RESUMO
The occurrence of acromegaly before the end of the growth period is very rare. We report a case of a patient who presented an acromegalo-gigantism. His height reached 2.45 m and his weight 145 kg. He had a typical facial dysmorphy and an insulin requiring diabetes mellitus. There was no sign of cardio-respiratory failure or of endocrine deficiencies. The echocardiography showed that the left ventricule was moderately dilated and hypertrophied but the systolic function was preserved. Hormonal investigation revealed high growth hormone [GH] levels without suppression after oral glucose load. Other pituitary secretions were normal. Initial tomodensitometry revealed an invasive macroadenoa. The patient had two trans-sphenoidal resections of the tumor completed by radiotherapy [45 Gy]. Afterwards, because of still unsuppressed GH levels, the patient was treated with Octreotide. This first published case of acromegalo-gigantism in Tunisia is particular not only by its rarity but also by its moderated effects on vital functions in spite of along spontaneous evolution
RESUMO
We assessed the effects of Ramadan fasting on metabolic control, particularly change of HDL-cholesterol in 25 type 2 diabetic patients treated with diet or oral agents, with good metabolic control. Clinical and biochemical parameters and food intake were evaluated 3 weeks before Ramadan, in the fourth week of Ramadan and 3 weeks after Ramadan.There were no changes in body weight and blood pressure nor any metabolic complications. The mean plasma fasting glucose, serum fructosamin and haemoglobin A1c did not change. We found a negative relation between cholesterol intake during Ramadan and the change of HDL-cholesterol. When cholesterol intake was lower than 400 mg/day, plasma HDL-cholesterol increased by 13% at the end of Ramadan and by 23% 3 weeks after Ramadan