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Copyright of Cahiers Santé - Médecine Thérapeutique is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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]

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]

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]

Objective: The aim of this study was to estimate the prevalence of cardiovascular disease and investigate cardiovascular risk management among type 2 diabetes (T2D) patients in the city of Meknes. Materials and methods: In a non-interventional cross-sectional study, we enrolled adult outpatients (= 18 years old) with T2D from the endocrinology and diabetology consultation of the Military Hospital of Meknes from June 2021 to January 2022. Informed consent was signed by all participants in the study. Assessment of cardiovascular risk was based on European Society of Cardiology (ESC) Guidelines on cardiovascular disease prevention in clinical practice of 2021. Clinical, biological and therapeutic data were compared between patients with and without cardiovascular disease. Data were analyzed using SPSS version 18 statistical software. Results: One hundred eighty T2D patients were enrolled. The mean age was 59.42 ± 8.72 years. The prevalence of cardiovascular disease was 13.3%. The prescription of statin (p < 0.001), antihypertensive treatment (p < 0.001) and platelet aggregation inhibitors (p < 0.001) was significantly higher in patients with cardiovascular disease. Overall, 5.6% patients were prescribed a blood glucose-lowering agent with demonstrated cardiovascular benefit. This prescription was higher in patients with cardiovascular disease (5 (20.8%) vs. 5 (3.2%); p = 0.004). It was found that 7.2% patients had an optimal cardiovascular risk factor management. Conclusions: The prevalence of cardiovascular disease among T2D patients is high in the city of Meknes. Despite an optimal prescription of cardiovascular medications, comprehensive control of cardiovascular risk factors is not achieved in most patients. The use of blood glucose-lowering agents with demonstrated cardiovascular benefit was low but significantly higher among patients with cardiovascular disease. [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]

Background. Immunological investigations are intended for diagnosing T1D in atypical clinical presentation, also exploring the predisposition to T1D in a context of multiple autoimmune disorders or among the siblings of a patient with type 1 diabetes. While the diagnosing or the screening of T1D using five antibodies presents high expenses especially in emerging countries, it is for interest to determine their prevalence in order to choose the most frequent and most relevant. The aim of our study is to determine the prevalence of antibodies in Moroccan population. Methods. We investigated 62 T1D patients, the prevalence of autoantibodies was 74% for glutamic acid decarboxylase 65 auto-antibody (GADA), 46% for insulinoma-associated protein 2 autoantibody (IA2A), and 3% for islet cell antibodies (ICA). GADA and/or IA2A were reported in all patients (100%). The GADA frequency was neither associated with the duration of diabetes nor the age of patients. Results. Finally, GADAs are by far the best markers for T1D, IA2As complements GADAs and increases the diagnostic sensitivity for detection of pancreatic autoimmunity and ICA should be abandoned because of its low prevalence. [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]

Diabetes is a risk factor for bad prognosis of COVID-19. Many mechanisms can explain the bad prognosis of COVID-19 in diabetics, but they remain hypothetical. The high prevalence of diabetes on the African continent, particularly in North Africa (12.2%), constitutes a threat of increased morbidity and mortality linked to COVID-19. We must pay particular attention to this fragile population, with more time and resources, especially for the elderly, obese or those with chronic complications of diabetes who have a high risk of developing severe forms. [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]

Copyright of Pan African Medical Journal is the property of Pan African Medical Journal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)