Primary aldosteronism (PA) is a major cause of secondary hypertension associated with increased target organ damage beyond the effects of blood pressure (BP). This study aimed to compare BP characteristics and cardio-renal complications between patients with PA and essential hypertension (EH) in a Tunisian population. We conducted a retrospective study of 227 hospitalized patients (112 with PA and 115 with EH) at a tertiary care center between 2003 and 2023. Clinical, biological, and cardiovascular data were analyzed. Multivariate regression analysis was used to identify independent factors associated with target organ damage, which were more prevalent in PA. Patients with PA had longer hypertension duration, higher systolic and diastolic BP levels, and a higher prevalence of resistant hypertension. Chronic kidney disease (CKD) and left ventricular hypertrophy (LVH) were significantly more frequent in patients with PA (28.7 vs 14.4%; p = 0.01 and 47.4 vs 16.7%; p < 0.001, respectively). After multivariable adjustment, PA remained independently associated with LVH (aOR= 3.1; 95% CI [1.2-7.9]; p = 0.02), whereas its association with CKD was attenuated (p = 0.06; aOR: 2.0 [1.0-4.2]). Baseline aldosterone showed good discriminative ability for LVH (AUC = 0.715; 95% CI: [0.627-0.803]; p < 0.001), with an optimal cut-off value of 135.7 pg/mL. In conclusion, PA was associated with more severe hypertension and a markedly increased risk of LVH compared with EH, supporting a direct deleterious cardiac effect of aldosterone excess and underscoring the importance of early diagnosis and targeted treatment.

INTRODUCTION:Intermittent fasting (IF) exposes patients with adrenal insufficiency (AI) to complications related to undertreatment. We aimed to determine the effect of IF during Ramadan on the quality of life of patients with secondary adrenal insufficiency (SAI) compared to healthy controls. SUBJECTS AND METHODS:It is a prospective case-control study conducted at the Department of Endocrinology of La Rabta University Hospital in Tunisia. Fifty patients with SAI and 100 age-, sex- and body mass index-matched controls were enrolled and followed up throughout Ramadan 2023. All participants answered the Addison's disease quality of life questionnaire (AddiQoL) before Ramadan and during the third week of fasting. RESULTS:There were 33 women and 17 men, median age: 43 years (IQR: 34-55), median duration of SAI: 7.5 years (IQR: 4-12.5), treated with hydrocortisone at a median dose of 0.24 mg/kg/day (IQR: 0.20-0.27). Before Ramadan, there was no significant difference between patients and controls in the global AddiQoL score, fatigue score, and emotional sphere score (89 vs. 93, p = 0.196; 24 vs. 24, p = 0.354, and 24 vs. 25, p = 0.536, respectively). The score of AI symptoms was altered in patients (27 vs. 30, p = 0.021). During fasting, the global AddiQoL score (8.2% vs. 0%, p = 0.005), the fatigue score (8% vs. -1.7%, p = 0.003), the emotional sphere score (4.2% vs. 0%, p = 0.009), and the AI symptoms' score (9.1% vs. 0%, p = 0.017) improved in patients compared to controls. CONCLUSION:Ramadan fasting improved the quality of life in SAI patients by reducing fatigue, emotional stress, and AI symptoms. TRIAL REGISTRATION:Registered on 'ClinicalTrials.gov' under the identifier ID: NCT05827965.

Purpose:Metformin efficacy and tolerance vary at equivalent dose in type 2 diabetes. Inter-individual variability in the response to metformin with approximately 35% of patients failing to achieve initial glycemic control may be explained by genetic polymorphisms that affect the drug's pharmacokinetics and pharmacodynamics. Differences in the frequencies of pharmacogenomic risk alleles associated with metformin response may also account for interethnic variability in drug effects. The aim of this study was to assess the impact of M420del, R61c, and G401S polymorphisms in the SLC22A1 gene which encodes the organic cation transporter (OCT1) on metformin response and tolerance in a cohort of Tunisian patients with type 2 diabetes. Methods:This prospective study included 73 newly diagnosed type 2 diabetic patients. Clinical and biological assessments were conducted before and three months after initiation of metformin therapy. Patients were genotyped for the M420del, R61c, and G401S polymorphism of SLC22A1 using Polymerase Chain Reaction (PCR) followed by Restriction Fragment Length Polymorphism (RFLP) analysis. Metformin efficacy was defined as an HbA1c reduction of ≥ 1% and metformin- induced gastrointestinal adverse effects were recorded using a questionnaire. Results:Thirty-nine patients (53%) were classified as responders to metformin. The M420del, R61C and G401S variants were not significantly associated with metformin efficacy (p: 0.8, p: 0.77, and p: 0.49 respectively). Twenty-seven patients (37%) experienced gastrointestinal adverse effects following metformin initiation. The G401S polymorphism and the haplotype (NoDel) CA were significantly associated with gastrointestinal adverse effects. Conclusion:In Tunisian type 2 diabetes, the M420del and R61C do not appear to be associated with metformin efficacy or the gastrointestinal intolerance. However, the G401S polymorphism may be implicated in the occurrence of metformine-induced gastrointestinal adverse effects.

Objectives: Intermittent fasting was associated with complications in patients with adrenal insufficiency (AI). The study aimed to evaluate the impact of therapeutic education and drug adjustment on Ramadan fasting outcomes in patients with secondary AI (SAI). Methods: A case-control prospective interventional study including patients with SAI willing to fast Ramadan 2023, and age-, gender-, and body mass index-matched healthy fasting controls. Before Ramadan, clinical examination, education for lifestyle measures, and hydrocortisone intake adjustment were performed. The occurrence of complications and the number of fasted days during Ramadan 2023 were reported and compared with those of Ramadan 2022 in patients and controls. Results: A total of 50 patients; 33 women, median age: 43 years (34-55), median duration of SAI: 7.5 years (4-12.5), and 100 controls were enrolled, and fasted in 2023. Thirty-four patients and 100 controls fasted in 2022, corresponding to a 32% increase in fasting patients. Compared to 2022, there was a significant decrease in the frequency of complications in 2023 in patients compared to controls. The number of fasted days did not change. No severe event happened during the 2023 fasting. In patients, apart from the age that was higher in former fasters compared to new fasters, age, gender, body mass index, blood pressure levels, renal clearance, disease duration, and daily hydrocortisone dose were not associated with new versus former fasters, high versus low-risk patients, or incomplete versus complete month fasters. Conclusions: Therapeutic education enabled more patients with SAI to fast and reduced the frequency of complications during fasting. Registered on "clinical trials.gov," April 12, 2023, under the identifier ID: NCT05827965. (c) 2025 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

Levothyroxine (LT4) absorption test is indicated in patients with refractory hypothyroidism to distinguish between pseudo-malabsorption and malabsorption. However, this test is not standardized and its interpretation remains controversial. The aim of the present study was to evaluate the different interpretations of the LT4 absorption test to confirm or infirm a disorder of LT4 absorption in patients with refractory hypothyroidism. This was a retrospective study including patients who were admitted for refractory hypothyroidism. LT4 absorption test was performed in all patients. Four different equations were used to interpret the test: The LT4 absorption rate, FT4 increment, FT4 increase rate, and FT4 ratio. Celiac disease serology and digestive endoscopy with biopsy were performed in all patients. Seven patients were enrolled in this study. Their median age was 38 years. The median duration of hypothyroidism was 2.6 years. The median dose of LT4 was 4 µg/kg/day. Before the LT4 absorption test, the median TSH and FT4 levels were 72.59 mIU/L and 0.52 ng/dL, respectively. Using LT4 absorption rate and FT4 ratio formulas, the test was consistent with the diagnosis of malabsorption in all patients. However, when using FT4 increase rate, four patients (P1, P2, P4, and P5) had malabsorption and three patients (P3, P6, and P7) had pseudo-malabsorption. According to the FT4 increment, six patients (P1, P2, P4, P5, P6, and P7) had malabsorption and one patient (P3) had pseudo-malabsorption. Etiological investigations revealed the presence of Helicobacter pylori gastritis in four patients (P1, P2, P4, and P5). Patients 3, 6, and 7 admitted non-compliance with LT4 treatment when confronted with evidence about pseudo-malabsorption. The FT4 increase rate seemed more effective than LT4 absorption rate, FT4 ratio, and FT4 increment in differentiating pseudo-malabsorption from malabsorption. However, further multicenter studies involving larger sample sizes would be useful to confirm these findings.

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Evaluate diabetic patients’ knowledge, practices, and the prevalence of complications during Ramadan fasting (RF) before and after an education program. We conducted a prospective study including 140 consecutive diabetic patients (DP) who intended to observe RF in 2023. Patients underwent a questionnaire and received pre-Ramadan education (PRE) according to the IDF-DAR 2021 recommendations. Practices and outcomes (hypoglycemia, hyperglycemia, and cardiovascular events) of RF patients were determined during Ramadan 2022 and 2023 using a questionnaire. Participants mean age was 56.0 ± 9.3 years. Their knowledge level was good, average, and poor in 37.1

Introduction Les objectifs de notre étude étaient d’étudier la cinétique de la glycémie et de la cortisolémie au cours du test à l’hypoglycémie insulinique (THI) et de déterminer les temps les plus appropriés pour le dosage du cortisol. Méthodes Il s’agit d’une étude transversale et descriptive incluant 100 patients suspects d’insuffisance corticotrope (IC). Le protocole consistait à réaliser un prélèvement de base pour la glycémie à jeun et la cortisolémie puis une injection de l’insuline rapide 0,1 à 0,2UI/kg en intraveineux. Un prélèvement au moment de l’hypoglycémie puis des prélèvements toutes les 10minutes pendant 60minutes. Un sujet était répondeur si la cortisolémie était≥18μg/dL après un nadir de glycémie veineuse<0,40g/L. Résultats L’âge moyen était de 41,4±15,12 ans et le genre ratio (F/H) était de 0,2. Quarante-deux patients avaient une réponse adéquate au THI et 58 patients avaient une IC. La cortisolémie de base était positivement corrélée au pic de cortisol (r=0,56, p<10-3). Un cut-off de cortisolémie de base à 9,75μg/dL pourrait prédire la réponse au THI avec une sensibilité à 59 % et une spécificité à 73 %. Vingt-six patients avaient une réponse précoce et 16 patients avaient une réponse tardive. Les prélèvements les plus appropriés sont T20min, T30min, T40min et T50min avec une sensibilité à 98 %. Conclusions Il faut multiplier les prélèvements après la survenue de l’hypoglycémie et surtout au-delà de 30minutes pour ne pas retenir à tort le diagnostic d’IC.

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Introduction L’objectif de ce travail était de déterminer les facteurs prédictifs de la réponse au test à l’hypoglycémie insulinique (THI). Méthodes Il s’agit d’une étude transversale et descriptive incluant 100 patients suspects d’insuffisance corticotrope (IC). Le protocole du THI consistait à réaliser un prélèvement pour la glycémie à jeun et la cortisolémie puis une injection de l’insuline rapide 0,1 à 0,2UI/kg en intraveineux. Un prélèvement au moment de l’hypoglycémie puis des prélèvements sanguins toutes les 10 minutes pendant 60 minutes. Un sujet était répondeur si la cortisolémie était≥500nmol/L après un nadir de glycémie veineuse<0,40g/L. Résultats Cinquante-huit patients avaient une IC et 42 patients avaient une réponse adéquate au THI (26 patients avaient une réponse précoce et 16 avaient une réponse tardive). Une hypotension orthostatique a été objectivée chez 18 patients non répondeurs versus un répondeur. La cortisolémie de base moyenne était significativement plus élevée que chez les sujets répondeurs (p<0,001). Il y avait une corrélation significative positive entre la cortisolémie de base et la cortisolémie aux différents temps de prélèvement (p<0,01) et avec le pic de cortisol (r=0,56 ; p<10−3). Une cortisolémie de base>270nmol/L pourrait prédire la réponse au THI (sensibilité à 59 % et spécificité à 73 %). Une cortisolémie de base<310nmol/L pourrait prédire une réponse tardive au THI (sensibilité 62 % et spécificité 82 %). Conclusions La cortisolémie de base est le meilleur facteur prédictif de la réponse au THI.

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

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. 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. 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

Introduction L’ectopie thyroïdienne est une anomalie de migration de la thyroïde au cours du développement embryonnaire. Celle-ci est responsable souvent d’une hypothyroïdie dès les premières années de vie. Cependant, quelques cas de thyroïde ectopique peuvent être présents malgré la présence de la thyroïde au niveau basi-cervical. Nous rapportons le cas d’une patiente opérée pour une maladie de Basedow qui a récidivé sur thyroïde ectopique. Observation Il s’agit d’une patiente âgée de 20 ans, adressée pour prise en charge d’une hyperthyroïdie en rapport avec une maladie de Basedow. La patiente a alors eu une thyroïdectomie totale avec installation d’une hypothyroïdie traitée par lévothyroxine. Par ailleurs, les taux de TSH au cours du suivi étaient supérieurs à la normale du fait de la mal observance thérapeutique. Dix années après, les besoins de la patiente en hormones thyroïdiennes diminuaient progressivement. Parallèlement, un scanner cervico thoracique réalisé devant l’apparition d’une dysphonie avait objectivé une masse de 20*7*28mm de l’espace rétro-pharyngé postéro latérale droit cadrant avec une thyroïde ectopique. La scintigraphie thyroïdienne avait alors confirmé son caractère fonctionnel. Le diagnostic de récidive de maladie de Basedow sur thyroïde ectopique avait alors été retenu et la patiente avait bénéficié d’une cure d’Iode radioactif à la dose de 12 mCi dans un but ablatif. L’évolution ultérieure a été marquée par la disparition du tissu ectopique sur les imageries morphologiques. Conclusions Le défaut de traitement substitutif ainsi que l’hyperstimulation par les anticorps anti récepteurs de la TSH peuvent expliquer le développement d’un tissu thyroïdien ectopique post thyroïdectomie totale.