[Atypical presentation of a premature ovarian failure with deletion of X chromosome]. / Présentation atypique d'une insuffisance ovarienne prématurée par délétion du chromosome X (à propos d'un cas).

In order to illustrate a particular clinical presentation of premature ovarian failure, we report the case of a 16-year-old girl, who presented with primary amenorrhea. Physical examination discovered central obesity and an extent acanthosis nigricans in the neck and in the axillae. Pubertal stage was quoted S3P3 and external genitalia were normal. Oral glucose test revealed glucose intolerance and hormonal investigation discovered hyperinsulinemia and elevated level of FSH. Pelvic echography found infantile internal genitalia and genetic analysis discovered a deletion in the long arm of one of X chromosomes.

Ketosis-onset diabetes in Tunisian adults: immunological markers and beta-cell function.

The aim of this study in Tunisia was to classify ketosis-onset diabetes in adult patients. All patients aged > 30 years without known diabetes, presenting with ketosis and admitted to our department were studied. Patients with secondary or gestational diabetes and those on corticoid therapy or with coinciding infection were excluded. The data included clinical characteristics, immunological markers and beta-cell function. Of the 63 patients, islet-cell antibodies were present in 27.0%, glutamic acid decarboxylase antibodies in 25.4% and thyrosin phosphatase antibodies in 19.0%. Beta-cell functional reserve was preserved in 54.0%. Our results confirm that patients with ketosis-onset diabetes mellitus in adulthood are a heterogeneous group.

Ketosis-onset diabetes in Tunisian adults: immunological markers and beta-cell function

The aim of this study in Tunisia was to classify ketosis-onset diabetes in adult patients. All patients aged >/= 30 years without known diabetes, presenting with ketosis and admitted to our department were studied. Patients with secondary or gestational diabetes and those on corticoid therapy or with coinciding infection were excluded. The data included clinical characteristics, immunological markers and beta-cell function. Of the 63 patients, islet-cell antibodies were present in 27.0%, glutamic acid decarboxylase antibodies in 25.4% and thyrosin phosphatase antibodies in 19.0%. beta-cell functional reserve was preserved in 54.0%. Our results confirm that patients with ketosis-onset diabetes mellitus in adulthood are a heterogeneous group

[Macroprolactinoma revealed by an exophthalmos]. / Macroadénome à prolactine révélé par une exophtalmie.

With the purpose of illustrating a particular circumstance of giant macroprolactinoma diagnosis, we report the case of a 54-year-old woman who was seen in the Endocrinology department with the suspected diagnosis of hyperthyroidism in presence of unilateral exophthalmos. The patient reported headaches during the last year and secondary amenorrhea since she was 38 years old. The ophthalmologic examination confirmed the unilateral left exophthalmos, which was associated with oculomotor paralysis and vision loss. The computed tomography demonstrated a great mass of the sella extending in all directions and destroying the bone. The hormonal investigation confirmed the diagnosis of prolactinoma, with a level of 8723 ng/ml, and revealed hypopituitarism. The start of bromocriptin treatment was followed by a fall in the prolactin level to less then 200 ng/ml in 1 month. This case is particular regarding the giant macroprolactinoma in a woman discovered by an unusual visual complication.

Unusual presentation of multiple endocrine neoplasia type 2A in a patient with the C634R mutation of the RET-protooncogene.

The aim of this paper is to report an atypical presentation of MEN2A, in a patient carrying the C634R mutation of the RET-protooncogene. A 41-year-old Tunisian woman was admitted to our department with newly diagnosed hyperglycemia. She had a history of bilateral urinary stone recurrence, managed successfully on two occasions. On physical examination a thyroid node of 1cm on the left side was found. Laboratory evaluation and imaging findings confirmed the diagnosis of primary hyperparathyroidism. During cervicotomy, the parathyroid adenoma was resected and the thyroid node was suspected to be a carcinoma. Total thyroidectomy, with appropriate neck nodal resection, was performed. Histological examination confirmed the diagnosis of parathyroid adenoma and revealed a multifocal and bilateral medullary carcinoma. These findings led to the diagnosis of multiple endocrine neoplasia. DNA-analysis demonstrated a germline Cys634Arg mutation in the RET-protooncogene. During the postoperative follow-up, blood pressure as well as the level of urinary methoxylated metabolites increased progressively. Imaging findings were compatible with the diagnosis of bilateral pheochromocytoma. In conclusion, this case report of MEN 2A linked to a 634 RET mutation was peculiar by its revelation mode (1) hyperparathyroidism moreover linked to an adenoma and (2) associated with diabetes, mechanisms of which are probably multifactorial (familial type 2 diabetes, hypercalcemia, catecholamines excess).

[Adrenal gland hemangioma: a case report]. / Hémangiome surrénalien: à propos d'un cas.

Hemangioma is a benign vascular tumor composed of angioblastic cells. The adrenal gland localization is very rare, with only fifty cases reported in literature. We report a case of adrenal gland hemangioma diagnosed in a 55-year-old woman who presented a cervical neoplasm. The non-specific imaging features, the tumor size and the clinical context led to mandatory surgical resection. The pathological examination established the diagnosis of adrenal gland hemangioma.

[MRI and pituitary adenoma]. / IRM et adénomes hypophysaires.

Pituitary is the most important gland of the organism which can be affected by many diseases, especially by adenomatous processes. Classically macroadenoma, microadenoma and picoadenoma are described, according to the size of the pituitary adenoma. The diagnosis of microadenoma was long considered a highly difficult task and that of picoadenoma was impossible by computed tomography. Recently, the high resolution of multiplanar MRI has enabled the diagnosis of microadenomas measuring less than 3 mm (picoadenoma). For macroadenoma, MRI not only contributes to diagnosis but is particularly important to assess the extension and to detect possible complications. The aim of our study is to illustrate MRI features in pituitary adenoma.

[Celiac disease revealed by hypocalcemia complicating total thyroidectomy: a case report]. / Maladie coeliaque révélée par une hypocalcémie secondaire à une thyroïdectomie totale: à propos d'un cas.

In order to illustrate a particular circumstance of diagnosis of celiac disease, we report the case of 54-year-old women with a history of thyroid enlargement with normal thyroid function and positive anti-peroxidase antibodies. Immediately after total thyroidectomy with preservation of the parathyroid glands, she developed tetany with total serum calcium level at 50mg/l. Intravenous calcium infusion increased the calcium level and led to resolution of hypocalcemia-induced signs but there was no result when calcium and vitamin D were taken orally. The diagnosis of malabsorption was very probable in light of the family history of celiac disease, the anemia and the hypoalbuminemia. The diagnosis was confirmed by antibodies assay and endoscopy. The PTH level was less than 1 pg/l and radiography showed signs of hyperparathyroidism. Gluten-free diet, calcium and vitamin D led to an improvement of serum calcium.

[Quality of ambulatory care of non-insulin dependent diabetic patients]. / La qualité de la prise en charge ambulatoire des patients diabétiques non insulinotraités.

We assessed the quality of care provided to non-insulin treated diabetic patients by examining the medical records of 248 such patients attending our outpatient department in 2002. The mean age was 59.5 (SD 10.1) years, 62.1% were women and known duration of diabetes was 8.6 (SD 5.9) years. The majority of patients were treated with a combination of sulfonylurea and metformin. Glycaemic control was assessed using fasting blood glucose in 96.8% of patients, post-prandial blood glucose in 31.9% and glycated haemoglobin in 52.4%. Weight was measured at least once for 88.7% of patients, blood pressure for 91.1% of patients and lipid levels for 64.9%. Body mass index was less than 25 kg/m2 in 12.3% of patients and blood pressure less than 140/90 mmHg in 40.3%. Foot examination was noted in only 2% of records, electrocardiography was performed for 25% of patients and fundoscopy for 21%. Proteinuria was documented in 19.8% of patients and plasma urea and/or creatinine in 57.3%.

The metabolic syndrome in an Arab population: a first look at the new International Diabetes Federation criteria.

AIMS: To report the prevalence of the metabolic syndrome in Arab men and women using the new International Diabetes Federation (IDF) criteria, and to compare this with the prevalence using the 1999 World Health Organization (WHO) and 2001 National Cholesterol Education Program Adult Treatment Panel III (NECP ATPIII) definitions. METHODS: The study involved 863 subjects (343 men and 520 women) aged > or = 40 years living in Tunis, Tunisia, taken from an initially randomized, population sample. RESULTS: The prevalence of the metabolic syndrome using the IDF criteria was found to be 45.5%; 55.8% in women and 30.0% in men (P < 0.001), higher than the rates of 28.7% (WHO) and 24.3% (NECP ATPIII) using the previous definitions. Using all the definitions, the prevalence was higher in women than in men predominantly because of significant differences in central obesity and high-density lipoprotein (HDL) cholesterol and, to a lesser extent, hypertension. CONCLUSION: The increased prevalence using the IDF criteria compared with the 1999 WHO criteria and the 2001 NCEP ATPIII definitions is striking and has huge implications for public health worldwide. The major reason for the higher rate using the new definition seems to be the predominant focus placed on central obesity. Using tighter criteria for fasting glycaemia has also played a factor. The question remains as yet unanswered as to whether the new IDF criteria are better at predicting hard outcomes such as diabetes mellitus and cardiovascular diseases.

Clinical and metabolic characteristics of newly diagnosed diabetes patients: experience of a university hospital in Tunis.

PURPOSE: The aim of our retrospective study was to explore the clinical and metabolic characteristics of newly diagnosed diabetes patients over the age of 30 years. METHODS: Study participants were consecutive, newly diagnosed patients with diabetes, over the age of 30 years, presenting to our university hospital department between January 1999 and June 2003. Clinical and metabolic data were collected retrospectively by medical record review. RESULTS: Three hundred seventy patients were included; mean age was 54.1+/-14.0 years; 49% were women and a family history of diabetes was reported in 52% of patients. Patients presented with acute complications in 40% of cases. Symptoms of polyuria-polydipsia and weight loss were present at diagnosis in 87% and 76% of cases respectively. 58% of our patients were obese or overweight (BMI> or =25 kg/m(2)), hypertension was present in 22%, hypertriglyceridemia in 27% and high LDL cholesterol in 27%. Neuropathy was diagnosed in 24%, nephropathy in 13%, coronary heart disease in 9%, retinopathy in 8% of cases, stroke in 3% and peripheral arterial disease in 2%. Insulin was prescribed initially in 47% of cases. CONCLUSIONS: Our results demonstrate that clinical symptoms and acute ketosis are the most common presenting features of diabetes mellitus in adults at the hospital level. Associated chronic complications are frequent.

[The quality of ambulatory care provided to non-insulin treated diabetic patients]

We assessed the quality of care provided to non-insulin treated diabetic patients by examining the medical records of 248 such patients attending our outpatient department in 2002. The mean age was 59.5 [SD 10.1] years, 62.1% were women and known duration of diabetes was 8.6 [SD 5.9] years. The majority of patients were treated with a combination of sulfonylurea and metformin. Glycaemic control was assessed using fasting blood glucose in 96.8% of patients, post-prandial blood glucose in 31.9% and glycated haemoglobin in 52.4%. Weight was measured at least once for 88.7% of patients, blood pressure for 91.1% of patients and lipid levels for 64.9%. Body mass index was less than 25 kg/m2 in 12.3% of patients and blood pressure less than 140/90 mmHg in 40.3%. Foot examination was noted in only 2% of records, electrocardiography was performed for 25% of patients and fundoscopy for 21%. Proteinuria was documented in 19.8% of patients and plasma urea and/or creatinine in 57.3%

Diabetes insipidus and panhypopituitarism revealing pituitary metastasis of small cell lung carcinoma: a case report.

Metastatic tumors of the pituitary gland are not commonly diagnosed during life in cancer patients. The occurrence of symptomatic lesions is also very unusual and difficult to differentiate clinically and radiologically from pituitary adenomas. We report a case of pituitary metastasis which was the prime manifestation of a small cell lung carcinoma in a 40-year-old man. This cancer was revealed by diabetes insipidus and a hypopituitarism.

Bioactivities of seven chrysanthemum species flowers powder on Spodoptera littoralis (Boiduval) larvae.

We have screened seven Chrysanthemum species, collected from different biotope in Tunisia for the antifeeding and growth regulatory activity against S. littoralis (Lepidoptera: Noctuidae) an insect pest of tomato. The flowers powder was added to the Poitout and Bues (1974) artificial diet at three concentrations: 4, 8, and 16%. After ten days of treatment, the consumed quantity determination revelled that these species have an antifeeding activity proportional to the concentration, more considerable for the C. fuscatum and C. Myconis flowers powder. At the concentration of 16% the larvae weight was significantly delayed in the average time to the control, these results were compared to the effect of Cestrum parquii on S. littoralis and Pieris brassicae The moulting date determination showed an elongation of the third, fourth and fifth stages at the high concentration probably due to the presence of juvenile hormones Analogues.

Imaging features of intrasellar tuberculoma: two cases.

Hypophyseal tuberculoma is extremely rare. It may be confused with other more common sellar tumors such as adenomas. Characteristic, but not specific, radiological features are in the majority of cases: intense enhancement on contrast CT and thickening of the pituitary stalk better visible on MRI. We describe imaging findings in two patients with pituitary tuberculosis. In these cases an accurate non-invasive diagnosis was found to be important as antituberculous chemotherapy is curative.

Quality of care of patients with type 2 diabetes in a Tunisian university hospital.

OBJECTIVES: The aim of this retrospective study was to explore the quality of ambulatory management provided to patients with type 2 diabetes. METHODS: Five hundred ninety-three patients with type 2 diabetes attended our outpatient department in 2002. Clinical and biological data were collected from the medical records of these patients. RESULTS: The mean age was 61.7 +/- 10.5 years; 60.5% were women and known duration of diabetes was 11.8 +/- 7.5 years. Eighty-five percent of patients had 2 or more visits and 58% were on insulin. Glycaemic control was assessed using fasting blood glucose in 97.3%, post-prandial blood glucose in 28.3% and glycated haemoglobin in 50.6% of cases. HbA1c was over 8% in 60.7% of patients. Weight was measured at least once in 86.5% of cases, blood pressure in 91.2% and lipids levels estimated in 58%. BMI was less than 25 kg/m2 in 16.2% of patients and blood pressure less than 140/90 mmHg in 40.1% of cases. Foot examination was recorded only in 5% of patients, ECG was performed in 23.8% of cases and fundoscopy in 19.2% of patients. Proteinuria was documented in 19.1% of cases and renal function assessed in 54.4% of patients. CONCLUSIONS: These findings suggest that the management of type 2 diabetes is still inadequately performed in our centre and more progress is needed to prevent micro and macrovascular complications.

[Lymphocytic hypophysitis]. / Hypophysite lymphocytaire.

Lymphocytic hypophysitis is a rare inflammatory disease of the pituitary gland which may be related to an autoimmune process. Only twenty cases are reported in male. Patients usually present with symptoms of an expanding intrasellar mass or varying degrees of hypopituitarism. Most of the cases are misconsidered preoperatively as pituitary adenomas. We report a case of lymphocytic hypophysitis which has occurred at a 37-year-old-man.

[Study of the effect of converting enzyme inhibitors on microalbuminuria in diabetics]. / Etude de l'effet des inhibiteurs de l'enzyme de conversion (IEC) sur la microalbuminurie chez les diabetiques.

The authors report the results of a randomised trial using a converting enzyme inhibitor in 40 microalbuminuric diabetic subjects during 18 months. In the treated group, we observed a reduction of albuminuria from 57.4 mg/24 hours to 35.4 mg/24 hours at the end of the follow up, in contrast with a non significant progression in the group who didn't receive this medication. No significant modification in the clinical and biological parameters was observed during the follow up.