Hashimoto Thyroiditis in a Patient With Dubowitz Syndrome and Short Stature.

Dubowitz syndrome (DS) is a rare genetic disorder characterized by multiple morphological abnormalities, short stature, and different degrees of mental disability. Endocrinological evaluation should be done for these subjects, as they can suffer from multiple hormonal derangements. We present a case of a 12-year-old Lebanese girl, diagnosed with Dubowitz syndrome, who presented to our clinic for short stature. She had received growth hormones (GHs) and improved her height. More investigations showed the presence of Hashimoto thyroiditis with normal thyroid stimulating hormone, so hormonal follow-up was recommended. The association between Dubowitz syndrome and Hashimoto thyroiditis has not been described so far. Thus, in the setting of this syndrome, it is worthwhile to check for growth hormone deficiency and Hashimoto's thyroiditis.

A Case Report of a Thyrotropin-Secreting Pituitary Macroadenoma.

Thyroid-stimulating hormone (TSH)-secreting pituitary adenoma is a rare case that is characterized by high or inappropriately normal thyrotropin levels along with an increase in thyroid hormones that lead, in most of the patients, to signs and symptoms similar to those of hyperthyroidism problems. Its diagnosis and management are still challenging. A 65-year-old male patient presented to the emergency department for palpitations. He was firstly misdiagnosed due to incomplete lab tests. After a full workup, he was found to have TSH-secreting pituitary adenoma and referred to trans-sphenoidal surgery for macroadenoma excision. Currently, he is maintained on somatostatin analogue and methimazole. This is the second case report of TSHoma in Lebanon with signs and symptoms of thyrotoxicosis. Usually, the clinical features of TSHomas vary between patients which makes the confirmation of diagnosis more difficult. Surgery is still the first line of treatment with the addition of encouraging effects of medical therapy consisting of somatostatin analogues.

Effects of hormone therapy on blood pressure.

OBJECTIVE: Although hormone therapy remains the most efficacious option for the management of vasomotor symptoms of menopause, its effects on blood pressure remain unclear. This review scrutinizes evidence of the mechanisms of action of hormone therapy on signaling pathways affecting blood pressure and evidence from clinical studies. METHODS: Comprehensive Ovid MEDLINE searches were conducted for the terms "hypertension" and either of the following "hormone therapy and menopause" or "selective estrogen receptor modulator" from year 2000 to November 2013. RESULTS: In vitro and physiologic studies did not reveal a clear deleterious effect of hormone therapy on blood pressure. The effect of oral therapy was essentially neutral in large trials conducted in normotensive women with blood pressure as primary outcome. Results from all other trials had several limitations. Oral therapy had a neutral effect on blood pressure in hypertensive women. Transdermal estrogen and micronized progesterone had a beneficial effect on blood pressure in normotensive women and, at most, a neutral effect on hypertensive women. In general, tibolone and raloxifene had a neutral effect on blood pressure in both hypertensive and normotensive women. CONCLUSIONS: Large randomized trials are needed to assess the effect of oral hormone therapy on blood pressure as a primary outcome in hypertensive women and the effect of transdermal preparations on both normotensive and hypertensive women. Transdermal preparations would be the preferred mode of therapy for hypertensive women, in view of their favorable physiologic and clinical profiles. The decision regarding the use of hormone therapy should be individualized, and blood pressure should be monitored during the course of treatment.

High burden of rheumatic diseases in Lebanon: a COPCORD study.

AIM: To estimate the prevalence of rheumatic diseases in Lebanon and to explore their distribution by geographic location, age, and gender. METHOD: Using the Community Oriented Program for the Control of Rheumatic Diseases (COPCORD) methodology, a random sample of 3530 individuals aged 15 and above was interviewed from the six Lebanese governorates. Positive respondents were evaluated by rheumatologists using the internationally accepted classification criterion of the American College of Rheumatology for the diagnosis of rheumatic diseases. RESULTS: Prevalence rates of current and past musculoskeletal problems were 24.4% and 8.4%, respectively. Shoulder (14.3%), knee (14.2%) and back (13.6%) were the most common pain sites. Point prevalence of rheumatic diseases was 15.0%. The most frequent types of rheumatic diseases were of mechanical origin, namely soft tissue rheumatism (5.8%) and osteoarthritis (4.0%). Rheumatoid arthritis (1.0%) and spondylathropathies (0.3%) constituted the most common inflammatory diseases. Coastal areas had the lowest prevalence of all diseases except for fibromyalgia. All diseases showed an increasing prevalence pattern with age and a higher prevalence among women than men. CONCLUSION: This is the first study to give population-based estimates of rheumatic diseases in Lebanon. The high burden calls for public health attention for early detection, control and prevention of these conditions. Point prevalence of individual diseases was within the range of results from other COPCORD surveys with some variations that can be attributed to differences in methodology and geo-ethnic factors.

Multiple myeloma and diabetes.

Multiple myeloma is a malignant plasma cell disorder that accounts for approximately 10% of all hematologic cancers. It is characterized by accumulation of clonal plasma cells, predominantly in the bone marrow. The prevalence of type 2 diabetes is increasing; therefore, it is expected that there will be an increase in the diagnosis of multiple myeloma with concomitant diabetes mellitus. The treatment of multiple myeloma and diabetes mellitus is multifaceted. The coexistence of the two conditions in a patient forms a major challenge for physicians.

Extracranial venous stenosis is an unlikely cause of multiple sclerosis.

BACKGROUND: Extracranial venous stenosis (EVS) has recently been implicated as the primary cause of multiple sclerosis (MS). OBJECTIVE: The aim of this study was to determine the presence of EVS in MS patients. METHODS: We performed selective extracranial venography on 42 patients with early MS (EMS): clinically isolated syndrome (CIS) or relapsing-remitting MS (RRMS) of less than 5 years duration, and late MS (LMS): RRMS of more than 10 years duration. Magnetic resonance imaging (MRI) and clinical relapse data were reviewed for all patients with EVS. RESULTS: EVS was present in 7/29 patients with EMS and 12/13 patients with LMS, a highly significant statistical difference (p< 0.001). Only 3/42 patients (all in the LMS group) had two vessel stenoses, while the rest had only one vessel involved. EVS was seen in 1/11 patients with CIS compared with 6/18 RRMS patients of less than 5 years duration. Disease duration was greater in patients with EVS overall (p < 0.005). LMS remained an independent predictor of EVS following multivariate adjustment for gender, age at disease onset and Expanded Disability Status Scale (EDSS) (Adjusted Odds Ratio = 29 (3-298); p = 0.005]. Within the EMS group, patients with (n = 7) and without (n = 22) EVS had similar EDSS and disease duration, suggesting similar disease severity. No clear correlation could be found between site of EVS and anatomic localization of either clinical relapses or MRI gadolinium-enhancing lesions. CONCLUSIONS: We conclude that EVS is an unlikely cause of MS since it is not present in most patients early in the disease and rarely involves more than one extracranial vein. It is likely to be a late secondary phenomenon.