Interest of the waist-to-height ratio to predict metabolic syndrome in type 2 diabetic patients.

INTRODUCTION: Metabolic syndrome (MetS) is defined as a cluster of risk factors for cardiovascular disease. AIM: To determine the optimal cut-off point of the waist-to-height ratio (WHtR) at which MetS can be identified with maximum sensitivity and specificity in a sample of Tunisian type 2 diabetic patients. METHODS: We enrolled 457 type 2 diabetic patients in a cross-sectional study. Blood pressure, anthropometric indices, fasting glucose, and lipid profile were measured. WHtR was calculated. MetS was defined according to the IDF criteria. Receiver operating characteristic (ROC) curve analysis was used to identify the optimal cut-off value of WHtR in MetS screening with maximum sensitivity and specificity. RESULTS: The overall prevalence of MetS was 79.8%, it was higher in women than in men (85.5% vs 61.4%; p.

Salivary cortisol levels during Ramadan fasting in hydrocortisone-treated secondary adrenal insufficiency patients.

OBJECTIVE: Patients with adrenal insufficiency have difficulties in fasting during the month of Ramadan with an increased risk of complications. Cortisol levels are unknown in these patients. The objective of this study was to assess the daily cortisol profile in hydrocortisone-treated patients with secondary adrenal insufficiency (SAI) and healthy controls during a fasting day. METHODS: A cross-sectional matched case-control study on 50 hydrocortisone-treated SAI patients and 69 controls who are used to fast. Clinical and therapeutic data were collected. Five salivary samples for cortisol measurement were collected throughout a fasting day of the third week of Ramadan 2019. RESULTS: Salivary cortisol levels were significantly higher on awakening, at midnight and before the predawn meal in patients compared with controls. The circadian cortisol rhythm was disrupted in patients. The area under the salivary cortisol level versus time curve (AUC) was lower than the 2.5th percentile of the controls in one patient (2.5%) and higher than the 97.5th percentile in 23 patients (59%) who were considered overtreated. Age ≥ 35 years was independently associated with overtreatment (adjusted odds ratio = 12.0; 95% CI (2.0-70.4); p = 0.006). Seven patients broke their fasting for a complication compared with no one of the controls (p = 0.001). No factor was associated with this risk. CONCLUSIONS: Salivary cortisol levels were high in fasting hydrocortisone-treated SAI patients with a disruption of the circadian rhythm.

A Case of Von Hippel-Lindau Disease with Bilateral Pheochromocytoma and Ectopic Hypersecretion of Intact Parathyroid Hormone in an Adolescent Girl.

Von Hippel-Lindau disease is an autosomal dominant inherited syndrome predisposing to a variety of highly vascularised tumors in different organs. Although bilateral pheochromocytoma was reported in patients with von Hippel-Lindau disease, the coexistence of primary hyperparathyroidism is not a common condition. We report an observation of a primary hyperparathyroidism secondary to an ectopic secretion of intact parathyroid hormone in a 17-year-old girl with von Hippel-Lindau disease and bilateral pheochromocytoma. She presented with a newly diagnosed diabetes mellitus and a severe arterial hypertension. Blood tests disclosed hypercalcemia with increased intact PTH level. Cervical ultrasound and sestamibi scintigraphy were normal. Twenty-four-hour urinary normetanephrine level was highly elevated pointing to a catecholamine-secreting tumor. The abdominal computed tomography showed bilateral adrenal masses. MIBG scintigraphy exhibited a high accumulation of the tracer in both adrenal tumors. Genetic testing revealed a mutation of the VHL gene. The patient underwent a bilateral adrenalectomy. The postoperative outcome was marked by normalization of blood pressure, blood glucose, calcium, and PTH levels. In our case, the elevation of intact PTH and its spontaneous normalization after surgical treatment of pheochromocytomas confirms its ectopic secretion.

Blood pressure evaluated by 24 h ambulatory blood pressure monitoring in Ramadan-fasting patients with corticotrope deficiency.

PURPOSE: The risks of Ramadan fasting on blood pressure (BP) in patients with adrenal insufficiency are unknown. This study aimed to evaluate the levels of BP and particularly the risk for hypotension during a fasting day compared with a nonfasting day in patients with corticotrope deficiency. METHODS: A prospective case-crossover study on 28 patients with known and treated corticotrope deficiency who were fasting the month of Ramadan. Clinical (eating and sleeping habits, abnormal symptoms, weight, height, and BP) and paraclinical (creatinine, sodium, and cortisol) data were collected. Patients had a 24 h ambulatory BP monitoring during a Ramadan fasting day then again during a nonfasting day. RESULTS: The data of 25 patients were analyzed; 20 women, median age: 40 years (IQR, 22.5-45.5), median duration of the disease: 6 years (IQR, 2.5-12). The prevalence of hypotension did not differ between the fasting day and the nonfasting day. Hour by hour BP levels comparison showed that both systolic and diastolic BP were significantly lower at 2.00 p.m. during fasting. BP variability was significantly lower during the fasting period compared with the same period during the nonfasting day. CONCLUSIONS: Fasting was not associated with an increased risk for hypotension in patients with known and treated corticotrope deficiency.

Assessment of quality of life in adult type 1 diabetic patients.

INTRODUCTION: Few studies have examined the quality of life (QOL) of type 1 diabetic patients (T1D) in adulthood and its association with glycemic control. AIMS: To assess the QOL of a Tunisian population of T1D adults and to identify the factors that may influence it. METHODS: It's a cross-sectional study including 100 T1D patients over 18 years of age whose QOL was assessed by the ADDQOL scale. A multivariate logistic regression analysis was performed to identify the factors independently associated with impaired QOL. RESULTS: The QOL score without diabetes was -1.5±0.7 indicating that patients' QOL would be better without diabetes. Factors associated with impaired QOL were age≥33 years (p=0.011), poor socioeconomic status (p=0.01),  longer-lasting diabetes (p=0.007), lower daily insulin dose (p=0.001), human insulin-based treatment (p=0.049), higher prevalence of hospitalization for ketoacidosis (p=0.003) and infectious complication (p=0.008), higher incidence of hypoglycemia (p=0.003), higher prevalence of nephropathy (p=0.029) and diabetic retinopathy (p=0.038), higher HbA1c level (p=0.031) and irregular follow-up (p=0.021). According to multivariate analysis poor glycemic control (HbA1 ≥ 9.3%) and lower insulin dose (<0.84IU/Kg/d) were independently associated with impaired QOL. CONCLUSION: There is an association between glycemic control and QOL in T1D patients in adulthood, prompting us to consider this parameter in the management of T1D patients.

Prednisolone or hydrocortisone replacement in patients with corticotrope deficiency fasting during Ramadan result in similar risks of complications and quality of life: a randomized double-blind controlled trial.

PURPOSE: The aims of the study were to compare the risk of complications and the quality of life in patients with corticotrope deficiency, who fasted during Ramadan. Both hydrocortisone and prednisolone were compared as treatments. METHODS: A randomized double-blind crossover clinical trial conducted in the department of Endocrinology of the University Hospital la Rabta in Tunis, during Ramadan 2018, on 53 patients with known corticotrope deficiency treated with hydrocortisone 20 mg per day and who were willing to fast during Ramadan. Patients were randomized into two groups; AB that received hydrocortisone twice daily for 14 days then prednisolone once daily with a placebo for 14 days and group BA that received the two treatments in the reverse order. Patients had to complete a daily follow-up sheet about their eating and sleeping habits, the occurrence of complications and blood glucose monitoring and also to respond to the AddiQoL questionnaire at the end of each treatment period. RESULTS: Fifty patients' data were analyzed; 29 men, mean age: 42.4 ± 13.3 years, mean duration of the disease: 8.1 ± 7.6 years. The frequency of complications, mean blood glucose levels and the quality of life did not differ on hydrocortisone compared to prednisolone after adjustment for the sequence of the treatment. CONCLUSIONS: the risks of Ramadan fasting in patients with corticotrope deficiency were the same on hydrocortisone or prednisolone.

Developed diplopia due to a pituitary macroadenoma during pregnancy.

Physiologic pituitary enlargement is common during normal pregnancy. However, symptoms such as diplopia, blurred vision and headache resulting from physiologic pituitary enlargement are very rare during pregnancy. A 43-year-old woman complained of sudden headache and left eye ptosis at 36th weeks of gestation. An magnetic resonance imaging (MRI) demonstrated the pituitary enlargement and a macroadenoma without a compressing of the optic chiasm, but with an extension to the left cavernous sinus. 48 hours after the prescription of the bromocriptine, we had a spectacular evolution with disappearance of the headache and a total regression of the ptosis. We report a case of visual loss due to the physiologic pituitary enlargement or to the macroadenoma during pregnancy, which regressed after the prescription of bromocroptine.

The risk for hypoglycemia during Ramadan fasting in patients with adrenal insufficiency.

OBJECTIVES: The risk for hypoglycemia during Ramadan fasting in patients with adrenal insufficiency (AI) is not fully known. The aims of this study were to evaluate this risk objectively and to determine the associated factors. METHODS: This prospective case-crossover study included 25 women and 5 men with known and treated AI and a median age of 38.5 y. Patients underwent clinical examination and a fasting blood sample was collected to measure glucose, urea, creatinine, sodium, potassium, cortisol, growth hormone and free thyroxine. A 24-h continuous glucose monitoring system (CGMS) using iPro2 (Medtronic, Parsippany, NJ, USA) with Enlite sensor (Medtronic) was performed for each patient during a Ramadan fasting day then again during a nonfasting day. RESULTS: Interstitial glucose levels during the 24-h period, the fasting period, and the fasting period after exclusion of the 5 postprandial hours were significantly lower during the fasting day than on the nonfasting day. Hypoglycemia occurred in three patients (10%) during the fasting day but not during the nonfasting day (P = 0.23). Hypoglycemia was asymptomatic in two cases. Male sex was significantly associated with the occurrence of hypoglycemia. CONCLUSION: Interstitial glucose levels were lower during fasting in patients with AI. However, the risk for hypoglycemia was not increased.

Ramadan fasting in patients with adrenal insufficiency.

AIM: The risks of fasting during Ramadan in patients with adrenal insufficiency are unknown. The aims of this study were to evaluate these risks in such patients, to determine the risk factors and finally to set some recommendations. METHODS: It is a cross-sectional study about 180 patients with known and treated adrenal insufficiency. The patients responded to a 14-item questionnaire concerning their knowledge about the disease and fasting during the last month of Ramadan. RESULTS: There were 132 women and 48 men. The mean age was 47.6 ± 15.0 years (14-79). One hundred and thirty eight patients (76.7 %) were advised by their physician not to fast. Ninety-one patients (50.5 %) tried to fast. Complications occurred in 61 cases (67.0 %): asthenia in 88.5 % of cases, intense thirst in 32.8 %, symptoms of dehydration in 49.2 % and symptoms of hypoglycaemia in 18 %. One patient was hospitalized. Fifty-five patients (60.4 %) were able to fast for the whole month. Age, gender, duration of the disease, its primary origin, associated hypothyroidism, diabetes mellitus, hypertension or diabetes insipidus and daily dose of hydrocortisone did not significantly differ between fasters and non-fasters, full-month-fasters and partial-month-fasters, and fasters with complications and fasters without complications. The frequency of adequate knowledge about the disease was significantly higher in full-month-fasters vs. partial-month-fasters, and in fasters without complications vs. those with complications. CONCLUSION: In patients with adrenal insufficiency, fasting can cause complications especially if the level of knowledge about the disease is low.