[Sheehan syndrom [of 40 cases]]

We proposed to undertake a study on the epidemiology, clinical, hormonal and evaluative profiles of 40 observations of antehypophysary failure of Sheehan postpotrum-syndrom assessed between 1980 and 1994. The occurance of hemorrhagic delivery is relatively early [29 years average], but the diagnosis was done 7years and half later [ranges going from 2 to 20 years]. Child delivery took place at home in 92% cases. The abondant hemorrhagy was found in 38 patients. The absence of this hemorrhagy in 2 of our patients leads to the hypothesis of lymphocytary hypophysite of poetpaetum. In case of the immediate post-partum the agalactia and the absence of recouvering are constant signs. In the mouths following the child-delivery, the clinical report of SHEEHAN syndrome did not show any particularities, compared to the classic form. In the absence of a dynamic hormonal explorations, we can not discuss neither the importance of hormonal deficiency, norther their repartition. The short term development under substitutive treatment, in good with ponderal advantage and with resumption of normal physical activities. At long term, an adherence failure to treatment was noticed in 6 patients

[Evaluation of autoinjection of insulin in 52 insulin treated diabetics]

Education is an essential part of treatment of diabetes. Self inject ion is one of the objectives of curriculum in every insulin treated diabetic. Auto-injection is necessary to avoid parenterally transmitted infectious diseases and to reduce dependence of patient on medical staff. This study evaluate in a standardized way self injection of insulin in two groups of insulin treated diabetics. Group I is constituted by 14 insulin treated diabetics recently educated in a standardized and unified way at diabetes and endocrinology unit CHU Ibnou Rochd. Group II is constituted of 38 insulin treated diabetics educated in diversified and non controlled way. The results show the frequency of sepsis mistakes. 10 patients in group I and 23 patients in group II. Mistakes in know-how are present in 2 patients in group I et 9 patients in group II. The consequence is the variability of the quantity of insulin injected. Zoning is executed by every patient of group I, but by none from by 17 patients of group II. Frequency of sepsis mistakes and know how mistakes in our study shows the importance of standardized and unified way of educating patients in auto injection of insulin. The reinforcement of learning needs to repeat the instruction many times and to evaluate it until the perfect doing of the self injection by the patient

[ medullary thyroide carcinoma]

The medullary thyroid carcinoma [M.T.C] spread at the expense of C-cell, combine with Apudomatoses or neuroscriptopathies. It is responsible for a high secretion of calcitonine, which is a true "tumor marker" for detection and follow-up of this carcinoma. Familial incidence, bilaterality and association with pheochromocytoma justifies the pentagastrin stimulation tests in family membres every patient with MCT. This screening displays the existence of C-cell hyperplasia, which is a preneoplasic stage allowing recovery. The M.T.C is revealed by a motor diarrhea, flushes or metastases. Locally, it is a nodule hard, painful nodule often bilateral in family cases. It is hypofixant at 131 -iode scintiraphy and needle cytoponction gives an interesting orientation of diagnosis. Treatment is surgical with first the cure of pheochromocytoma if any, then principe total thyroidectomy with systematic cervical lymph node dissection completed sometimes by radiotherapy and/or chemotherapy. Pronosis is relatively good. "Prophylactic" treatment of M.T.C. should encourage a multidisciplinary cooperation on the national scale

Acute adrenocortical insuffisciency three years after long term glucocorticoid therapy

The presentation of a case of acute adrenocortical insufficiency after long term glucocorticoid therapy allows a discussion about the risk and the failure to recognize this disease. The degree and duration of supression of hypothalamic-pituitary-adrenal axis depends on the duration and total dose of glucocorticoid therapy. After long term therapy with high doses there is profound and prolonged supression. The deficit of pituitary ACTH secretion is predominant. The control of return to normal, needs hormonal exploration particularly the rapid ACTH stimulation test. A modification of glucocorticoid therapy is useful to decrease the pituitary inhibition. On the other hand, ACTH therapy is unjustified. When the hormonal evaluation is impossible, careful observation is necessary during and long after the withdrawal, to avoid acute decompensation during stress

Gonadotrophic regulation in man. Respective role of testosterone, oestradiol, and non aromatisable androgens

The feed back system governing gonadotrophin secretion in man is complex. Clarification of the role of different steroids: testosterone [T], estradiol [E2] and non aromatizable androgens, uses varied experimental studies. It allows an analysis of the feed back: respective roles of different steroids, inter related effects: necessity of converting T to E2 and dihydrotestosterone [DHT] in periphery and in situ, anatomic level of the feed back, role of testosterone-estradiol binding globulin [TeBG]