[A rare cause of hypercorticism: ACTH-secreting pheochromocytoma (a case report)]. / Une cause rare d'hypercorticisme: un phéochromocytome sécrétant l'ACTH (à propos d'un cas).

Ectopic ACTH-secreting pheochromocytoma is a very rare cause of Cushing´s syndrome, posing diagnostic and therapeutic challenges. We here report the case of a female patient with suspected severe Cushing´s syndrome associated with melanoderma, arterial hypertension resistant to triple therapy and unbalanced diabetes treated with insulin therapy. Biologically, urinary ethoxylated, 24-hour urinary free cortisol and ACTH were very high. Imaging showed a 3.5 cm left adrenal mass. The patient underwent left adrenalectomy after medical preparation, with good clinico-biological outcome. Anatomopathological examination confirmed the diagnosis of pheochromocytoma. This case study highlights the importance of measuring methoxylated derivatives in any patient with ACTH-dependent Cushing´s syndrome associated with an adrenal mass. The aim is to ensure early treatment and avoid life-threatening complications.

Cystic adrenal pheochromocytoma, a very exceptional form: case report.

A pheochromocytoma is a tumor that typically originates within the chromaffin cells of the adrenal glands, resulting in excessive production of catecholamines. Cystic forms are exceptional and pose a diagnostic challenge, especially those that are non-secreting. The most prevalent symptom associated with this condition is arterial hypertension, which can be either persistent or, more commonly, intermittent. The Ménard triad, comprising headaches, excessive sweating, and palpitations, may accompany episodes of hypertension. The presence of elevated levels of methoxylated derivatives serves to confirm the diagnosis of an adrenal pheochromocytoma. We report the case of a woman who presented with arterial hypertension associated with the Ménard triad, along with elevated methoxylated derivative levels. Imaging modalities revealed a predominantly cystic left retroperitoneal mass. The diagnosis of a cystic pheochromocytoma was established and confirmed through histological examination of the surgical specimen after adrenalectomy.

[Precocious puberty: experience in the Pediatric Endocrinology Unit at the Children's Hospital in Rabat]. / Puberté précoce: expérience de l´unité d´endocrinologie pédiatrique à l´Hôpital d´Enfant de Rabat.

Introduction: precocious puberty is defined as the development of sexual characteristics before 8 years of age in girls and 9 years of age in boys. The purpose of our study was to describe the clinical, paraclinical and etiological profile of precocious puberty. Methods: we conducted a retrospective descriptive study from 1999 to 2017 in the Pediatric Endocrinology Unit at the Rabat Children's Hospital. Results: ninety-nine children were included in the study. The average age of girls was 4.25 ± 2.6 years, while that of boys was 3.6 ± 1.8 years. There was a female predominance (90%; 90 girls). The telltale signs in girls were dominated by breast development (77.77%). In boys, the most common reason for consultation was pubic hair (70%). Biologically, in central precocious puberty, the mean peak LH level after GnRH stimulation was high (17 IU/L) with a mean peak LH to peak FSH ratio of 1.30. The causes included: dissociated early puberty (60.60%), pathological early puberty (39.40%). In the latter, we noted a predominance of precocious pseudopuberty (58.98%). Concerning the central precocious puberty, idiopathic central precocious puberty was the most common etiology in girls (62.5%). In all boys, central nervous system lesion was found. Conclusion: our study confirms that central pathological precocious puberty is often related to a lesion of the central nervous system in boys, thus justifying systematic brain imaging.

Associations between clinical characteristics and angiotensin-converting enzyme gene insertion/deletion polymorphism in Moroccan population with Type-2 diabetic nephropathy.

Diabetic nephropathy (DN) is one of the severe complications of Type-2 diabetes mellitus (T2DM) and a major cause of end-stage renal disease in these patients. Results from published studies on the relationship between angiotensin-converting enzyme (ACE) insertion/ deletion (I/D) gene polymorphism and patients with DN are still conflicting. We compared the clinical characteristics and the genotype frequencies of ACE polymorphism in 130 T2DM Moroccan patients with DN and 85 T2DM Moroccan patients without DN (controls) using specific primers in a polymerase chain reaction. The degenerative complications of diabetes were significantly higher in the group with nephropathy. The distribution of the I/D genotypes was in Hardy-Weinberg equilibrium. The D allele was the most frequent allele in the Moroccan population in both groups studied (P = 0.68), however, there was no significant difference between the genotypes in T2DM patients with or without DN (P = 0.78). The ACE gene I/D polymorphism was not associated with an increased risk of DN in the Moroccan population.