[Facticious hypoglycaemia and diabetes: diagnosis difficulty]

There are many facticious diseases, and their diagnosis is often difficult, facticious hypoglycaemia due to auto-administration of insulin or secondary to insulin secretagogues drugs are probably under estimated. We report the case of a 25 years old woman who presents a particular facticious hypoglycaemia. she pretends to be treated for diabetes with insulin injection for 2 years. We suspect the [facticious diabetes] since she has normal fasting blood glucose level and without hyperglycaemia after her hypoglycaemic episodes, we decided to stop insulin injections, and realize that hypoglycaemia only happen when her husband comes and disappear when she has no visitors. Insulinemia and C-peptide coupled of the blood glucose level in addition to the oral provocated hyperglycemia confirm the diagnosis of facticious hypoglycaemia. the patient denied the insulin injection and we concluded she has a Munchhausen syndrome

[Utilisation of HbAlc in general practice]

Diabetes is a common, costly, and highly morbid chronic illness that requires continuing medical care to prevent acute complications and to reduce the risk of long-term complications. There is no definitive treatment for this disease, and the only way to avoid its complications is to obtion adurable equilibrant glycemic targets. The glycated haemoglobin and especially the HbAlc has become the [gold standard] for assessing and monitoring glycaemic control in patients with type 1 and type 2 diabetes. All laboratories determining HbAlc should use methods certified by the national glycohemoglobin standardisation program diabetes control and complications trial [NGSP/DCCT]. The upper limit of normal for such methods is generally from 4 to 6%. Sometimes, its interpretation should be reviewed because of red blood cells anomalies. Nowadays, HbAlc is recommended for the follow up of the diabetic patients. However, its role as a diabetes screening test or for diagnosis is not conclusively established. Actually, measurements of HbAlc allows clinicians to directly use their laboratory value to estimate future risk of micro and macro vascular complications

[Germinoma with double localisation: hypophysitis and suprasellar]

Germinoma is an embryonic tumor of the childhood and adolescence. It represents less than 1% of intracranial neoplasms. The simultaneous presence of a pineal and a sellar germinoma is exceptional. We report a case of this association and we review the diagnostic and therapeutic difficulties that have to be faced with these tumors in our context

[ case of spontaneous pregnancy with Sheehan's syndrome]

Pregnancy in Sheehan syndrome is rare. Pituitary necrosis is sometimes incomplete and some remaining gonadotropic cells may induce ovulations. We report the case of a patient who presented with Sheehan syndrome and received cortisone and thyroxin substitutive therapy but no estrogen-progestogen treatment. One year later, the patient presented with a spontaneous pregnancy which was carried out until term. She delivered a healthy new born who was not breast-fed

Primary hyperaldosteronism: about 2 cases

syndrome of primary hyperaldosteronism [PHA] includes hypertension and hypokalemia in he presence of an excessive production of aldosterone with low renin levels. The identification in a hypertensive patient is particularly interesting because this pathology is a curable ause of HTA. We report two such cases

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