Introduction: Autonomously hyperfunctioning thyroid nodules, also known as "hot nodules", are defined by increased uptake of radiotracers compared to the surrounding thyroid parenchyma on scintigraphy. It has been believed that hot nodules have a low rate of malignancy, while an increasing number of thyroid carcinoma cases are being diagnosed in patients with hyperthyroidism. Case Presentation: A. J, a 50-year-old patient. She presented with signs of hyperthyroidism. Laboratory tests showed peripheral hyperthyroidism with an inhibited TSH of 0.03 μIU/ml and T4L of 37 pmol/L. The scintigraphy revealed a focus of hyper fixation almost completely affecting the right lobe which corresponded to a hot nodule most likely pre-extincted in the remaining parenchyma. The patient was initiated on synthetic antithyroid medication and, after achieving euthyroidism, she was referred to surgery. Right loboishmectomy was performed. The histological study revealed a 0.5 cm intralobular non-encapsulated microcarcinoma papillary on a background of thyroid dystrophy. Discussion: The initial evaluation of a thyroid nodule begins is the measurement of serum TSH and the performance of a thyroid ultrasound, followed by a thyroid radionuclide scan if the TSH is subnormal. Malignant nodules are usually non-functioning. The prevalence of malignancy associated with a hot nodule range between 1-10.3%. In many cases, thyroid cancer is not known preoperatively but is found incidentally during the postoperative histological examination of the thyroid. Most of these malignancies were of papillary carcinoma and less often follicular or Hurthle histological types, and they are small in size, and the majority are microcarcinomas. Conclusion: Further evaluation and characterization of the association between a hot thyroid nodule and malignancy are needed. In the case of our patient, the discovery of papillary carcinoma was incidental and was made during the postoperative histological examination .......
Familial neurohypophysial diabetes insipidus (FNDI), an autosomal dominant disorder, comes in many forms that are differentiated by the inheritance pattern and the underlying genetic lesion. The disease is caused by mutations in the vasopressin-neurophysin 2- copeptin protein (AVP-NPII), in wolframin (WFS1) or in proprotein convertase subtilisin/kexin type 1 (PCSK1) genes. Materials and methods: In this study, we report a case of familial neurohypophyseal DI in three generations; followed in unit of the endocrinology, diabetology, metabolic diseases and nutrition department of the Mohammed VI University Hospital of Marrakesh. Results: This was a 45-year-old patient who had been suffering from polyuro-polydipsia syndrome since the age of 12, with daily urine volumes ranging from 8.0 to 15.0 litres, but had not seen a doctor. The patient was born without complications and had normal puberty. In the family history, three other members of the patient’s family have also had polypolypolydispic syndrome since adolescence, covering three generations, including the patient’s mother, her younger sister and daughter. A water restriction test was performed but the patient did not tolerate it. We completed with the minirin test with a good clinical response: urine concentrated with a volume of 500ml, and urinary osmolarity at H4 of 276.13 (Fig 2). As presented in (Fig 3), cranial MRI revealed a hypersignal region in the posterior pituitary lobe. Serum cortisol, thyroid function, and estrogen were all in the normal range The growth hormone (GH), insulin like growth factor (IGF)-1 levels and the genetic testing were not performed due to limited financial resources. After treatment with oral desmopressin 60 ug two times daily was started, the symptoms of polydipsia and polyuria were satisfactorily controlled.
Obesity is associated with increased sensitivity to pain, including neuropathic pain (DN).The objective of this study is to determine the prevalence of DN in obese patients, to assess its impact on the quality of life and to identify the factors associated with it. This is a prospective and descriptive study conducted over a period of 4 months. All patients with BMI over 30 kg/m2, non-diabetics were included. The evaluation of neuropathic pain was made by the DN4 score. The visual pain scale was calculated. Quality of life was assessed using the SF-12 score. Statistical analysis was performed using SPSS 26. A total of 111 patients were included. The average age was 44.79 years old. The majority were women. The average BMI was 38.69 kg/m2. The prevalence of neuropathic pain was 59.1%. The average VAS was 4.32. Physical quality of life was impaired in 66.7% of patients and 71.4% had an impairment of mental life. In univariate analysis, neuropathic pain was more common in women, in older subjects, in cases of prediabetes, in cases of vitamin D deficiency and in patients with impaired physical and mental quality of life. The Spearman correlation study had shown that the DN4 Score was positively correlated with pain VAS, and negatively correlated with physical quality of life and mental quality of life. DN is common in obese patients. It is responsible for a significant impact on the quality of life, hence the importance of detecting and treating it.
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