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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: 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]

Coronary spasm related to thyrotoxicosis is a complication rarely reported in the literature. Its initial clinical presentation is often more severe with more diffuse involvement and resistance to medical treatment compared to classic coronary spasm. Its diagnosis relies on a careful clinical analysis and a comparative study of electrocardiographic data. Coronary angiography should be avoided as much as possible as well as treatment by nonselective beta-blocking agents because of the risk of worsening hyperthyroidism and coronary vasoconstriction. We report a case of coronary spasm secondary to Graves' disease whose management was inspired by lessons learned from clinical cases reported in the literature. [ABSTRACT FROM AUTHOR]

Metformin is one of the prevalent treatments for type 2 diabetes. It is widely used in diabetology due to its safety and effectiveness. For more than a decade, there was a growing interest on the benefit of metformin in multiple tumor locations, especially in the breast cancer. Epidemiological data shows a reduced incidence of breast cancer in patients on metformin. The underlying mechanism of this benefic effect could be the limitation of tumor cell proliferation by downregulating the insulin/IGF-1 axis and phosphorylation of mTOR. However, the available data are not sufficient to support the use of metformin in breast cancer as an anti-tumor therapy. Ongoing trials are evaluating the benefit of metformin in different stages of breast cancer. Additional researches including potential biomarkers are needed to confirm the accurate efficacy of metformin treatment in the prevention and the recurrence of breast cancer. [ABSTRACT FROM AUTHOR]

Bilateral macronodular adrenal hyperplasia (BMAH) is a rare cause of adrenal Cushing's syndrome, accounting for less than 1% of cases. We here report the case of a 48-year-old patient with diabetes and hypertension presenting with clinical signs of Cushing's syndrome. Etiological assessment enabled clinicians to retain the diagnosis of Adrenocorticotropic hormone (ACTH)-independent hypercortisolism associated with BMAH. Unilateral left adrenalectomy was performed based on noriodocholesterol scintigraphy results, with good outcome. However, given the risk of recurrence and cardiovascular complications, long-term monitoring was scheduled. [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]

Autoimmune hypothyroidism is a common medical condition. Its revelation by thyrotrophic hyperplasia is an unusual and may be misdiagnosed as a pituitary adenoma. A 35-year-old man is referred to us for endocrinological assessment before surgery of a pituitary macroadenoma with bitemporal hemianopsia. Biological data reveal profound primary hypothyroidism. With thyroid hormone substitution, the thyroid function was normalized. Follow-up magnetic resonance imaging, showed the complete shrinkage of the pituitary mass attesting of a thyrotrophic pituitary hyperplasia. This case highlights the importance of a multidisciplinary assessment of pituitary masses to avoid unnecessary surgery and to prevent consequences of sellar masses. [ABSTRACT FROM AUTHOR]

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]