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Cherchir F, Oueslati I, Yazidi M, Chaker F, Mizouni H, Feki M, Chihaoui M. Long-term complications of permanent hypoparathyroidism in adults: prevalence and associated factors. Endocrine 2024:10.1007/s12020-024-03765-9. [PMID: 38460072 DOI: 10.1007/s12020-024-03765-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 02/26/2024] [Indexed: 03/11/2024]
Abstract
INTRODUCTION Patients with Chronic hypoparathyroidism (CHPT) receiving conventional treatment are exposed to several long-term complications including basal ganglia calcifications, posterior subcapsular cataract, kidney stones, and renal insufficiency. The aim of this study was to assess the prevalence and the associated factors of these complications in patients with CHPT. METHODS We conducted a cross-sectional study including 58 patients with CHPT. All participants underwent physical examination, biochemical assessment (total serum calcium, serum phosphorus, serum albumin, intact-PTH, serum magnesium, 25-hydroxy-vitamin D, serum creatinine, thyroid stimulating hormone (TSH), and 24-hour urinary calcium), slit lamp examination, brain computed tomography scan (CT-scan), and renal ultrasound. RESULTS Participants had a mean age of 52.6 ± 16.4 years and a gender ratio (women/men) of 3.5. Fahr syndrome, cataract, urolithiasis, and renal failure were found in 55%, 62%, 12%, and 17% of cases, respectively. CHPT duration >15 years (Adjusted-OR = 43.1, 95-CI: 2.63-703.06, p = 0.008) and poor adherence to treatment (Adjusted-OR = 8.04, 95%-CI: 1.52-42.42, p = 0.014) were independently associated with the risk of Fahr syndrome. Age >55 years (adjusted-OR = 5.07, 95-CI: 1.10-23.42, p = 0.037), disease duration >15 years (adjusted-OR = 20.21, 95-CI: 1.54-265.84, p = 0.022), and magnesium level <0.8 mmol/l (adjusted-OR = 36.46, 95-CI: 3.75-354.08, p = 0.002) were independently associated with the risk of subcapsular cataract. Only hypercalciuria (Adjusted-OR = 21.27, 95-CI: 2.31-195.91, p = 0.007) was an independent risk factor for kidney stones. Renal failure was not associated with kidney stones (p = 1). However, creatinine clearance was negatively correlated with age (r = -0.784; p < 10-3) and disease duration (r = -0.352; p = 0.007). CONCLUSION Our results revealed high prevalences of neurological, ocular, and renal complications in patients with CHPT and emphasized the importance of regular biological monitoring, therapeutic adjustments, screening, and adherence to treatment in the prevention of these complications.
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Affiliation(s)
- Faten Cherchir
- Department of Endocrinology, La Rabta university hospital, Faculty of Medicine, University of Tunis-El Manar, Tunis, Tunisia
| | - Ibtissem Oueslati
- Department of Endocrinology, La Rabta university hospital, Faculty of Medicine, University of Tunis-El Manar, Tunis, Tunisia.
| | - Meriem Yazidi
- Department of Endocrinology, La Rabta university hospital, Faculty of Medicine, University of Tunis-El Manar, Tunis, Tunisia
| | - Fatma Chaker
- Department of Endocrinology, La Rabta university hospital, Faculty of Medicine, University of Tunis-El Manar, Tunis, Tunisia
| | - Habiba Mizouni
- Department of Radiology, La Rabta university hospital, Faculty of Medicine, University of Tunis-El Manar, Tunis, Tunisia
| | - Moncef Feki
- Laboratory of Biochemistry, La Rabta university hospital, Faculty of Medicine, University of Tunis-El Manar, Tunis, Tunisia
| | - Melika Chihaoui
- Department of Endocrinology, La Rabta university hospital, Faculty of Medicine, University of Tunis-El Manar, Tunis, Tunisia
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Cherchir F, Oueslati I, Salhi S, Ben Hamida A, Yazidi M, Chihaoui M. Persistent hypernatremia secondary to adipsic central diabetes insipidus in a patient with herpes-induced meningoencephalitis and COVID-19 infection: a case report. J Int Med Res 2024; 52:3000605241235747. [PMID: 38502003 PMCID: PMC10953016 DOI: 10.1177/03000605241235747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/12/2024] [Indexed: 03/20/2024] Open
Abstract
Central diabetes insipidus (CDI) typically manifests as a polyuria-polydipsia syndrome, in which normonatremia is generally maintained through the polydipsia. A 53-year-old woman presented with diabetic ketosis and hyperosmolar hyperglycemic syndrome. Her medical history included herpes meningoencephalitis, which was associated with confusion and amnesia. On physical examination, she was apyretic, confused, and had signs of extracellular dehydration. Her capillary glucose concentration was high and her urine was positive for ketones. Laboratory investigations revealed severe hyperglycemia, hypernatremia (plasma hyperosmolarity of 393.6 mOsm/L), and mild acute renal failure. In addition, she had a paucisymptomatic COVID-19 infection. Intravenous rehydration with isotonic saline solution and insulin therapy were effective at controlling the ketosis and ameliorating the hyperglycemia, but failed to normalize the hypernatremia and hyperosmolarity. She was not thirsty and had a urine output of 1 L/day, with urinary hypotonicity. Desmopressin administration reduced the hypernatremia and hyperosmolarity to within their normal ranges, and the patient's urinary osmolarity increased to 743 mOsm/L. Therefore, adipsic CDI was diagnosed. Endocrine investigations revealed isolated central hypothyroidism. The results of pituitary magnetic resonance imaging were normal. Thus, patients with impaired thirst may have an atypical presentation of CDI. In addition, the diagnosis of adipsic CDI is particularly challenging.
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Affiliation(s)
- Faten Cherchir
- Department of Endocrinology, La Rabta University Hospital, University of Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Ibtissem Oueslati
- Department of Endocrinology, La Rabta University Hospital, University of Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Salma Salhi
- Department of Endocrinology, La Rabta University Hospital, University of Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Asma Ben Hamida
- Department of Endocrinology, La Rabta University Hospital, University of Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Meriem Yazidi
- Department of Endocrinology, La Rabta University Hospital, University of Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Melika Chihaoui
- Department of Endocrinology, La Rabta University Hospital, University of Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
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Cherchir F, Oueslati I, Yazidi M, Chaker F, Chihaoui M. Assessment of quality of life in patients with permanent hypoparathyroidism receiving conventional treatment. J Diabetes Metab Disord 2023; 22:1617-1623. [PMID: 37975128 PMCID: PMC10638176 DOI: 10.1007/s40200-023-01292-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 08/25/2023] [Indexed: 11/19/2023]
Abstract
Introduction Patients with permanent hypoparathyroidism suffer from multiple complaints and are exposed to long-term complications that might compromise their well-being. The aim of this study was to assess the quality of life (QoL) in patients with permanent hypoparathyroidism receiving conventional therapy and to determine the associated factors. Methods This was a cross-sectional matched case-control study including 53 patients with permanent hypoparathyroidism and 53 matched controls. Biochemical blood parameters (calcium, phosphate, albumin, magnesium, 25-hydroxy-vitamin D, creatinine, TSH, and PTH) and 24-hours calciuria were measured in patients with hypoparathyroidism. QoL was assessed in all participants using the Short Form 36 Health Survey (SF-36). Results The study included 53 patients (41 women and 12 men) with hypoparathyroidism receiving conventional therapy.Their mean age was 52.8 ± 16.5 years. In comparison with controls, patients with hypoparathyroidism had significantly lower scores in all eight domains of SF-36 (p < 10- 3). Patients with poor socioeconomic conditions had lower SF-36 scores than those with good conditions.The etiology of hypoparathyroidism, the disease duration, the control of the disease, and the body mass index did not significantly interfere with SF-36 scores. SF-36 total score was negatively correlated with age (r=-0.619, p < 10- 3) and symptoms of hypocalcemia (r=-0.284, p = 0.039), and positively correlated with creatinine clearance (r = 0.559, p < 10- 3), magnesium level (r = 0.345, p = 0.011), and 25 hydroxy-vitamin D level (r = 320, p = 0.021). No significant correlations were found between SF-36 scores and other biological parameters such as calcemia, phosphatemia, phosphocalcic product, PTH, TSH, and calciuria. Conclusion Patients with permanent hypoparathyroidism had impairment in their QoL. Age, socioeconomic conditions, renal function, magnesium level, and 25 hydroxy-vitamin D level may interfere in the decline of the QoL of these patients.
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Affiliation(s)
- Faten Cherchir
- Department of endocrinology, La Rabta University Hospital, Faculty of Medicine of Tunis, University of Tunis-El Manar, Tunis, Tunisia
| | - Ibtissem Oueslati
- Department of endocrinology, La Rabta University Hospital, Faculty of Medicine of Tunis, University of Tunis-El Manar, Tunis, Tunisia
| | - Meriem Yazidi
- Department of endocrinology, La Rabta University Hospital, Faculty of Medicine of Tunis, University of Tunis-El Manar, Tunis, Tunisia
| | - Fatma Chaker
- Department of endocrinology, La Rabta University Hospital, Faculty of Medicine of Tunis, University of Tunis-El Manar, Tunis, Tunisia
| | - Melika Chihaoui
- Department of endocrinology, La Rabta University Hospital, Faculty of Medicine of Tunis, University of Tunis-El Manar, Tunis, Tunisia
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Cherchir F, Oueslati I, Mouelhi Y, Talbi E, Feki M, Yazidi M, Chihaoui M. Levothyroxine liquid oral substitution as an alternative treatment for refractory hypothyroidism due to gastrointestinal malabsorption: A case report. SAGE Open Med Case Rep 2023; 11:2050313X231209229. [PMID: 37927364 PMCID: PMC10623934 DOI: 10.1177/2050313x231209229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/02/2023] [Indexed: 11/07/2023] Open
Abstract
Tablets of levothyroxine (LT4) are the most used form for the treatment of hypothyroidism. Some patients may present with refractory hypothyroidism despite a high daily LT4 dose. We report the case of a 49-year-old woman who was admitted to our department for refractory hypothyroidism. She was treated with 300 μg oral LT4 tablets daily (3.9 μg/kg/day). Despite good compliance and regular intake of high doses of LT4, she had persistent symptoms of hypothyroidism and a thyroid-stimulating hormone level of 92.4 mIU/L. LT4 absorption test was consistent with the diagnosis of malabsorption. Etiological investigations revealed Helicobacter pylori gastritis. Helicobacter infection was adequately treated, but symptoms of hypothyroidism and elevated thyroid-stimulating hormone persisted. Increased LT4 doses (400 μg) failed to normalize thyroid-stimulating hormone levels. Thus, she was put on LT4 liquid form at a dose of 80 drops/day per day (400 µg). Two weeks later, she presented with clinical and biological improvement with a normal free thyroxine level of 1.14 ng/dL. Patients with gastrointestinal disorders may present with refractory hypothyroidism despite increasing doses of LT4. Switching to liquid formulation may resolve this problem.
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Affiliation(s)
- Faten Cherchir
- Faculty of Medicine of Tunis, Department of Endocrinology, La Rabta University Hospital, University of Tunis El Manar, Tunis, Tunisia
| | - Ibtissem Oueslati
- Faculty of Medicine of Tunis, Department of Endocrinology, La Rabta University Hospital, University of Tunis El Manar, Tunis, Tunisia
| | - Yasmine Mouelhi
- Faculty of Medicine of Tunis, Department of Endocrinology, La Rabta University Hospital, University of Tunis El Manar, Tunis, Tunisia
| | - Emna Talbi
- Faculty of Medicine of Tunis, Laboratory of Biochemistry, La Rabta University Hospital, University of Tunis El Manar, Tunis, Tunisia
| | - Moncef Feki
- Faculty of Medicine of Tunis, Laboratory of Biochemistry, La Rabta University Hospital, University of Tunis El Manar, Tunis, Tunisia
| | - Meriem Yazidi
- Faculty of Medicine of Tunis, Department of Endocrinology, La Rabta University Hospital, University of Tunis El Manar, Tunis, Tunisia
| | - Melika Chihaoui
- Faculty of Medicine of Tunis, Department of Endocrinology, La Rabta University Hospital, University of Tunis El Manar, Tunis, Tunisia
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Madani MA, Cherchir F, Bibi M, Zehani A, Chaker K, Nouira Y. Bilateral adrenal myelolipoma revealing an adrenal insufficiency: A case report. Int J Surg Case Rep 2023; 107:108330. [PMID: 37230061 DOI: 10.1016/j.ijscr.2023.108330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/11/2023] [Accepted: 05/12/2023] [Indexed: 05/27/2023] Open
Abstract
INTRODUCTION Once mostly discovered on autopsy, adrenal myelolipomas are now increasingly diagnosed due to the frequent use of modern imaging methods. However, bilaterality remains quite rare. We present the case of a 31 years old female patient treated in our department for a bilateral adrenal myelolipoma which revealed an unknown peripheral adrenal insufficiency. CASE PRESENTATION We describe the case of a 31-year-old woman in apparent good health with no medical history who was explored for recurrent right lumbar pain by a computed tomography scanner which showed a large right adrenal mass and a smaller lesion in the left adrenal gland. Preoperative biology revealed an unknown peripheral adrenal insufficiency. Right open sub-costal adrenalectomy was performed, Histological examination confirmed the diagnosis of bilateral adrenal myelolipomas and radiological surveillance was planned for the left tumor. DISCUSSION Adrenal myelolipoma (AML) is a rare, benign and typically non-functional tumor of the adrenal gland, usually unilateral and asymptomatic, incidentally detected on CT. Commonly diagnosed between the fifth and seventh decades of life. It can affect both sexes our patient is a 31-year-old female and presented with bilateral AML. Unlike previous reported cases, our patient has a previously unknown peripheral adrenal insufficiency, which could be incriminated in the development of his bilateral adrenal myelolipomas. The optimal management depends on both clinical presentation and tumor characteristics. CONCLUSION Adrenal myelolipoma is a rare tumor. Endocrinological investigation should be performed to detect and treat endocrine disorders. The therapeutic attitude depends on tumor size complications and clinical complaints. METHODS This is a case report from our urology department, and has been reported in line with the SCARE criteria.
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Affiliation(s)
- Mohamed Anouar Madani
- Department of Urology, LA RABTA Hospital, University of TUNIS EL MANAR, Tunis, Tunisia.
| | - Faten Cherchir
- Department of Endocrinology, LA RABTA Hospital, University of TUNIS EL MANAR, Tunis, Tunisia
| | - Mokhtar Bibi
- Department of Urology, LA RABTA Hospital, University of TUNIS EL MANAR, Tunis, Tunisia
| | - Alia Zehani
- Department of Anatomic Pathology, LA RABTA Hospital, University of TUNIS EL MANAR, Tunis, Tunisia
| | - Kais Chaker
- Department of Urology, LA RABTA Hospital, University of TUNIS EL MANAR, Tunis, Tunisia.
| | - Yassine Nouira
- Department of Urology, LA RABTA Hospital, University of TUNIS EL MANAR, Tunis, Tunisia
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Cherchir F, Gharbi Y, Chaker F, Khessairi N, Chihaoui M. Profil clinicobiologique, radiologique et thérapeutique des adénomes hypophysaires non sécrétants. Annales d'Endocrinologie 2023. [DOI: 10.1016/j.ando.2022.12.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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Cherchir F, Khessairi N, Gharbi Y, Grassa A, Chaker F, Chihaoui M. Atteinte ophtalmologique dans les macroadénomes hypophysaires non sécrétants : les facteurs de mauvais pronostic. Annales d'Endocrinologie 2023. [DOI: 10.1016/j.ando.2022.12.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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Cherchir F, Naceur I, Haouari AA, Ben Achour T, Ben Mansour H, Bellil K, Said F, Houman MH. Unilateral pseudouveitis revealing a pancreatic neuroendocrine carcinoma: A case report. Clin Case Rep 2022; 10:e05563. [PMID: 35280094 PMCID: PMC8905139 DOI: 10.1002/ccr3.5563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/17/2022] [Accepted: 02/20/2022] [Indexed: 12/04/2022] Open
Abstract
Neuroendocrine tumors are a heterogeneous group of tumors with a wide range of malignant potential that tend to have a relative prolonged course. These tumors infrequently metastasize to the orbit. To the best of our knowledge, ocular metastases from pancreatic neuroendocrine tumors (PNETs) have never been reported in the literature. We report the case of a 61-year-old man who presented with progressive deterioration of general condition with unilateral recurrent episodes of non-granulomatous panuveitis of the left eye related to a choroidal metastasis. Radiological imaging and histopathological analyses led to the diagnosis of metastatic pancreatic neuroendocrine carcinoma as the primary tumor. Choroidal metastases from neuroendocrine tumors are extremely rare, but compromise patients' well-being because of visual impairment. Uncommonly, these metastases can be the first manifestation of unknown tumors, warranting further investigations to detect the primary cancer.
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Affiliation(s)
- Faten Cherchir
- Department of Internal MedicineLa Rabta University HospitalUniversity of Tunis El ManarTunisTunisia
| | - Ines Naceur
- Department of Internal MedicineLa Rabta University HospitalUniversity of Tunis El ManarTunisTunisia
| | - Ahmed Anas Haouari
- Department of Medical OncologySalah Azaiez InstituteUniversity of Tunis El ManarTunisTunisia
| | - Tayssir Ben Achour
- Department of Internal MedicineLa Rabta University HospitalUniversity of Tunis El ManarTunisTunisia
| | - Hajer Ben Mansour
- Department of Medical OncologySalah Azaiez InstituteUniversity of Tunis El ManarTunisTunisia
| | - Khadija Bellil
- Department of Anatomic PathologyLa Rabta University HospitalUniversity Tunis El ManarTunisTunisia
| | - Fatma Said
- Department of Internal MedicineLa Rabta University HospitalUniversity of Tunis El ManarTunisTunisia
| | - Mohamed Habib Houman
- Department of Internal MedicineLa Rabta University HospitalUniversity of Tunis El ManarTunisTunisia
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Cherchir F, Oueslati I, Ayari S, Yazidi M, Laamouri R, Chaker F, Chihaoui M. Neuropathie optique au cours de l’ophtalmopathie Basedowienne : prévalence, conséquences et facteurs associés. Annales d'Endocrinologie 2021. [DOI: 10.1016/j.ando.2021.08.411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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