AUTHOR]

Ocular inflammatory reactions secondary to treatment with bisphosphonates are a rare entity. Their physiopathological mechanism is still poorly understood but seems to be linked to an immunological reaction mediated by some cytokines. Observation: We report the case of a 63-year-old patient followed for severe osteoporosis and treated with zoledronate. The patient presented 6 weeks after the initiation of treatment with a decrease in visual acuity diagnosed as acute anterior uveitis. Conclusion: Acute anterior uveitis is an important entity to be aware of because a good evaluation and rapid management can reduce complications involving the visual prognosis. [ABSTRACT FROM AUTHOR]

Introduction: Pheochromocytomas are catecholamine-producing tumors presenting with various clinical symptoms and a serious potentially lethal cardiovascular complications due to the potent effects of secreted catecholamines. Glucoregulation disorders could also occur leading to impaired glucose tolerance and diabetes mellitus. The aim of our study was to determine the effects of adrenalectomy on patient recovery with regard to their glycemic status. Materials and Methods: Case notes of all patients who underwent adrenalectomy surgery for pheochromocytoma from 2009 to 2018, followed up in the Department of Diabetology, Endocrinology, and Nutrition at University Hospital Center Hassan II of Fez, were retrieved, and data were collected from them to identify those with preoperative diagnosis of glucoregulation disorder and to verify if adrenalectomy can reverse or improve glycemic abnormality. Results: Overall, 23 patients underwent surgery for pheochromocytoma, 26% of cases had diabetes mellitus, whereas 34.78% had glucose intolerance. One year after surgery, diabetes and glucose intolerance were cured in 57.14% of cases. We noticed also that patients with large and symptomatic tumors were more likely to develop preoperative diabetes; it was also more likely to persist in patients who had an elevated body mass index (BMI). Conclusions: In our data, diabetes and glucose intolerance were found concurrently with pheochromocytoma in 60.78% of patients. Thus, it is important for clinicians to screen for glycemic disorder when pheochromocytoma is diagnosed, especially in patients with other risk factors for developing type 2 diabetes such as elevated BMI. Removal of these tumors can reduce insulin secretion and severe peripheral insulin resistance making early diagnosis important. [ABSTRACT FROM AUTHOR]

Background: Type 1 diabetes mellitus (T1DM) is an autoimmune disorder caused by pancreatic β-cells destruction. Anti-pancreatic antibodies are the witness of β-cell destruction and their dosage is mainly used for etiological diagnosis. Patients with T1DM are at increased risk of developing other autoimmune reactions, which may involve other organs, resulting in organ specific autoimmune disease. The most frequently encountered are autoimmune thyroid disease, followed by celiac and gastric disease and other rare autoimmune diseases. Objectives: The purpose of this study is to investigate the prevalence of autoimmune markers in patients with T1DM. Methods: The study was conducted at the Department of Endocrinology of the Military Hospital Moulay Ismail in Meknes Morocco, from January 2016 to December 2018. All Type 1 diabetes patients consulting during the study period were included in the study. Their clinical and biochemical data were collected at their first presentation, made up of anti-pancreatic antibodies (glutamic acid decarboxylase [GAD] antibody, tyrosine phosphatase antibody, and islet cell antibody) and other organ-specific antibodies: the thyroid (antithyroid peroxidase antibody, antithyroglobulin antibody, and antithyroid-stimulating hormone receptor antibody), the intestine (IgA antitissue transglutaminase antibody), the adrenal gland (anti-21 hydroxylase antibody), and the stomach (antigastric parietal cell antibody and anti-intrinsic factor antibody). Results: Fifty-four patients were included, with an average age of 26 years. GAD, tyrosine phosphatase, and islet cell antibodies were detected in 74%, 22%, and 3.7%, respectively, of the 54 patients examined. The prevalence of extrapancreatic autoimmunity was 45% with a large preponderance among different immunities of those from thyroid and celiac diseases (CDs). Conclusion: Our results confirm that patients with Type 1 diabetes should be investigated for the presence of autoimmune diseases mainly from thyroid and CDs. [ABSTRACT FROM AUTHOR]

Cushing's syndrome is caused by prolonged exposition supraphysiological to endogenous or exogenous cortisol. Ectopic production of adrenocorticotropic hormone by lung carcinoid tumors is relatively rare. Most documented cases have been reported individually. This rare neoplasm low grade that may secrete adrenocorticotropin (ACTH) leading to rapid development of hypercortisolism which is the main mode of discovery, can be a real aggressive form. This report shows a high aggressiveness of this endocrine neoplasia, which was marked on the general, morphological, bone and psychiatric level. The trivialization of clinical signs had caused the delay in diagnosis with irreparable bone consequences. [ABSTRACT FROM AUTHOR]

Background: Thyroid nodules (TN) are more frequent in the iodine-deficient region and the proportion of benign nodules is higher compared to areas with sufficient iodine intake. Objective: The aim of this study was to assess factors associated with malignant TN specially the EU-TIRADS ultrasound score in a Moroccan population with a high prevalence of iodine deficiency. Methods: In a prospective cross-sectional study, we enrolled outpatients referred for TN with fine needle aspiration biopsy (FNAB) according to EU-TIRADS 2017 classification. Malignancy of TN was defined by histological results indicating a thyroid malignancy on thyroid micro-biopsy or after surgical resection if indicated. Results: 225 participants with TN were enrolled. The median age was 54 (42.5 to 62) years-old. The prevalence of malignant TN was 8.9%. Malignant TN were significantly smaller than non-malignant ones (p = 0.008) and sub-centimetric TN were more frequent in malignant TN (25% vs 1.5%; p < 0.001). On multivariate analysis, male gender (OR : 9.33 ; 95% CI [2.02 ; 43.01]; p = 0,004) and EU-TIRADS score of 5 (OR : 55.6 ; 95% CI [9.34 ; 327.91] ; p < 0.001) were independent factors associated with malignant TN. The EU-TIRADS score of 4 was not associated to malignant TN. Conclusion: Our data suggest a trend of over-diagnosing indolent thyroid cancer. The EU-TIRADS score of 4 was not associated with TN malignancy. Considering clinical, accessory sonographic features, and size threshold for FNAB in EU-TIRADS 4 score TN may refine the diagnosis performance of this score in our population [ABSTRACT FROM AUTHOR]

Les néoplasies pulmonaires à petites cellules et les tumeurs avec une différenciation neuroendocrinienne sont très fréquemment impliquées dans les syndromes paranéoplasiques. Elles peuvent perturber l'équilibre hydrique de deux manières, qui doivent être reconnues par l'interniste et l'endocrinologue. La plus fréquente est le syndrome de Schwartz-Bartter, qui fait suite à une sécrétion ectopique d'hormone antidiurétique par les cellules néoplasiques. La seconde est le diabète insipide central par le biais d'une destruction massive de l'hypothalamus par dissémination métastatique. Peu de cas sporadiques de diabète insipide central du fait d'une localisation secondaire ont été rapportés. Nous rapportons l'observation clinique d'une présentation inhabituelle de cancer pulmonaire à petites cellules, associé à un syndrome polyuropolydipsique, avec une bonne réponse au traitement. [ABSTRACT FROM AUTHOR]

Gestational diabetes is one of the most common medical complications of pregnancy, and its prevalence is increasing worldwide. Although the HAPO study resulted in the diagnostic criteria of gestational diabetes of the international association of diabetes and pregnancy study groups, they are not yet accepted by all learned societies. Also, the cost-effectiveness of early gestational diabetes research remains to be determined. A new classification in four categories instead of two, has just been published in 2024 suggesting a promising prognostic interest. Despite the great popularity of metformin, its use in gestational diabetes remains controversial due to the transplacental passage and the lack of long-term follow-up data and insulin now remains the first-line treatment. Continuous glucose monitoring is a promising tool that certainly improves glycemic control, but its use in gestational diabetes, in particular patients not treated with insulin, suffers from a low level of evidence. [ABSTRACT FROM AUTHOR]

Background. The thyrotropin-secreting adenomas are very rare and even more rare when they simultaneously coexist with thyroid carcinoma. So far, only sixteen cases have been reported in the literature. Here, we present a unique case of successful management of a concurrent case of thyrotropin-prolactinoma with papillary thyroid carcinoma. Case Presentation. A 50-year-old Moroccan woman underwent a total thyroidectomy and complementary totalization by iratherapy for papillary thyroid carcinoma, who presented persistence of an inappropriate secretion of the thyroid-stimulating hormone (TSH > 4 mUI/L) despite of levothyroxine suppressive therapy (300 μg/d). After eliminating noncompliance, interfering medicines, and thyroid malabsorption, a pituitary adenoma (12 mm) was documented at magnetic resonance imaging. The patient has had transsphenoidal pituitary adenomectomy with histology confirming a thyrotropin-prolactin-secreting adenoma. After surgery and lanreotide treatment failures, we noted a complete response (TSH < 0.5) with cabergoline treatment (3 mg/week). Conclusion. The unusual association of thyroid adenocarcinoma and TSHoma enriches the hypothesis of a potential link between thyrotropic hypersecretion and thyroid carcinogenesis. Our case also illustrates the difficulty of monitoring thyroid carcinoma in nonremission of a TSHoma. [ABSTRACT FROM AUTHOR]

Fahr syndrome is a rare anatomo-clinic disease whose most common cause is primary or postoperative hypoparathyroidism. It is characterized by bilateral and symmetrical intracerebral calcifications located in the central gray nuclei, most often associated with phosphocalcium metabolism disorders. We here report the case of a 54-year old patient who had been treated for primary hypoparathyroidism for 20 years, presenting with amnesic disorders revealing Fahr syndrome secondary to hypoparathyroidism. [ABSTRACT FROM AUTHOR]