[Congenital hypothyroidism: about 5 observations]

Congenital hypothyroidism is one of the most frequent endocrine disease in childhood and its consequences are potentially harmful on the neurological and intellectual development of the child. We report the following 5 cases to underline the rarity of certain aetiologies and importance of an early management. Our first case involves a brother and a sister coming from Ouezzane [endemic zone], who presented at the age of 20 with an enormous goitre and cretinism. The second case is about two brothers and one sister coming from Sale [a non endemic area], with consanguineous parents. The first case was discovered at birth because of a neonatal goiter. The diagnosis in the second and third siblings was made when they were around 2 years of age because of a goitre and signs of hypothyroidism. Hormonal substitution was prescribed with a good physical and psychomotor evolution. If iodine deficiency remains the most frequent aetiology, other causes such as hormonogenesis disorders must be considered in non endemic area. In our countiy, systematic screening for congenital hypothyroidism during the neonate period, as well as an early treatment will make it possible to improve the physical and psychomotor prognosis of congenital hypothyroidism

Adrenal incidentalomas

The increased use of morphological explorations more and more frequently involoves the fortuitous discovery of the adrenal tumours. Adrenal incidentalomas have become a common clinical and therapeutic problem. The aim of this study is to determine their frequency, the prevalence of the secreting and non secreting tumours, to establish the role of morphological and hormonal data in the therapeutic decision and to show the action to be taken recommended by our department. Our study reports 24 patients presenting with an adrenal incidentaloma. Our patients profited from a meticulous clinical examination, hormonal and morphological evaluation. The therapeutic decision rested on solid arguments. A clinical, endocrinological and morphological monitoring was recommended among all our patients. On 300 patients with adrenal tumours, we reported 24 cases of incidentalomas, that is to say a prevalence of 8%. The average age is 42 years with a clear female prevalence [17 women- 7 men]. The discovery of the mass was made primarily by abdominal ultrasound [18 cases]; these masses unilateral was 17 cases and bilateral in seven cases. Hormonal exploration discovered eight secreting tumours [six are pheochromocytomas, one is an adrenocortical adenoma and the other is an adrenocortical carcinoma]. Abdominal CT scan was practiced among all our patients, it evalueted the parameters with malignant tumours [large mass, irregular contours, necrosis...] in nine cases. All the patients with secreting and suspected tumours were operated. The not operated seven patients were re-examined periodically for 36 months [12-72 month]. The adrenal mass was disappeared in two cases, regressed in one case and remained stable among four patients three of then profited from cyto puncturo with results, returned negative. Within sight of this work, it appears to propose a systematic adrenalectomy in the event of hypersecreting tumour or suspect of malignaney than to operate all the incidentalomas

non functioning pituitary adenomas: about 24 case]

We present a retrospective study of 24 cases of non functioning pituitary adenomas which represent 10% of all our cases of pituitary adenomas. Macroadenomas were present in 76% of these patients and in 50% the diagnosis was made because of visual abnormalities that were isolated or associated to headache. The main endocrine symptoms were menstrual disturbances [46%] or sexual impotence [36%]. The first choice treatment was surgery in 46% of the cases

[Diabetes and microalbuminuria: about 87 cases]

Microalbumimuria is now, considered to be the reference parameter for an early screening of diabetic renal involvement. It constitutes also a predictive marker for a cardiovascular morbidity risk. Our goal in this study was to identify the different clinical and biologic factors that may correlate .with microalbumimuria. In type 1diabetic patients, microalbumimuria was, found to be correlated with the duration of diabetes [p=0,004], the retinopathy [p< 0,001], as well as with hypertension [p=0,001]. No correlation was found with BMI, HbAlc or serum lipid levels. In type 2 diabetes, we found a correlation between microalbumimuria and BMI [p=0,008], total cholesterol [p=0, 001], HbAI C [p=0,029], serum creatinine [p=0, 04], retinopathy [p> 0, 01] and hypertension [p=0,003]. An early management of these different factors may limit the risk and the evolutivity: of diabetic nephropathy

La maladie de cushing de l'enfant [a propos de 4 cas]

Cushing's syndrome is rarely met before the adult age. We report four observations of between 11 and 16 years old. The symtomatology is particular at this age. It's characterized by both faciotruncal obesity and growth slowing down which is always very noticed. The cortisol plasmatique, and mainly a fre urinary cortisol, is really pathologic. The dynamic tests are for the cushing's syndrome. The pituitary scanography shows a microadenoma in 2 cases from 4. For another case, nuclear magnetic resonance imaging was better than scanography. These 4 observations show either the difficulty met in therapeutic responsibility and the recent proposed attitude by first intention, but there is problem of a postoperative growth hormone deficiency: which should be compensated. The radiotherapy gives best result compared with adult, it was realized for two patients because their parents didn't admit any surgical intervention. The medical treatment is important for the hypercortisolism control before surgical operation, or waiting for the radiotherapy efficiency. Words keys: Cushing's, Cushing disease, children

Graves disease results of two methods of the radical treatment

The graves disease remains one of the major preocupations of the endocrinologist. It's a variable disease and its treatment is purely symptomatic and medical in the first purpose. Surgical versus Radioactive Iodine treatment are discussed. Through a retrospective study of 250 cases of Graves disease, 150 patients treated by surgery and 100 by radioactive iodine, we tried a comparative evaluation of these two methods. The analysis of the patients documents shows that the complications are less frequent in the patients who received the radioactive iodine, did not present hypoparathyroidism [the major complication of surgery]. The hypothyroidism is observed in only 27% of the cases after 22 +/- 6,8 months, versus 4 1,5% in the patients who underwent surgery [17 +/- 4,8 months]

puberties precoces

Precosious puberty is defined by appearance of sexual characteristics before eight years of age in girls and nine years of age in boys. We reported 14 cases of precosious puberty in endocrinology service of Ibn Sina Hospital in Rabat. Subjects were 11 girls and 3 boys, with an average of 5.08 +/- 2.5 years and signs of precosious puberty, of whom 6 were diagnosed as definite central precosious puberty, 3 cases as precosious pseudo puberty and 5 cases as a premature thelarche, which is a partial form of precosious puberty. The purpose of this study was to define clinical and biological symptomatology and prognostic problems

Le cancer parathyroidien [a' propos d'un cas]

The parathyroidal carcinoma is a rare disease which represents I% of the causes of primary hyperparathyroidism. About 200 cases are registered in the literature. A 31 year old woman, presented, 5 years ago, a tumor in right thyroidical lodge and a severe emaciation without adenopathy or dysthroidism. This mass was hypoechogen and scintiscan didn't fix it. In addition to that she presented. A biological inflammatory syndrome, hypercalcinemia and a diffuse bone demineralization. She was operated on in March 92 [total thyroidectomy]. Histology and especially immunohistochemistry led us to conclude to a parathyroidal carcinoma Through our observation and literature review we try to analyze the histological,biological and clinical particularities of this neoplasia. Keys Words: Hyperparathyroidism. Parathyroidal carcinoma

Thyroidite tuberculeuse [a' propos de 3 cas]

In our country, tuberculosis, a social curse, rages on endemic mode. The thyroid localization is exceptional [0,2%] and its clinical manifestation is usually misleading. The positive diagnosis is based on presumptive elements [contagion, other localization of tuberculosis] and the certitude is based on anatomopathology and/or put BK to the fore. We report three cases of confirmed tuberculosis thyroid in endocrinology, diabetology and nutrition service during ten years. The course of illness with treatment has been marked by a rapid amendment of clinical and biological symptomatology and an entire recovery

Le goitre endemique: Enquete pilote au Maroc

An investigation concerned 600 children aged between 10 and 14 years has allowed to value the frequency of the goitre by iodine deficiency in mountainous zone of Morocco. The frequency is estimeted at 65,2% with predominance in girls. In more than 90% of the cases, iodine in urine was lower than 5 ug/dl and confirm the iodine provided deficiency. By the light of these results, the therapeutic actions to conduct are discussed

Maladie de Basedow: Utilisation de doses elevees d'antithyroidiens de synthese dans la preparation a la chirurgie

With the intention to abridge the duration of the hospitalization for preparing Grave's disease to surgery, we have conduct a study about 30 patients. In 21 cases taken haphazardly without modification of the associate treatment, a treatment by 16 tab/day of antithyroid drugs was used that is to say the double of the habitual do sage. The normal rate of thyroid hormons was obtained after an average delay of 17 days under high quantities of antithyroid drugs against 29-46 days in the 9 patients under 8 tab/day that is to say one reduction of the hospitalization duration of 50%. We didn't note a singnificant difference for the undesirable effects of antithyroid drugs or the complications per and post surgery

Bone manifestations during Von Recklinghausen disease. About 8 cases

About 8 cases of osseous lesions in patients with Von Recklinghausen disease, the authors report the different radiologic findings encountered in this affection

Retard statural et maladie coeliaque

19 patients have consulted for statural delay of weight between June 1980 and December 1982. The age of the patients was between 13 and 20 years. They were between 1,30 m and 1,48 m tall. Their weight between 20 and 43 Kg. - The etiological checkup show: a constitutional statural delays with simple delay of puberty, a prolactine adenom, a turner syndrome, an insipid diabete, 2 hypophysis deficiencies, a chronic pyelonephrite by association of a syndrome of the unilateral junction to a bilateral vesicuo-ureteral reflux. 11 coeliac sicknesses whose positive.diagnostic, was established by jejunal biopsy and test to diet without gluten. Due to the predominance of this etiology and the presence In the patients of a radiological endocrine note [bone age less than the statural age] we did a complete endocrinien checkup on these patients with one test of TRH which showed an exaggerated repose in TSH. It seems to us that this THR test could be an important element for checkup and diagnostic of coeliac sickness

[Pseudo-myxoma peritonei. report of a case]

Pseudomyxoma peritonei remains a rare condition, resulting from diffusion in the peritoneal cavity of a mucoid matter resulting from the effraction of a mucosecretant epithelium organ. This diagnosis is not easy and should be discussed when there is an atypical increase of the volume of the abdomen. The authors report a case of this unusual entity review the literature and emphasize the practical therapeutic aspects

Tests cliniques pour le diagnostic des dysthyreoses [a propos de 93 cas]

It is about 3 clinical tests on dysthyreosis search with quotation of signs. The first is a diagnosis test of hyperthyroidism, the second of hypothyroidism. And the third, searchs for the therapeutic efficiency among treated hyperthyroidism. This clinical investigation concerned 85 patients suspected of dysthyreosis or treated hyperthyroidism and 8 reference students free of any thyroidal pathology. The biological investigations consisted of T3 and/or T4 and/or TSH dosages.- Among the reference students, these tests permit and exclusion diagnosis in 100% of the cases.- With the dysthyreosis patients, there is a perfect correspondance between clinical scores and radio-immunological dosages in 76,5% of the cases

Hepatocholangiome et Cushing paraneoplasique

A case of paraneoplasic cushing's syndrome, the rarest a etiology of which is reported and correlated in our analysis to habitual a etiologies such as bronchogenic carcinoma thymic or pancreatic which could be a causative factor in such syndrome. To our knowledge and after meticulous study of medical litterature, the observation we present is the only case of hepatic cholangioma associated with paraneoplasic cushing's syndrome