[Diabetic ketoacidosis and thyroid storm occurring while awaiting radical treatment, about 2 cases]

The association of uncontrolled type 1 diabetes and Grave's disease may induce metabolic decompensation leading to the simultaneous occurrence of diabetic ketoacidosis and thyroid storm. This double endocrine emergency, although rare, is known to be life-threatening. Diagnostic difficulties due to an atypical presentation of thyroid storm that can be masked by diabetic ketoacidosis result in delayed diagnosis and treatment and therefore in a fatal outcome. We report two cases in whom early recognition and intensive treatment have led to an improved outcome. Radical treatment of the Grave's disease immediately at the diagnosis of the associated type 1 diabetes may prevent this double complication

hyperosmolar decompensation of diabetes mellitus about 57 case

Between 1989 and 2000, 57 cases of hyperglycaemic hyperosmolarity were diagnosed in the department of Endocrinology-Diabetology of Farhat Hached Hospital in Sousse. The age of our patients was between 46 and 98 years and the sex-ratio was 0.9. Type 2 diabetes was found in 87.8% of cases, while patients under insulin therapy represented 12.2% of the cases and patients with unknown diabetes 35%. The precipitating cause was an acute infection in 59.6% of the cases, a iatrogenic cause in 42.1% [a use of diuretics in 33.3%], and a cerebrovascular accident in 20%. A handicap was present in 43.8% of the patients. Dehydration was present in all our cases, while a comatous state was found in 12.5% and hypotensive shock in 8.7%. On admission, the blood sugar was found to be between 21.4 to 64 mmol/l and the calculated osmolarity between 320 and 465 mosmol/kg. The mortality rate was 10.5% while the evolution was good in 80% of the cases

[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

[Hypoglycemic comas from multiple sources in a type 1 diabetic]

Iterative hypoglycaemic comas in type 1 diabetic patients are a serious problem which may be caused by many factors like educational errors, unawareness of hypoglycaemia and also adrenal insufficiency and diabetic nephropathy while factitious hypoglycaemia is the major diagnostic pitfall. We report an unusual case of a 35-year-old man, who presents a type 1 diabetes for the past 23 years, and who had unexplained hypoglycaemic comas for the past four months even after decreasing his insulin doses. The investigation revealed factitious insulin injections but also the presence of adrenal insufficiency Graves' disease and diabetic nephropathy without renal failure. Psychiatric evaluation showed a depressive state induced by diabetic complications and hyperthyroidism. This case report emphasizes the fact that organic and factitious causes of hypoglycaemia may be present in the same patient that is referred for type 1 diabetic hypoglycaemia

[Long-term evolution of human macroprolactinomas treated with dopaminergic]

The aim of this study is to evaluate the long-term results of dopaminergic therapy in macroprolactinoma in the male. We report 5 cases of macroprolactinoma in men [age 27 to 40 years]. Four of the patients had expansive macroprolactinoma while the fifth one had an enclosed one. One patient was treated after failure of radio-surgical therapy, whereas the four other patients did not have prior surgery. Prolactin level was higher than 2500 mU/l in all cases with the presence of hypopituitarism and visual field amputation. All patients were initially treated with bromocriptin and had hormonal and pituitary CT or RMI follow up. Favourable evolution occurred in four patients with prolactin level normalisation within a few months to two years. There was a tumoral shrinkage in three cases within a period of 5 years. Bromocriptin resistance occurred in only one patient. Two years after ineffective pituitary external radiotherapy, quinagolide treatment lead to normalise prolactin levels and to reduce adenomous mass. These results emphasize the efficacy of dopaminergic therapy as first approach in macroprolactinoma in male. Nevertheless, it requires good compliance and the absence of side effects. Therefore, long acting dopaminergic or D2 receptor specific dopaminergic agents are excellent alternatives to surgery