[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

[Congenital pituitary stalk interruption syndrome-Report of 6 cases]

Pituitary stalk interruption is a non-negligible cause of growth hormone [GH] deficiency. We report 6 cases [5 boys and 1 girl] with complete congenital GH deficiency. The average age was 13 years. 4 out of 6 cases [66, 6%] had corticotrophic hormone deficiency; 1 of 6 cases [16, 6%] had a hypothyroidism. 2 out of 4 children older than normal age of puberty had gonadotropin deficiency [50%]. Diabetes insipidus was not prsent and hyperprolcatinemia was present in 2 cases. 4 children had past history of fetal distress. Pituitary stalk interruption was assessed by the means of magnetic resonance imaging [MRI]. The cause of the stalk interruption syndrome is unknown. The MRI in this syndrome revealed ectopic posterior lobe location, stalk interruption and hypoplastic anterior-lobe. The outcome is progressive evolution towards panhypopituitarism and these patients require regular clinical survey and hormonal controls

[Infections and diabetes complications degenerative]

We present a retrospective study of 195 diabetic patients how were hospitalized during the year 2002 and who had an evolution of the role of the different degenerative complications in the occurrence of different infections. The most common bacterial infections encountered were in the urinary tract [n =21], the soft tissue [n[degree] 21] and the bronchopulmonary tract [n =12]. In the soft issue infections, the foot was concerned in 40% of the cases. Urinary tract injections were more common in women [p<0.05]. The frequency of urinary tract infections, septicemia, and bronchopulmonary tract injections was not significantly linked to the existence of degenerative complications, exception the case of the .foot infections that were more frequent in patients with arterial or neuropathic disease of the lower e-extremities

[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