Rojbi Imen

Background: Cushing’s disease (CD), caused by an ACTH-secreting pituitary adenoma, remains one of the most challenging endocrine disorders to diagnose and treat. The coexistence of resistant hypertension, metabolic complications, and complex vascular anatomy such as “kissing carotids” further complicates management. Case Presentation: We report a 40-year-old man with long-standing hypertension referred for evaluation of resistant blood pressure. Physical examination revealed classical Cushingoid features. Endocrine testing confirmed ACTH-dependent Cushing’s syndrome. Pituitary MRI was limited by a rare vascular variant medialized internal carotid arteries (“kissing carotids”) which obscured visualization of the adenoma. The patient underwent endoscopic transsphenoidal surgery in a specialized neurosurgical center, confirming a corticotroph adenoma. Postoperatively, cortisol levels normalized, and metabolic and cardiovascular comorbidities markedly improved. Conclusion: This case highlights the diagnostic and therapeutic complexity of ACTH-dependent Cushing’s disease with challenging pituitary anatomy. Expert multidisciplinary management remains essential to achieve remission and prevent long-term sequelae.

Choroidal calcification is an uncommon benign lesion occurring in predominantly elderly. This condition is ordinarily idiopathic. However, it can be caused by phosphocalcic metabolism disorders. We report the case of a 72-year-old woman followed-up in the ophthalmology department for proliferative diabetic retinopathy who was found to have a bilateral yellowish lesion in the fundus during a routine eye examination corresponding to a choroidal calcification. Metabolic analyses led to the diagnosis of primary hyperparathyroidism. Choroidal calcifications warrant a systemic evaluation to identify a potential underlying disease.

Background and Aims: Glucocorticoid-induced diabetes mellitus (GC-DM)is an underdiagnosed condition that sometimes requires urgent treatment. Indeed, the risk factors of GC-DM as well as its therapeutic management are little known. The aim of this study was to review the characteristics of the population at risk for developing GC-DM as well as its therapeutic modalities. Methods: A retrospective descriptive study was conducted at Charles Nicolle Hospital in Tunis enrolling 52 patients with GC-DM who were followed up in the Department of Endocrinology and Internal Medicine (1992-2020). Results: Mean age of patients was 47,8 ± 15,3 years. Eighteen patients (35%) had a family history of diabetes. The median body mass index (BMI) was 25.35 kg/m² [22.04-29.95]. Overweight was found in 25% and obesity in 25%. Twenty-two patients (42%) had hypertension, 21 (40%) had dyslipidaemias and 10 (19%) had IFG. The main underlying diseases requiring steroid therapy included vasculitis in 24 patients (46%) and autoimmune diseases in 15 patients (29%). In 54% of the patients, steroid therapy was administered at a high dose, in 35% at a very high dose, and in 11% at a medium dose. The median fasting blood glucose level at the time of diagnosis of GC-DM was at 14 mmol/L [9-18]. Fifteen patients (29%) developed GC-DM after 1 year. A pharmacological treatment was combined with lifestyle and dietary measures in 50 patients (96%). Oral antidiabetic agents alone were prescribed in 50% of the patients, insulin therapy: alone in 40% and in combination with oral antidiabetic agents in 6%. Methylprednisolone pulse therapy was significantly associated with initiation of insulin. Conclusion: Diabetes should not be neglected during steroid therapy. Strategies for prevention, detection and therapeutic management of GC-DM are the key elements to control the Morbi-mortality related to this condition.