Precocious puberty and hypothalamic hamartoma

Central precocious puberty is exceptionally due to hypothalamic hamartoma in girls under one year of age. A small girl hospitalized for exploration of precocious puberty started since the age of 7 months. Exploration of the hypothalamic-pituitary axis confirmed the central origin of this puberty. Magnetic resonance imaging [MRI] showed a small pediculate hypothalamic hamartoma [HH]. Evolution under triptorelin [recoil of 6 years] was favourable with notably the secondary sexual characters disappearance, the slowing of the speed of growth and the bony maturation. Central precocious puberty must make search HH even in girl. Its pathogenesis again controversial, seem to be in this age probably multifactorial. Our observation illustrates the efficiency of long-acting GnRH agonists during the central precocious puberty due to HH even in infantile form

[Treatment of allergic rhinitis prevents asthma]

Bronchial hyperresponsiveness can be associated to rhinitis or a chronic cough The aims of this study were firstly to explore theses signs, and secondly to prove the effect of local treatments in the reduction of asthma risk development 12 patients with allergic rhinitis benefited of a clinic exam, a rhinoscreen exam and a metacholine bronchial challenge. The same patients were explored again two months later after a local corticoid treatment Results showed that all patients presented a bronchial hyperresponsiveness at the first visit and after the local treatment a meaningful improvement was established

[Hypoglycemic comas from multiple sources in a type 1 diabetic]

Iterative hypoglycaemic comas in type 1 diabetic patients are a serious problem which may be caused by many factors like educational errors, unawareness of hypoglycaemia and also adrenal insufficiency and diabetic nephropathy while factitious hypoglycaemia is the major diagnostic pitfall. We report an unusual case of a 35-year-old man, who presents a type 1 diabetes for the past 23 years, and who had unexplained hypoglycaemic comas for the past four months even after decreasing his insulin doses. The investigation revealed factitious insulin injections but also the presence of adrenal insufficiency Graves' disease and diabetic nephropathy without renal failure. Psychiatric evaluation showed a depressive state induced by diabetic complications and hyperthyroidism. This case report emphasizes the fact that organic and factitious causes of hypoglycaemia may be present in the same patient that is referred for type 1 diabetic hypoglycaemia

[Long-term evolution of human macroprolactinomas treated with dopaminergic]

The aim of this study is to evaluate the long-term results of dopaminergic therapy in macroprolactinoma in the male. We report 5 cases of macroprolactinoma in men [age 27 to 40 years]. Four of the patients had expansive macroprolactinoma while the fifth one had an enclosed one. One patient was treated after failure of radio-surgical therapy, whereas the four other patients did not have prior surgery. Prolactin level was higher than 2500 mU/l in all cases with the presence of hypopituitarism and visual field amputation. All patients were initially treated with bromocriptin and had hormonal and pituitary CT or RMI follow up. Favourable evolution occurred in four patients with prolactin level normalisation within a few months to two years. There was a tumoral shrinkage in three cases within a period of 5 years. Bromocriptin resistance occurred in only one patient. Two years after ineffective pituitary external radiotherapy, quinagolide treatment lead to normalise prolactin levels and to reduce adenomous mass. These results emphasize the efficacy of dopaminergic therapy as first approach in macroprolactinoma in male. Nevertheless, it requires good compliance and the absence of side effects. Therefore, long acting dopaminergic or D2 receptor specific dopaminergic agents are excellent alternatives to surgery

Valeurs de reference spirometriques chez la population Tunisienne

The present study was performed to provide prediction equations and more precise lower limits of normal for spirometic parameters in helthy, well-screened Tunisian subjects as these are unknown. Lung volumes and forced expiratory flows were measured in a random sample of 977 non smoking persons 18-70 years of age [444 women, 533 men]. Techniques and equipment followed the international recommendations. All measurements were carried out using a body plethysmograph. Prediction equations were generated by multiple linear regressions using height and age as independent variables. Upper and lower limits were determined with a non parametric method. Mean values of predicted parameters for Tunisan were lower than for Caucasians and higher than values for black Africans. Spitrometric reference values derived from Tunisian population might be helpfull to" estimate the lung function in the epidemiologic field and for assessement of pulmonary diseases