[Association of Cushing syndrome and anti-phospholipid syndrome: about one case]

Cushing syndrome is a pro-thrombotic state that contributes to an increase in mortality. The antiphospholipid syndrome is characterized by repetitive thrombosis associated with the presence of autoantibodies against phospholipids or membrane proteins. Their association has not yet been described. We report the case of a 47 year old patient in whom the hormonal exploration of an adrenal incidentaloma led to the diagnosis of Cushing syndrome. He returned five years later with cerebral thrombophlebitis, bilateral lower limbs phlebitis and bilateral pulmonary emboli. An antiphospholipid syndrome was confirmed by positive anti-cardiolipin and anti-beta2 glycoproteine-I antibodies. The patient recovered after anti-coagulant treatment and resection of the adrenal adenoma. Thrombo-embolic complications during Cushing syndrome, especially when severe and extensive, must lead to the search for another acquired thrombotic condition, especially the antiphospholipid syndrome

[About age of diabetes]

Diabetes in the elderly is increasing significantly in medical practice. This retrospective study is about 261 patients over 60 years of age at the diagnosis of diabetes. The main conditions of diagnosis were fortuitous discovery [50, 9%], cardinal signs [23, 3%] and complication in 19, 2% of the cases. Systematic screening was rare [6, 9%]. A microangiopathy was seen in 27, 6% of the cases corresponding to an undetected diabetes and vascular lesions were found in 15, 7% of the cases. The majority of patients had type 2 diabetes [95, 8%] and 8,896 of them were already requiring insulin therapy. 44.4% of the patients were also treated for other conditions and 19.9% had a handicap. Our results suggest the need for an early screening and for a complete clinical and etiologic evaluation when diabetes is found in the elderly

Apport de l'iode 131 dans la prise en charge des cancers differencies de la thyroide [d'origine vesiculaire]

Radioiodine 131 has an important place in the management of well differentiated thyroid cancer. Patient preparation for radioiodine 131 administration must be rigorous and is based on the stimulation of endogenous TSH production, which requires a hypothyroid state after withdrawal of suppressive T4-therapy. The introduction of recombinant human TSH would simplify the protocol of preparation and improve the quality of life of patients. The diagnosis place of radioiodine 131 knew significant changes following the introduction of the serum thyroglobulin measurement. This tumour marker has a central role in the strategy of follow up and tends to be the principal element of indication for a diagnosis exploration with radioidine 131. the systematic ablation of thyroid remnants remains controversial particularly in patients with good prognosis fectors; the efficacy of low activities is also still debatable. The optimal follow up strategy and the indication of remnant ablation must take in account the prognosis factors of survival and recurrence. Radioiodine-131 therapy permits frequently the cure of distant metastases, particularly in infraradiological pulmonary forms. This fact outines the importance of an early detection of tumour recurrence based on the conjunction of radioiodine 131 and thyroglobulin. Side effects of radioiodine 131 therapy are generally limited it the precautionary measures are well applied; leukaemia constitutes the main risk but this complication is very uncommon and occurs after a high cumulative activity