The insulin tolerance test (ITT) is the most reliable method for diagnosing growth hormone deficiency (GHD). Our study aimed to determine a new glycemic threshold that allows for an adequate growth hormone (GH) response without increasing the risk of deleterious outcomes. This study was conducted retrospectively on children who were suspected of GHD. There were two groups of children: group 1 (G1) consisted of children who underwent an ITT and reached a hypoglycemic level of 2.2 mmol/l, and group 2 (G2) included those who did not reach biochemical hypoglycemia but exhibited clinical hypoglycemic symptoms, which led to cessation of the test. Our population consisted of 129 patients. The mean nadir blood glucose level was 1.798 ±0.25 mmol/l in G1, significantly lower than in G2, at 2.57 ±0.28 mmol/l (p < 10-3). GH in G1 reached a mean peak of 4.71 ±3.20 ng/ml, significantly lower than in G2 (8.56 ±5.99 ng/ml) (p = 0.01). Among G1, 86% of the patients presented a GHD, compared to 55.6% in G2. The proportion of somatotrophic deficiency was significantly higher in G1 compared to G2 (p = 0.01). Receiver operating characteristic curve analysis revealed a threshold of 2.44 mmol/l with a sensitivity of 90% and a specificity of 60% (area under the curve = 0.915; confidence interval 95% (0.87-0.96). Based on our findings, we recommend implementing this new threshold when hypoglycemic symptoms are present. This higher threshold offers several benefits, including reduced risk to patients, while maintaining accurate interpretation of the test with good sensitivity and specificity.

INTRODUCTION:International guidelines for the management of coronary artery disease highlight the importance of LDL-C(low density lipoprotein-cholesterol)measurements in assessing cardiovascular risk and monitoring patients. In clinical practice,its direct measurement is complex and expensive. Therefore,calculating LDL-C using several formulas is simpler and less costly. AIM:T o evaluate the accuracy of LDL-C estimation formulas of Friedewald,Sampson and Martin/Hopkins compared to its direct measurement in Tunisian patients. METHODS:A cross-sectional study was conducted including patients following in the Endocrinology Department of Farhat Hached University Hospital of Sousse.Clinical data, metabolic parameters,and lipid profiles including Direct LDL-cholesterol measurement were analyzed. LDL-C was estimated using Friedewald,Martin/Hopkins, and Sampson formulas. RESULTS:A total of 148 patients were included in the study.The male-to-female ratio was 0.51.The mean age of the patients was 58 ± 14.8.The majority of our patients were diabetic (84.5%). Most patients had uncontrolled diabetes (81.8%).Type 2 diabetes was the predominant form (85.6%).The three formulas,Friedewald,Sampson,and Martin/Hopkins provided comparable fasting correlation values with measured LDL-C(r=0.52, 0.55, and 0.47, respectively). One hour after meal intake, LDL-C estimation using the three formulas was similar, showing a strong correlation with measured LDL-C (r > 0.7 for all three formulas). At two hours postprandial, the three formulas showed a moderate correlation with the measured LDL-C value. CONCLUSION:In this study,all three formulas Friedewald, Sampson, and Martin/Hopkins demonstrated acceptable accuracy in estimating LDL-C compared with direct measurement in Tunisian patients. Overall, these findings support the usefulness of formula-based LDL-C estimation as a practical and cost-effective alternative in routine clinical practice.

Acromegaly is most commonly caused by a growth hormone (GH)-secreting pituitary adenoma. In exceptionally rare circumstances, pituitary imaging fails to reveal an adenoma, thereby raising suspicion for ectopic acromegaly. Here, we report the case of a 70-year-old patient who presented for evaluation of headaches and glycemic control. Investigations confirmed ectopic acromegaly due to peripheral GH secretion. The source of GH secretion was a probable digestive neuroendocrine tumor (NET). Given the patient's refusal of surgical intervention, treatment with a somatostatin analog was initiated, resulting in glycemic control consistent with the targets defined according to the patient's age and comorbidities. Insulin-like growth factor 1 (IGF-1) levels subsequently normalized. The diagnosis of GH-secreting ectopic acromegaly is based on correlating clinical manifestations with biochemical evidence of GH excess and appropriate imaging studies. Management is largely driven by surgical removal of the responsible lesion when possible, complemented by somatostatin analogs when indicated. The epidemiology and pertinent literature of this uncommon condition are discussed.

Background: Polycystic ovary syndrome (PCOS) is a complex condition linked to long-term health risks such as cardiovascular disease, type 2 diabetes, and metabolic syndrome. Subclinical hypothyroidism (SCH) shares overlapping symptoms with PCOS, but their relationship remains debated. SCH prevalence in PCOS patients and its impact on cardiovascular and metabolic health is debated and thus warrants further research. This research examined the association between SCH and PCOS in a Tunisian clinical-based population. Methods: We conducted a prospective cross-sectional study of 161 PCOS patients and 75 age-matched controls recruited from 2023 to 2024. All participants underwent thyroid function testing, metabolic profiling, and hormonal assays. Statistical analyses included Mann-Whitney U, Kruskal-Wallis, and chi-square tests, with age/BMI-adjusted linear regression models. Results: Among 236 participants (161 PCOS, 75 controls), SCH prevalence was higher in PCOS patients (14.9%) compared to controls (5.3%, p = .048). Adjusted for age and BMI, median TSH levels were higher in the PCOS group (2.2 mIU/L vs 1.75 mIU/L, p = .006), while FT4 levels were lower (14.26 pmol/L vs 15.26 pmol/L, p = .007). Positive TPOAb prevalence was higher in PCOS (12.4% vs 2.7%, p = .049). TSH levels varied across PCOS phenotypes ( p = .003), with Phenotypes A and B showing higher levels than Phenotype C (A > C, p = .019; B > C, p < .001). SCH was highest in Phenotype A. SCH in PCOS was associated with impaired glucose tolerance ( p = .011), higher blood fasting glucose ( p = .033), higher total cholesterol ( p = .022), and hypertriglyceridemia ( p = .018). Conclusion: SCH is more prevalent in PCOS and may worsen insulin resistance and dyslipidemia. Addressing thyroid dysfunction in PCOS patients may be beneficial for more effective management strategies, ultimately improving reproductive, metabolic, and cardiovascular outcomes for affected women.

Background/Objectives: Non-functional pituitary macroadenomas (NFPMA) are uncommon pituitary lesions that do not cause hormonal hypersecretion and are most often discovered at the macroadenoma stage. Consequently, they are more challenging to diagnose, often mimicking other non-secreting sellar masses, among which hypophysitis should be carefully considered. This study aimed to differentiate between non-functioning pituitary macroadenomas (NFPMA) and hypophysitis, two distinct sellar pathologies with overlapping MRI features, by developing a diagnostic score based on clinical, biological, and radiological criteria. Methods: We conducted a prospective study, including 56 patients with NFPMA and 16 patients with hypophysitis primarily of the lymphocytic subtype. A total of 31 clinical, biological, and radiological variables were analyzed using univariate and multivariate statistical methods to identify significant predictors and to establish a diagnostic score. Results: Nine significant criteria were identified: female sex, headaches, visual disturbances, corticotropic insufficiency, pituitary volume ≤ 7 cm3, loss of the posterior pituitary bright spot, cavernous sinus invasion, optic pathway compression, and pituitary stalk thickening. The established score demonstrated significant performance in predicting the diagnosis of hypophysitis (p < 0.001; Area Under the Curve = 0.967; 95% CI = 0.926–1). The sensitivity and specificity of this score were 93.8% and 87.5%, respectively, using a threshold ≥0.5. The median score was −2 (interquartile range = [−3.5; 0.5]), with extremes ranging from −6.5 to 9. Among these, pituitary stalk thickening emerged as a key diagnostic indicator. Conclusions: This simple and effective multi-parametric score enables rapid and accurate differentiation of hypophysitis from NFPMA, helping to avoid unnecessary surgical interventions and to improve the management of pituitary insufficiencies and may be especially valuable in settings when biopsy is unavailable or risky.

INTRODUCTION:Adrenal incidentalomas are adrenal masses detected on imaging performed for reasons other than suspected adrenal disease. Although most adrenal incidentalomas are nonfunctioning adenomas, some require treatment, particularly hormonally active or malignant lesions. OBJECTIVE:The purpose of this study was to analyze the clinico-hormonal and radiological characteristics of adrenal incidentalomas, to determine radiological features predictive of malignancy, and to compare nonfunctioning and cortisol-secreting adenomas in terms of radiological features. METHODS:This study involved 153 adult patients diagnosed with adrenal incidentaloma between 2015 and 2023. Clinical, hormonal, and imaging data were collected for all participants. RESULTS:The mean age of patients was 55 ± 13 years. Autonomous cortisol secretion was the most common hormonal activity, observed in 17% of cases, while 73.85% of patients had non-functional tumors. The most frequent diagnosis was adenoma, identified in 80.4% of patients. Adrenocortical carcinoma and pheochromocytoma were each diagnosed in 3.9% of patients. The mean size was significantly greater in adrenocortical carcinoma cases than in lipid-poor adenomas (61 ± 27.07 mm vs. 26.97 ± 11.85 mm; p = 0.027). The mean non-contrast CT density of adrenocortical carcinoma was 29.7 Hounsfield units, with a range of 18 to 41. Furthermore, cortisol-secreting adenomas were significantly larger than non-secreting adenomas and were more often lipid-poor. Contralateral adrenal atrophy and hepatic steatosis were significantly more prevalent in cortisol-secreting adenomas compared to non-secreting adenomas: (26.1% [n = 6] vs. 1.1% [n = 1]; p < 10⁻³) and (47.8% [n = 11] vs. 18.1% [n = 17]; p = 0.003), respectively. CONCLUSIONS:We examined the clinical, radiological, and hormonal profiles of patients with adrenal incidentalomas, finding results consistent with existing literature. The main etiology in our series was a non-functioning adrenal adenoma. Autonomous cortisol secretion is the most prevalent hormonal activity. Imaging played a key role not only in distinguishing benign from malignant lesions but also in identifying features suggestive of cortisol secretion.

INTRODUCTION:Diabetes mellitus has emerged as a global public health issue due to its increasing prevalence and the increased risk of developing cancers. Pancreatic cancer is believed to be both a consequence of pre-existing diabetes and a potential cause of new-onset diabetes. AIM:This study aims to compare the characteristics of patients with pancreatic ductal adenocarcinoma and newly diagnosed or long-standing diabetes mellitus. METHODS:A multicentric retrospective study was conducted over 13 years at two university hospitals in Sousse, Tunisia. Included patients had whether a newly diagnosed or a long-standing diabetes mellitus with histologically confirmed pancreatic ductal adenocarcinoma. Statistical analysis using appropriate tests was conducted. RESULTS:The prevalence of diabetes mellitus was 44.6% among three hundred and seven patients with pancreatic cancer. The male-to-female ratio in patients with pancreatic ductal adenocarcinoma was 2.6:1. Patients' mean age was 63.9 years, with the majority being over 50 years old. Most patients had no family history of diabetes and exhibited significant weight loss, low body mass index, and uncontrolled diabetes. The comparison between individuals with newly diagnosed diabetes and those with long-standing diabetes revealed numerous similarities, apart from significant differences in drinking patterns (p = 0.03), tumor size (p = 0.018), and smoking in the subgroup of males (p = 0.044). CONCLUSION:Patients over 50 with newly diagnosed diabetes mellitus, particularly those who consume alcohol occasionally and men who are not heavy smokers, should undergo further evaluation to identify potential early-stage pancreatic ductal adenocarcinoma.