[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

[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

[TSH-secreting adenoma: Difficulty in management and review of literature-about one case]

TSH-secreting adenomas are rare; they represent less than 2 or 3% of all pituitary adenomas. We report a case of TSH-secreting adenoma in a 52 year old man revealed by cardiac arrythmia. The diagnosis was made in presence of hyperthyroidism with a TSH in the upper limit of normal value, with an increase in the alpha sub-unit and with the presence on the MRI of a pituitary macroadenoma. The patient was treated with somatostatin analogues before transphenoidal surgery. TSH-secreting adenomas are classically revealed by hyperthyroidisni with inappropriate secretion of TSH and a pituitary adenoma. Transphenoidal surgery is the recommended treatment but the results are not always satisfactory because most adenomas are invasive macroadenomas. Somatostatin analogues improve management and prognosis of these adenomas

[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

[Prognostic factors for surgical cure in acromegaly]

Surgery is the treatment of choice in acromegaly. To determine the prognostic factors for surgical cure in growth hormone secreting pituitary adenomas, we studied 35 patients who underwent surgery between 1986 and 2005. We compared the clinical, biological and tumoral characteristics of the cured group [n=19] and those of the non cured group [n=16]. A young age and in invasive adenoma were factors for a poor surgical prognosis. Other factors for bad surgical prognosis are reported in the literature such as a preoperative GH level higher than 50 ng/ml, a monohormonal finding at immunohistochemistry and no GH suppression after surgery

[ 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

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

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