[Pituitary deficiency of elderly subject: analysis of 14 cases]

The pituitary deficiency [PD] of the old subject is rare. To study the clinical biological etiologic and therapeutic characteristicsof PD in old subject. We report in this work a retrospective study of 14 patients older than 65 years presenting pituitary deficiency. This PD is characterized by a female preponderance [78, 5%of cases] and insidious initial symptomatology dominated by signs of thyreotrope deficiency and with a less degree of the signs of corticotrope sufficiency Anaemia [57, 5%] hypoglycaemia [28, 5%] and hyponatremia [21, 4%] are the most frequent biological signs. Hormonal exploration showed a dissociated pituitaiy deficiency in 11 cases [782 and global in 3 cases [21, 5%] The axis more touched is the gonadotrope axis [85, 7%] followed by the corticotrope [71, 4%] and thyreotrope axis [71, 4%]. The aetiologies are dominated by the Sheehan syndrome in 5 cases [35, 7%] followed by the hypophysis adenoma m 4 case [21, 4%]. The pituitary deficiency was idiopathic probably of vascular ongin in 2 cases [14, 28%] and secondary to primitive turcic saddle in 1 cases to a cyst of the pocket of Rathke in I case and to prolonged corticotherapy in 1 case. The hormonal substitutive treatment hare per-miffed a spectacular improvement in all the cases. It is necessary to think about the PD in the old subjects in front of minor signs and at the vascular ongin of this one witch remains the most frequent aetiology at the old subject especially those presenting atherogens factors

Impact of diet habits on clinical and biological characteristics of type 2 diabetics originating from south and costal regions

Type 2 diabetes is a very frequent pathology in our country. The objective of this study was to compare two diabetic populations recruited in the Monastir [M] and Sfax [S] areas. The aim of our study was to evaluate the effect of the diet on the evolution of the disease. The duration of diabetes was longer in the sample from Sfax and their levels for glycated haemoglobin and triglycerides were higher: 8.51 +/- 2.8 vs 10.2 +/- 3.6% [p=0.035] and 1.7 +/- 1.1 vs 2.6 +/- 1.3 mmol/l [p=0.006] respectively for group M and S. Total cholesterol, LDL-cholesterol and Apo AI levels were significantly higher in the M. group. Total homocysteine plasmatic levels were also significantly higher in the Monastir sample compared to the one from Sfax: respectively 23.3 +/- 15.4 vs 14.8 +/- 5.92 micro mol/l [p=0.002]. The protein food intake was positively correlated to the plasmatic homocysteine level only in the M. group [r= 0.439, p<0.001]. Olive oil consumption proved to be beneficial with a lowering of both systolic and diastolic blood pressure in the 2 groups [Monastir: r= -0.113, p<0.05 and Sfax: r= -0.403, p<0.001]. An appropriate and early management following the [Mediterranean diet] is called for in type 2 diabetes

[Primary Hypothyroidism subject of age: about 71 cases]

We report in this work a retrospective study of 71 patients older than 65 years who presented with primary hypothyroidism and were hospitalised. These patients represent 8.5% of all our hypothyroid patients. In our group, hypothyroidism was characterized by a female preponderance [72% of our cases] and by its atypical clinical presentation and the marked paucity of its clinical symptoms. The most frequent signs include physical asthenia [79%], weight increase [32%], cutaneo-mucosal signs [49.3%]. Anaemia and hyperlipidemia were the most frequent biological signs encountered [50% and 43% respectively] with hyponatremia found in 15% of the cases. Cardiovascular complications were present in 8 cases [11%]. A myxoedematous coma was present 3 patients [4%] and myopathy was seen in only one female patient. The aetiologies in our elderly patients were mainly auto-immune thyroiditis found in 74,6% of the cases and post-radiation hypothyroidism in 18.3%. Substitutive treatment was started during hospitalisation and the patients had thereafter a clinical and electrocardiographic follow-up to avoid ischemic coronary complications. The mean substitutive dose of L-thyroxine was 166 micro g/day