Shoulder capsulitis: What relation with diabetes mellitus in a moroccan population?

Introduction: Shoulder capsulitis (SC) is a common musculoskeletal complication in patients with diabetes. It can be particularly disabling. It is often overlooked by clinicians. The aim of this study is to evaluate the prevalence of retractile capsulitis and to identify the risk factors in a population of Moroccan diabetic patients. Materials and Methods: We realised a cross-sectional study including patients with diabetes mellitus (DM). We recorded the demographic and diabetic characteristics of our patients. SC and vascular complications were assessed by clinical and para-clinical investigations. The prevalence of SC was calculated. The factors associated with SC were evaluated by suitable statistical tests. Results: Three hundred and Sixty-five patients were included; 84.9% had Type 2 DM (T2DM). The mean age of the participants was 52.6 ± 13.6. Shoulder capsulitis was present in 12.6% of patients. In statistical analysis, age >50 years (P = 0.001), T2DM (P = 0.03), duration of progression >10 years (P = 0.03), dyslipidemia (P = 0.013) and macrovascular complications (P = 0.009) were associated with an increased frequency of SC. Conclusion: This study shows that the prevalence of SC is higher in diabetic patients. Therefore, inclusion of this pathology in the global management of the diabetic patient is necessary.

Résumé Introduction: la capsulite rétractile de l'épaule (CR) est une complication musculo-squelettique fréquente chez les patients diabétiques. Elle peut être particulièrement invalidante. Elle est souvent méconnue par les cliniciens. Cette étude a pour objectif d'évaluer la prévalence de la capsulite rétractile et d'identifier les facteurs de risque dans une population de patients diabétiques marocains. Methodes: Une étude transversale incluant des patients diabétiques. Nous avons enregistré les caractéristiques démographiques et les caractéristiques du diabète de nos patients. La CR et les complications vasculaires ont été évalués par des examens cliniques et para cliniques. La prévalence de la CR a été calculée, ensuite les facteurs associés à la CR ont été évalués par des tests statistiques adaptés. Resultat: 365 patients ont été inclus ; 84.9 % avaient un diabète de type 2. L'âge moyen des participants était de 52.6 ±13.6. Une capsulite de l'épaule était présente chez 12,6 % des patients. Dans l'analyse statistique, l'âge supérieur à 50 ans (P=0,001), le diabète de type 2 (P=0.03), la durée d'évolution >10 ans (P=0.03), la dyslipidémie (P=0.013) et les complications macro vasculaires (P=0.009) étaient associées à une fréquence accrue de la capsulite rétractile. Conclusion: cette étude montre que la prévalence de la CR est plus élevée chez les patients diabétiques. D'où la nécessité d'inclure cette pathologie dans la prise en charge globale du patient diabétique, et de la même manière, réaliser un dépistage de diabète chez les patients souffrant d'un capsulite rétractile. Mots clés: diabète sucré, complications musculo squelettiques, capsulite rétractile.

Acromegaly among a Moroccan population.

Acromegaly is defined as an acquired dysmorphytic syndrome due to excessive secretion of growth hormone (GH) and consequently of insulin-like growth factor-1 (IGF-1). This is a retrospective study of patients who were hospitalized in the Endocrinology Department of the Mohammed V Military Academic Hospital in Rabat over a period of 14 years (2008 to 2022), reporting on their clinical, paraclinical and evolutionary profiles and comparing the results with the data in the literature. Nineteen patients were included in our study. The mean age was 42.7 ± 11.6 years, with a male predominance. The clinical manifestations were dominated by a dysmorphic syndrome present in 97.4% of cases, followed by complications related to acromegaly in 88.9% of cases. The diagnosis was made when GH and IGF-1 values were elevated in 88.9% and 93.8% of cases, respectively; with a mean GH value of 25.1 µg/L. Magnetic resonance imaging (MRI) was used to diagnose the location of pituitary adenoma in all cases, 78.9% of which were macroadenomas and 21.1% microadenomas. The majority of patients (78.9%) had recourse to transsphenoidal surgery. Medical treatment was carried out in 89.5% of cases. Postoperative radiotherapy was performed in 33% of cases. Disease control was achieved in 30.1% of cases. This study shows the complex management of acromegaly. Disease control is a necessary condition in order to avoid complications, but is often difficult to obtain.

Reidel's Thyroiditis, a Diagnostic and Management Challenge: A Case Report and Review of the Literature.

Riedel's thyroiditis is a very rare inflammatory condition. It affects not only the thyroid gland but also the adjacent vital structures. It may also be associated with different forms of systemic fibrotic disorders. The exact etiology is unknown, but currently, the most favorable opinion is that it is a localized form of the systemic fibrotic process. We report the case of a 38-year-old woman, presented with a 10-month history of progressive hypothyroidism, dysphonia, and dysphagia. A Doppler ultrasound study revealed massive thyroid enlargement with multiple Eu TIRADS 3 and 4 nodules. Fine needle aspiration was noncontributive on two occasions. A hard subtotal thyroidectomy was performed. Pathological study confirmed Riedel's thyroiditis with the presence of IgG4 antibodies in immunohistochemistry. The patient was successfully treated with levothyroxine replacement and corticosteroid therapy with rapid resolution of obstructive symptoms. The case descriptions highlight the diagnostic challenge of this disease, describe the response to surgical management and corticosteroid therapy, and give a short review of the subject.

[Bilateral macronodular adrenal hyperplasia: a rare cause of Cushing's syndrome (a case report)]. / Hyperplasie macronodulaire bilatérale des surrénales: cause rare du syndrome de Cushing (à propos d'un cas).

Bilateral macronodular adrenal hyperplasia (BMAH) is a rare cause of adrenal Cushing's syndrome, accounting for less than 1% of cases. We here report the case of a 48-year-old patient with diabetes and hypertension presenting with clinical signs of Cushing's syndrome. Etiological assessment enabled clinicians to retain the diagnosis of Adrenocorticotropic hormone (ACTH)-independent hypercortisolism associated with BMAH. Unilateral left adrenalectomy was performed based on noriodocholesterol scintigraphy results, with good outcome. However, given the risk of recurrence and cardiovascular complications, long-term monitoring was scheduled.