Bone Mineral Density in Sheehan's Syndrome; Prevalence of Low Bone Mass and Associated Factors.

Hypopituitarism is a known cause of bone mineral loss. This study aimed to evaluate the frequency of osteopenia and osteoporosis in patients with Sheehan's syndrome (SS) and to determine the risk factors. This is a retrospective study of 60 cases of SS that have had a bone mineral density (BMD) measurement. Clinical, biological, and therapeutic data were collected. The parameters of osteodensitometry at the femoral neck and the lumbar spine of 60 patients with SS were compared with those of 60 age-, height-, and weight-matched control women. The mean age at BMD measurement was 49.4 ± 9.9 yr (range: 25-76 yr). The mean duration of SS was 19.3 ± 8.5 yr (range: 3-41 yr). All patients had corticotropin deficiency and were treated with hydrocortisone at a mean daily dose of 26.3 ± 4.1 mg. Fifty-seven patients (95%) had thyrotropin deficiency and were treated with thyroxine at a mean daily dose of 124.3 ± 47.4 µg. Thirty-five of the 49 patients, aged less than 50 yr at diagnosis and having gonadotropin deficiency (71.4%), had estrogen-progesterone substitution. Osteopenia was present in 25 patients (41.7%) and osteoporosis in 21 (35.0%). The BMD was significantly lower in the group with SS than in the control group (p < 0.001). The odds ratio of osteopenia-osteoporosis was 3.1 (95% confidence interval: 1.4-6.8) at the femoral neck and 3.7 (95% confidence interval: 1.7-7.8) at the lumbar spine. The lumbar spine was more frequently affected by low bone mineral mass (p < 0.05). The duration of the disease and the daily dose of hydrocortisone were independently and inversely associated with BMD at the femoral neck. The daily dose of thyroxine was independently and inversely associated with BMD at the lumbar spine. Estrogen-progesterone replacement therapy was not associated with BMD. Low bone mineral mass was very common in patients with SS. The lumbar spine was more frequently affected. The duration of the disease and the doses of hydrocortisone and thyroxine were involved in bone mineral loss.

Unilateral agenesis of internal carotid artery associated with congenital combined pituitary hormone deficiency and pituitary stalk interruption without HESX1, LHX4 or OTX2 mutation: a case report.

Agenesis of internal carotid artery (ICA) is an unusual finding in subjects with congenital Combined Pituitary hormone deficiency (CPHD) with only nine cases being reported to date but to our best knowledge none of them was genetically investigated. A 10-years old girl presented with severe growth failure (height 103 cm) with substantial bone age delay (3 years). She had no history of perinatal insults or familial CPHD. There was no evidence of mental retardation or craniofacial dysmorphism or ophtalmological abnormalities. She was first diagnosed with GH and TSH deficiency. Cerebral magnetic resonance imaging (MRI) showed hypoplastic anterior pituitary, flat sella turcica, absent pituitary stalk with ectopic posterior pituitary as well as agenesis of the left ICA and the left carotid canal. Genomic analysis of pituitary transcription factor HESX1, LHX4 and OTX2 showed no mutations. Treatment with GH and thyroxine was started. The patient remained free of neurovascular symptoms for 5 years but she presented at the age of 15 years with delayed puberty related to an evolving gonadotropin deficiency. ICA agenesis associated with CPHD is unusual and is often asymptomatic in children. Since the CPHD with pituitary stalk interruption cannot be due to HESX1, LHX4 or OTX2 mutation in our case, other pathogenetic mechanisms may be responsible for CPHD associated with unilateral ICA agenesis.

[Ambulatory blood pressure measurement and control in hypertensive diabetic patients]. / Appréciation du profil tensionnel par mesure ambulatoire de la pression artérielle chez les diabétiques hypertendus traités.

BACKGROUND: Good blood pressure control is one of the recommended targets in diabetic patient's management. AIM: To evaluate blood pressure (BP) control in hypertensive treated diabetic patients using ambulatory blood pressure measurement (ABPM). METHODS: Two hundred and six hypertensive treated diabetic patients were enrolled in this study (83 men and 123 women). Mean age were 60.3±9.6 years-old with mean diabetic duration of 9.1±8.2 years. All of them underwent 24 hours ABPM. Intervals between measurements were 20 minutes at diurnal period and 30 minutes at nocturnal period. RESULTS: 28 patients (13.6%) only were at recommended target levels of blood pressure control (mean diurnal BP<130/80 mmHg and nocturnal BP<115/65 mmHg) and 137 patients were at the most bed control levels (mean diurnal BP ? 140/90 mmHg or nocturnal BP ? 125/75 mmHg). Bed controlled patients had mildly higher waist circumference (p=0.08). Poor BP control was associated with non dipper character (p<0.001), diabetic nephropathy (p<0.01) and diabetic retinopathy (p<0.01). CONCLUSION: Our hypertensive treated diabetic patients were far from good blood pressure control. ABPM showed that the loss of nocturnal blood pressure fall was the most associated abnormality with poor BP control. Diabetic microangiopathy were more frequent in poor controlled patients.

[Erythrocyte abnormalities in thyroid dysfunction]. / Les anomalies ertyrocytaires au cours des dysthyroïdies.

BACKGROUND: Erythrocyte abnormalities are frequently associated with thyroid dysfunction. However, they are rarely investigated and related to the thyroid. AIM: This study was aimed to determine the nature and frequency of erythrocyte abnormalities in thyroid disease and look for their evolution after thyroid function restoration. METHODS: This retrospective study included 412 patients with peripheral thyroid disease; hyperthyroidism (n=235) or hypothyroidism (n=177). Hyperthyroidism was considered for TSH<0.10 ÌUI/ml and hypothyroidism for TSH>5.0 ÌUI/ml. Anemia was defined by hemoglobin level<13 g/dl in men and <12 g/dl in women, microcytosis by mean corpuscular volume (MCV)<80 fl, macrocytosis by MCV>98 fl, and hypochromia by mean corpuscular hemoglobin (MCH)<25 pg. Restoration of euthyroid state was considered in patients with normal TSH levels for at least 3 months. RESULTS: Anaemia was observed in 40.9% of patients with hyperthyroidism and 57.1% of patients with hypothyroidism. Among these, normocytic or macrocytic anaemia was present in 46.3% of cases. Whereas, microcytosis, with or without anaemia, was noted in 87.7% of patients with hyperthyroidism. FT4 was positively correlated with the number of red blood cells and haemoglobin, and inversely correlated with MCV and MCH. After restoration of euthyroid state, most erythrocyte abnormalities were corrected. CONCLUSION: Thyroid diseases are frequently associated with erythrocyte abnormalities, including normocytic anaemia in hypothyroidism and microcytosis in hyperthyroidism. These abnormalities should be investigated and corrected. Their presence could steer towards subclinical thyroid dysfunction, allowing its early management.

[Prevalence of degenerative complications of diabetes in an outpatient population]. / Prevalence des complications degeneratives du diabete sucre dans un echantillon de malades suivis en ambulatoire.

UNLABELLED: The aim of this study was to evaluate the frequency of micro and macro vascular complications among a cohort of diabetic out-patients without proteinuria. PATIENTS AND METHODS: It is a cross sectional study of 249 diabetic patients (126 mean and 123 women) 166 with type 2 diabetes and 83 with type 1 diabetes. Patients were recruited according to sex, age and diabetic duration stratification. Mean age was 45.2 +/- 6.6 years and mean duration of diabetic was 8.9 +/- 7 years. Diabetic complications were investigated through a questionnaire, physical examination, ECG eyes fundoscopy and microalbuminuria measured in overnight urine collection. RESULTS: Prevalence of diabetic micro angiopathy in our population was one of the most frequent in the world. Diabetic peripheral neuropathy and retinopathy were the most frequent complications found in our patients. It was 63.5% for peripheral neuropathy, 43.8% for retinopathy and 25.3% for microalbuminuria. Macro angiopathy, as defined by hypertension, coronary heart diseases (CHD), lower limb arteritis (LLA) or stroke, was found in 24.5% of patients. CHD rate was equal to 14.5% and LLA in 12.4%. Prevalence rates of vascular complications of diabetes were correlated with age, duration and type of diabetes. CONCLUSION: Prevention of diabetes complications needs early screening of glucose tolerance abnormalities, better glycemic control, reduction of associated vascular risk factors and identification of genetic factors predisposing to a higher cardiovascular risk.