Backgrounds:The fibrosis-4 index is a simple biomarker tool widely recommended to diagnose advanced hepatic fibrosis in patients with type 2 diabetes mellitus (T2DM). The primary aim of this study was to assess liver fibrosis risk among type 2 diabetes mellitus patients using the Fib-4 score, secondary to compare the prevalence of degenerative complications between patients according to Fib-4 index risk, and to evaluate the prevalence of metabolic dysfunction-associated-steatotic liver disease in our population. Methods:This is a descriptive-analytical cross-sectional study including 600 patients with type 2 diabetes mellitus who were followed at the Endocrinology-Diabetology and Nutrition Department of a university hospital center, for a period of 8 years and 10 months from January 2016 to October 2024. Results:The mean age in our population was 59±12.8 years. The median duration of diabetes was 6.4 years (1-15 years) with a median HbA1c value of 10.2±2.7%. Overweight and obesity were found in 39.2% and 34.5% of patients respectively, with a mean BMI of 28.2±5.9 kg/m2. The median of fibrosis-4 index was 1.09. Sixty-one percent of patients had a low risk of advanced liver fibrosis, 31% had an intermediate risk, and 8% had a high risk to develop an advanced liver fibrosis. Patients with a Fib-4 score ≥1.3 (indicating intermediate to high risk of liver fibrosis) had a statistically significantly higher prevalence of all microvascular complications and ischemic heart disease (p<0.001) compared to those with a Fib-4<1.3. There was no significant difference in HbA1c, arterial hypertension, metabolic syndrome, and dyslipidemia. However, the mean LDL-cholesterol was lower in the group with a Fib-4≥1.3 (p:0.024). Liver ultrasonography showed signs of metabolic dysfunction-associated steatotic liver disease in 47.7% of cases. Conclusion:Fibrosis-4 index should be considered for routine screening of liver fibrosis in patients with type 2 diabetes mellitus. This simple and cost-effective tool can help identify patients at high risk. The current study highlighted the benefits of using this score among patients with T2DM and supported the high prevalence of microvascular complications and ischemic heart disease among patients with Fib-4 index ≥1.3. Furthermore prospective studies are required to evaluate the incidence outcomes in this population.

Background and aims: Primary hyperparathyroidism (PHPT) is a common endocrine disorder; one of its common complications is renal calcifications. Our study aimed to determine the prevalence of renal calcifications (nephrolithiasis and nephrocalcinosis) in patients with primary hyperparathyroidism, to elucidate potential demographic, biochemical, radiological, and histological differences between patients with and without renal calcifications, and to assess potential risk factors associated with its occurrence. Methods: This was a retrospective, single-center, descriptive, and analytical study involving 62 patients with primary hyperparathyroidism (PHPT). Participants were assessed through serum and urinary parameters, kidney-urinary tract ultrasonography, and abdominal computed tomography (CT) scans to evaluate the presence or absence of renal calcifications. Results: We found 30 patients (48.4%) with renal calcifications, all of them nephrolithiasis, and only 2 cases (6.7%) had nephrocalcinosis associated with nephrolithiasis; and they were all detected by abdominal CT scan. Compared to patients without renal calcifications, those who had renal calcifications had a significantly higher prevalence of diabetes, BMI, waist circumference, PTH 1- 84, alkaline phosphatase, and lower 25-hydroxy vitamin D (25-(OH)-D). No significant difference was found between the two groups in other studied parameters. Higher BMI and lower 25-(OH)-D were potential risk factors for renal calcifications in multivariate regression analysis. Conclusion: The combination of PHPT and renal calcifications is still common and often asymptomatic.

Background and aims. Male prolactinoma remains a singular entity. Our study represents the first reported experience of male prolactinoma in Northern Africa. Our work aimed to characterize prolactinomas in the male population, an entity known for its aggressive features, and also to highlight the specific challenges encountered in a North African clinical context. Methods. This is a retrospective descriptive study of male patients presenting with prolactinoma at the endocrinology, diabetology and nutrition department of a university hospital center over a 10-year period. Results. The mean age at diagnosis was 37 ± 11 years. Mass effect related symptoms were present in 83% of cases. Decreased visual acuity was found in 60% of cases. Galactorrhea was found in 13% of cases, decreased libido in 60% of cases, and gynecomastia in 20% of cases. At the time of diagnosis, the mean prolactin level was 4,685 ng/ml (79-33,000). All patients had hypogonadotropic hypogonadism. Among our patients, 66% had undergone dopaminergic agonists as monotherapy, and pituitary surgery was performed in 33% of cases in conjunction with dopaminergic agonists. After a 30-month average follow-up, medical treatment achieved prolactin control in 83% of cases and tumor shrinkage in 70%, while surgery achieved prolactin control in 85% and tumor shrinkage in 70% of cases. Conclusion. Prolactinoma in men is usually invasive and of considerable volume, putting patients at risk of mass effect related symptoms, especially ophthalmologic complications. Hence the importance of early, multidisciplinary and personalized management.

Introduction: Histiocytosis-lymphadenopathy plus syndrome is a rare autosomal recessive multisystemic disorder caused by mutations in the SLC29A3 gene, which encodes the nucleoside transporter hENT3. This mutation has been linked to a group of syndromic histiocytoses including H-syndrome, pigmented hypertrichosis with insulin-dependent diabetes, Faisalabad histiocytosis and familial Rosai-Dorfman disease. Case description: We report the case of an 18-year-old woman from an Arab country with no parental consanguinity who presented to our department with uncontrolled diabetes, repeated severe hypoglycaemic episodes, short stature and delayed puberty. Her history included exocrine pancreatic insufficiency, marked skin hyperpigmentation with thickening of the lower limbs, skeletal deformities, chronic anaemia, impacted teeth and a constellation of findings strongly evocative of H-syndrome. In addition, she presented with multiple deep lymphadenopathies. Discussion: This case reflects the variable expression of H-syndrome. We report, for the first time, dental inclusion as a possible additional feature of this syndrome. The patient presented with a severe systemic form involving multiple organs, including pancreatic insufficiency, diabetes with persistent glycaemic instability despite multiple daily insulin injections and close monitoring, delayed puberty requiring initiation of transdermal oestradiol therapy, and dermatological manifestations poorly responsive to topical treatments. These findings underscore both the heterogeneity of clinical presentation and the challenges in managing H-syndrome. Conclusion: With fewer than 100 cases described worldwide, histiocytosis-lymphadenopathy plus syndrome remains vastly underdiagnosed. This case highlights the importance of recognising its characteristic clinical features and aims to raise awareness among clinicians, encouraging them to consider uncommon diagnoses when faced with unusual combinations of dermatological, endocrine and skeletal signs.

Background: Managing type 1 diabetes in school is a real challenge for teachers, parents, and students themselves. Involving school educators in providing care and support is becoming more of a necessity than a luxury to facilitate access to healthcare services in schools for children with type 1 diabetes. Objectives: Our work aimed to assess the background knowledge of teachers on type 1 diabetes and evaluate the impact of an educational intervention in improving this knowledge. Methods: We included 346 participants working in elementary schools. We collected data on anonymous data sheets. Then, a first pre-coded questionnaire was distributed to the participants to assess their background knowledge of type 1 diabetes. Afterward, a simplified educational session was delivered to them. Subsequently, the same pre-coded questionnaire was distributed for evaluation after education. Results: Around 84% of the participants recognized polyuria and polydipsia as major signs of diabetes. Only 35.3% of them knew the definition of hypoglycemia. Hyperglycemia was identified by 65% of the participants. About 40% believed children cannot exercise, while 55.5% thought taking free sugar before exercise was mandatory. We found a significant correlation between a good level of knowledge and knowing a person with diabetes (aOR=2.66, CI95%: 1.51-4.70, p=0.001). There was a significant improvement in knowledge after the educational intervention (p=0.0001). Conclusion: Our study showed a lack of information about type 1 diabetes among teachers. We also proved the effectiveness of targeted education in correcting misconceptions and encouraging awareness of type 1 diabetes.

Empty Sella Syndrome (ESS) is characterized by a herniation of cerebrospinal fluid into the pituitary fossa, frequently causing pituitary dysfunction. Although ESS is generally asymptomatic, it can lead to progressive hormonal deficiencies. Long-term studies of pituitary function in patients with ESS are lacking. This study aimed to evaluate pituitary function in ESS patients, monitor the progression of hormone deficiencies, and explore the impact of gender, age, and body mass index (BMI). This is a descriptive and analytical study involving 41 patients diagnosed with ESS and treated at our university hospital between 2014 and 2024. All patients underwent MRI and endocrine testing for cortisol, thyrotropin, free thyroxine, prolactin, growth hormone, gonadal hormones, and testosterone. The median duration of follow-up was 5 years, with a range of 6 months to 10 years. Data was collected and analyzed using SPSS version 21. At diagnosis, 82.9% of patients had at least one pituitary hormone deficiency, primarily in the adrenal, gonadal, and growth hormone axes. Women were more likely to develop gonadal dysfunction (34.1%) than men (21.9%). A positive correlation between age and adrenal/gonadal insufficiency was observed. Additionally, a significant association was found between higher BMI and gonadal insufficiency, highlighting the role of obesity in exacerbating pituitary dysfunction. ESS is commonly linked to pituitary dysfunction, particularly in the adrenal and gonadal axes. Gender, age, and BMI influence the development and progression of hormonal deficiencies, underscoring the need for regular endocrine evaluation and long-term follow-up in these patients.

Background:Primary hyperaldosteronism (PHA) is a common cause of secondary arterial hypertension (AH), characterized by autonomous aldosterone secretion. It is frequently underdiagnosed and may persist even after surgical intervention. Objectives:The present study aimed to identify preoperative factors that could predict whether hypertension would persist or normalize following surgery and to outline relevant diagnostic characteristics. Methods:We conducted a descriptive, analytic, retrospective cohort study at a single center. The study included patients with PHA who were followed up at the Department of Endocrinology, Diabetology, and Nutrition in a hospital affiliated with Mohamed the First University of Oujda (CERBO), admitted between December 2014 and August 2023. Data were retrospectively collected from patient records over a 9-year period, involving 27 patients with PHA confirmed by an elevated aldosterone-to-renin ratio (ARR). Persistent disease was defined by persistent hypokalemia and hypertension (blood pressure > 140/90 mm Hg) after six months. Patients were divided into two groups: Those with complete resolution of hypertension (group A) and those with persistent hypertension (group B). Data were analyzed using SPSS version 21. Results:The mean age of patients was 48.47 ± 10.87 years, with a female predominance (66.7%). The etiological assessment identified Conn's adenoma in 70.4% (n = 19) of cases and bilateral adrenal hyperplasia in 29.6% (n = 8). Surgery was performed in 51.9% (n = 14) of cases, with 50% (n = 7) maintaining persistent hypertension post-surgery, while 28.6% (n = 4) showed a reduction in antihypertensive medications. Two predictive factors for persistent hypertension were identified: Age > 50 years and hypertension duration > 5 years. Predictive factors for normalization of hypertension post-surgery included systolic blood pressure (SBP) < 140 mm Hg, diastolic blood pressure (DBP) < 90 mm Hg, glomerular filtration rate (GFR) > 90 mL/min/1.75 m2, and a low incidence of diabetes and dyslipidemia. Conclusions:This study demonstrates that PHA can lead to resistant hypertension, highlighting the necessity for further research in this area.

Background: Pheochromocytomas (PCC) and paragangliomas (PGL) are rare endocrine tumors. This study aimed to describe our experience with these two entities in a particular population. Material and methods: We identified patients with positive histopathological confirmations of PCC and PGL who were treated at a tertiary center hospital between 2014 and 2023. We analyzed the results for clinical presentations, treatment, and long-term outcomes. Results: A total of 35 cases (30 PCC, 5 PGL) were identified over 9 years. The mean age of our patients was 47 +/- 18.1 years, with an M/F sex ratio of 0.6. Blood hypertension was present in 58.8% of cases, and diabetes in 47% of cases. In 35.3% of the patients, PCC was discovered during the investigation of an adrenal incidentaloma, 8.8% in the context of hereditary diseases, and 55.9% following symptoms. All patients had high levels of urinary or plasma metanephrines. Imaging was performed in all patients, revealing a unilateral tumor in 90% of cases and bilateral tumors in 10%. At the postoperative follow-up, all hypertensive patients achieved good blood pressure control, resulting in a reduction in antihypertensive treatment. In addition, glycemic control improved significantly in the remaining cases. Long-term follow-up included three deaths, only one recurrence, and no metastases, with a mean follow-up of 4.6 +/- 1.3 years. Conclusion: The present study confirms that the clinical presentation of pheochromocytoma is variable and non-speuation, preoperative preparation, genetic testing, and complete surgical resection are crucial for its management.

Background and aims. Diabetic peripheral neuropathy (DPN) is the most prevalent chronic complication of diabetes. Several risk factors have been identified in recent studies, in particular metabolic syndrome (MetS). However, this association remains unclear. We aimed to determine the prevalence of DPN and to study its associated factors, especially the MetS as a potential risk factor of DPN in patients with Type 2 diabetes mellitus (T2DM). Methods. This was a retrospective and comparative study, with cross-sectional collected data, involving patients with T2DM from North Africa, followed up in the Department of Endocrinology-Diabetology-Nutrition at Mohammed VI University Hospital Center of Oujda, located in the eastern region of Morocco. Patients were grouped according to the presence (T2DM/DPN+, n = 110) or absence of DPN (T2DM/DPN-, n = 290). Data were collected from medical records and analyzed using SPSS software version 21. Results. DPN was found in 27.5% of the patients. The mean age was similar between the two groups, at 58.96 ± 11.86 years in the T2DM/DPN+ group and 57.10 ± 13.29 years in the T2DM/DPN- group. Males comprised 40.9% of the T2DM/DPN+ group and 31.7% of the T2DM/DPN- group, but this difference was not statistically significant (p = 0.054). Patients with DPN had a significantly longer duration of diabetes (median 10 years vs. 5 years, p < 0.001). Both groups showed glycemic imbalance, with mean HbA1c values of 10.71 ± 2.31% for T2DM/DPN+ and 10.40 ± 2.87% for T2DM/DPN-, without a significant difference. MetS was a significant predictor of neuropathy presence. The prevalence of DPN was greater in individuals with hypertension (p = 0.013), abdominal obesity (p = 0.010), elevated triglyceride levels (p = 0.007), and low HDLc (p = 0.013). Male sex and the duration of diabetes were found to be significant risk factors for the development of DPN. Conclusion. MetS and its components are strongly associated with the presence of DPN in patients with T2DM. Therefore, screening and optimal control of these risk factors may help prevent DPN in these patients. However, further intervention studies are needed to determine whether comprehensive multifactorial control in patients with T2DM and MetS can effectively prevent DPN.

Background Vitamin D is an essential component of healthy bones and its deficiency is widespread in obese patients. Through our study, we aimed to look into vitamin D status in obese and non-obese patients and determine its association with hypertension, glucose levels, and lipid profiles. Patients and methods A case-control study was laid out to compare serum Vitamin D levels between obese patients and controls. Obese patients (n= 67) over 18 years old were recruited from our Endocrinology-Diabetology and Nutrition department between March 2018 and September 2023. Controls (n= 60) were randomly assigned and were matched for age, sex, glycated hemoglobin, ethnicity, and geographic area. The levels of Vitamin D in the serum were determined in obese patients and non-obese controls. Results Average serum Vitamin D concentration was established in both groups, reaching 10,41±4,2ng/ml in obese patients and 15,14±6,1 ng/ml in the control group. The mean serum Vitamin D was significantly lower in the obese group (p=0,000). A positive correlation was noticed between body fat and serum Vitamin D (p<0,05). A significant correlation between vitamin D status and glycated hemoglobin in the obese group (p=0,047) was found, whereas it was insignificant in the control group (p=0,966). In addition, the correlation between vitamin D, blood pressure, and body mass index was significant (p=0.004) as well as between vitamin D and triglycerides (p=0.015) and cholesterol (p=0.014). Conclusion Vitamin D deficiency is common in obese patients, as highlighted by our study, which is in line with other findings. This may be explained by the fact that vitamin D must be supplied at a greater volume in obese patients. A significant correlation between BMI, vitamin D, glycated hemoglobin, blood pressure, triglycerides, and total cholesterol was found. The pathophysiology behind this association is complex. Further research is needed to clarify the relationship between vitamin D, adipose tissue, and the other components of metabolic syndrome.

INTRODUCTION:Ring chromosome 18 is a rare chromosomal disorder, and its association with Prader-Willi syndrome (PWS) is an extremely unusual condition. We described the clinical and biological profile of this association and highlighted the management of this case through GH therapy. To the best of our knowledge, this is the first reported association in the literature. CASE PRESENTATION:This report discusses a case of a 9-year-old child diagnosed with both PWS and ring 18 syndrome at the age of 3 years. The diagnosis of Prader-Willi syndrome with ring chromosome 18 was established using CGH ARRAY technique. It showed the absence of expression of paternal chromosome 15 in the 15q11-q13 region, and a karyotype showing ring chromosome 18 according to the formula: 46. XX (37)/46. XX r(18) (p11.3 ;q23) (27). CONCLUSIONS:Our case contributes to a better understanding of the clinical presentation of complex aberrations of chromosome 18 and that of PWS. The main common clinical features of this association were a moderate dysmorphic syndrome, hypotonia, grade II obesity with severe OSA, mild cognitive deficit with learning difficulties, and a discreet scoliosis. Diagnosis and management of this complex disorder require a multidisciplinary approach. The primary focus for those patients is to enhance their quality of life and prevent any potential complications.

Background and aims:Pheochromocytomas and paragangliomas are rare neuroendocrine tumors, responsible for inappropriate secretion of catecholamines, inducing metabolic disorders, increasing basal metabolic rate. Our study aimed to analyze the metabolic profile pre- and post-operatively in patients undergoing surgery for pheochromocytomas and paragangliomas and additionally to determine the predictive factors of metabolic remission. Methods:This was a retrospective, unicentric, descriptive, and analytical study with a duration of 9 years. It includes data from 35 patients followed up for pheochromocytoma or paraganglioma in the Endocrinology-Diabetology and Nutrition Department of a University Hospital Center. All patients underwent surgery for pheochromocytoma or paraganglioma. Results:Among the 35 patients, 51.4% of the patients with pheochromocytomas had diabetes mellitus, and 42.8% had dyslipidemia. We found that high levels of catecholamines were associated with the onset of diabetes. We also noted that patients with a long history of the disease were statistically at greater risk of developing dyslipidemia. After surgery, the body mass index of our patients had statistically increased, and 50% of patients experienced resolution or improvement of their diabetes. Improvement of dyslipidemia was observed in 53% of patients. We also found that the percentage of dyslipidemia was higher in patients who did not resolve their diabetes. Conclusion:Diabetes mellitus and dyslipidemia are metabolic complications that must be investigated in patients with pheochromocytoma. Post-operative monitoring of body mass index and changes in glycemic and lipid levels is essential to adapt therapeutic management.

Introduction and importanceEctopic pituitary neuroendocrine tumor (EPNET) is a very rare entity, seldom with apoplexy evolution. Only three cases of intracranial ectropic pituitary neuroendocrine tumor apoplexy were reported in the literature.Case presentationWe report the case of a 45-year-old woman with a history of amenorrhea, and headaches. Neuroimaging showed a very aggressive giant mass within the clivus with the invasion of the sphenoidal sinus and encasement of internal carotid arteries with an empty sella. Endocrinology work-up revealed an exceedingly high level of prolactin surprisingly without galactorrhea. Immunohistochemical analysis after an endonasal biopsy confirmed the diagnosis of prolactinoma. One month after Cabergoline initiation, an apoplexy of the ectopic pituitary neuroendocrine tumor occurred. Conservational management with a decrease in cabergoline dose was performed.DiscussionThis article highlights data from various cases reported in the literature in addition to our case to confirm the extreme rarity of apoplexy as a complication of EPNET.ConclusionPituitary apoplexy in ectopic pituitary neuroendocrine tumor is extremely rare. Therefore, in case of unusual localization of pituitary neuroendocrine tumor, a thorough follow-up is necessary to detect complications and ensure early management.

Background Type 1 diabetes represents a real public health problem whose incidence is continuously increasing. Its management must aim at maintaining an optimal glycemic control adapted to each patient (age, duration of diabetes and comorbidities). Recently, continuous glucose monitoring (CGM) has become a real mean of diabetes management. Aim of Study The objective of this work was to study the diagnostic and therapeutic interest of CGM. Methods: This is a retrospective descriptive study of 35 children and adolescents with type 1 diabetes treated with multi-injection regimen. All patients received a Medtronic iPro™2 CGM. Data collected were analyzed by SPSS 21 software. Results Thirty-five patients underwent CGM with an average duration of 6 days. The mean age of our patients was 11.6±6.6 years, with a female predominance (62.8%). The mean duration of diabetes was 4.1±3.6 years. The basal bolus regimen was used in 68.6% of patients and the insulin pump in 17.1%. The initial HBA1c (before blood glucose monitoring) was 8.9±2.6%. Glycemic instability was the main indication in 88.6% of patients, which was objectified at CGM with standard deviations greater than 50% of the mean blood glucose in 77.1% of cases. The second indication was hypoglycemia in 57.1% of cases, with time spent in hypoglycemia > 5% (<70 mg/dl) in 37.1% of patients. Immediately after sensor removal all patients received therapeutic adjustment. HBA1c 3 months after monitoring was 7.3±1.5%. Conclusion(s) Last studies have shown the interest of CGM in the diagnosis of glycemic excursions and asymptomatic hypoglycemia, and they have endorsed its therapeutic interest in improving glycemic control and quality of life. Our results are consistent with the literature.

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

Introduction Polycystic ovary syndrome (PCOS) is a common hormonal disorder among women of reproductive age. The current study sought to assess vitamin D status in women with PCOS compared to the control group and to describe the association between vitamin D deficiency and the features of PCOS.Material and methodology A descriptive retrospective study about 176 women of reproductive age was conducted. The sample was divided into two groups: individuals with PCOS (82 women) and healthy individuals without PCOS (94 women). Vitamin D deficiency was defined as a serum concentration less than 10 ng/ml. We used the Statistical Package for the Social Sciences (SPSS), version 21 for all analyses.Results In our study, vitamin D deficiency was observed in 40.2% PCOS patients and 24% controls. The 25(OH)D level was lower in PCOS women and the incidence of vitamin D deficiency and insufficiency were significantly higher in comparison with the control group (p < 0.05). Furthermore, PCOS women with insulin resistance or obesity had lower 25(OH)D levels in comparison with PCOS individuals without IR or obesity. Furthermore, a significant correlation was found between homeostatic model assessment for insulin resistance (HOMA-IR)/body mass index (BMI) and vitamin D status.Discussion and conclusion Vitamin D deficiency could be one of the etiological mechanisms of PCOS. In fact, the prevalence of vitamin D deficiency in PCOS women is evident, principally in those with obesity or IR. Also, the serum 25(OH)D level was correlated with parameters of insulin resistance and metabolic syndrome. Therefore, it is proposed that vitamin D supplementation may be beneficial for the management of PCOS patients.

Introduction: Rathke cleft cyst apoplexy is exceedingly rare, particularly in infants. The most prevalent clinical manifestations include headaches, visual field defects, and endocrine dysfunction. Treatment options range from surgery to conservative methods, taking into consideration the balance of benefits and risks, especially during critical life stages such as childhood. Case Presentation: We present the case of a 12-year-old boy admitted due to the recent onset of headaches and diabetes insipidus. Magnetic resonance imaging revealed Rathke cleft cyst apoplexy. Given the absence of compressive symptoms in a child at the early stages of puberty and without abnormalities in basic endocrine tests, a conservative strategy was employed, involving regular clinical, biological, and radiological follow-ups. The child experienced normal puberty without any endocrine deficiencies except for a partial growth hormone deficiency. Conclusions: For clinically asymptomatic children diagnosed with Rathke's cleft cyst apoplexy, adopting a conservative management approach is recommended, provided there is thorough clinical, biological, and radiological surveillance.